MOSAIC FAMILY HEALTH INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
MOSAIC FAMILY HEALTH INC (EIN 47-3298660)
Tax period
2022-07-01 to 2023-06-30
Filed
2024-05-07
IRS object ID
202411289349303401
Schema version
2022v5.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2024-05-07T15:39:05-05:00ReturnTs
Tax Period End2023-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST WASHINGTON STREETAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP549115481ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN473298660EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MOSAIC FAMILY HEALTH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMOSABusinessNameControlTxt
Phone9208322783PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1229 S MORRISON STAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKRISTINA SMITHPersonNm
Person TitleTREASURERPersonTitleTxt
Phone9208322783PhoneNum
Signature2024-05-07SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKRISTINAPersonFirstNm
Person LastSMITHPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL VANDENHOGENPreparerPersonNm
PTINP00499282PTIN
Phone9207318111PhoneNum
Preparation2024-05-07PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLEE VOGEL MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1229 S MORRISON STAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,594,576GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MOSAICFAMILYHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2015FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionOPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee51TotalEmployeeCnt
Total Volunteers6TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,457,090PYContributionsGrantsAmt
CY Contributions Grants$5,961,023CYContributionsGrantsAmt
PY Program Service Revenue$2,500,023PYProgramServiceRevenueAmt
CY Program Service Revenue$2,440,441CYProgramServiceRevenueAmt
PY Investment Income$5PYInvestmentIncomeAmt
CY Investment Income$13,112CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$180,000CYOtherRevenueAmt
PY Total Revenue$7,957,118PYTotalRevenueAmt
CY Total Revenue$8,594,576CYTotalRevenueAmt
PY Grants And Similar Paid$13,592PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$10,310CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,017,299PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,505,576CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$1,550CYTotalFundraisingExpenseAmt
PY Other Expenses$1,676,588PYOtherExpensesAmt
CY Other Expenses$1,763,609CYOtherExpensesAmt
PY Total Expenses$7,707,479PYTotalExpensesAmt
CY Total Expenses$8,279,495CYTotalExpensesAmt
PY Revenues Less Expenses$249,639PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$315,081CYRevenuesLessExpensesAmt
Total Assets BOY$2,443,578TotalAssetsBOYAmt
Total Assets EOY$2,840,466TotalAssetsEOYAmt
Total Liabilities BOY$319,254TotalLiabilitiesBOYAmt
Total Liabilities EOY$401,061TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,124,324NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,439,405NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,635,103ExpenseAmt
Grant$10,310GrantAmt
Revenue$2,620,441RevenueAmt
DescWE CONTINUE TO HOUSE AND TRAIN 21 FAMILY MEDICINE RESIDENTS. WE GRADUATED 7 RESIDENTS IN JUNE OF 2023 AND ADDED 7 NEW ONES. OUR CLINIC CONTINUES TO BE AN ORGANIZATION WHERE WE FOCUS ON COMMUNITY HEALTH AND SUPPORT AND EMPLOY THE REACH PROGRAM COORDINATORS AND ADVANCED CARE PLANNING PARTNERSHIP DIRECTOR. OUR FACULTY PHYSICIANS REMAIN ACTIVE IN TEACHING AND RESEARCH.Desc
Total Program Service Expenses$7,635,103TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document13IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee51EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SUSAN GOLDENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9205607090PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1229 S MORRISON STAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
KRISTINA SMITH
DIRECTOR, TREASURER2.00Yes (X)Yes (X)$0$0$0
KATIE BALL
DIRECTOR1.00Yes (X)$0$0$0
SARA MARQUARDT
DIRECTOR2.00Yes (X)$0$0$0
PETER ROLOFF MD
DIRECTOR1.00Yes (X)$0$0$0
MIKE BERGMANN
DIRECTOR1.00Yes (X)$0$0$0
MBONU IKEZUAGU
DIRECTOR1.00Yes (X)$0$0$0
LEE VOGEL MD
CEO65.00Yes (X)$254,244$0$57,968
ELIZABETH MENZEL MD
SECRETARY/PROGRAM DIRECTOR55.00Yes (X)$252,170$0$57,495
KATHRYN JACOBE MD
ASSISTANT PROFESSOR55.00$225,433$0$51,399Yes (X)
ALLEN R LAST MD
ASSISTANT PROFESSOR55.00$225,097$0$51,322Yes (X)
MEGAN EVERSON MD
ASSISTANT PROFESSOR55.00$217,421$0$49,572Yes (X)
LAURA VERHAGEN DO
ASSISTANT PROFESSOR55.00$228,893$0$52,188Yes (X)
DEBORAH SCHULTZ MD
ASSOCIATE PROFESSOR55.00$220,402$0$50,252Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,623,660TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$370,196TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MEDICAL COLLEGE OF WISCONSIN
8701 WATERTOWN PLANK ROADMILWAUKEEWI53226FACULTY COMP. AND ASSESSMENTS$1,868,761
WINC GME CONSORTIUM
425 WIND RIDGE DRWAUSAUWI54401RESIDENT WAGES$1,021,018
MEDICAL COLLEGE OF WISCONSIN AFFILIATED
8701 WATERTOWN PLANK ROADMILWAUKEEWI53226RESIDENCY COMP. AND ASSESSMENTS$597,533
EDGEMED HEALTHCARE LLC
4800 T-REX AVENUE 2ND FLOORBOCA RATONFL33431MEDICAL BILLING & PRACTICE MGMT.$144,574
THEDACARE
1818 N MEADE STAPPLETONWI54911INFORMATION TECHNOLOGY SUPPORT$116,418
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Membership Dues$5,393,715MembershipDuesAmt
Related Organizations$105,500RelatedOrganizationsAmt
Government Grants$69,472GovernmentGrantsAmt
All Other Contributions$392,336AllOtherContributionsAmt
Total Contributions$5,961,023TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICES621110$2,277,282$2,277,282
MEDICAL DIRECTOR & PRO623000$124,992$124,992
INSURANCE INCENTIVES621110$38,167$38,167
FieldValueIRS element (for citing)
Total Program Service Revenue$2,440,441TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,112TotalRevenueColumnAmt
Exclusion$13,112ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescASSESSMENT CREDITDesc
Business621110BusinessCd
Total Revenue Column$180,000TotalRevenueColumnAmt
Related Or Exempt Func Income$180,000RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$180,000OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,594,576TotalRevenueColumnAmt
Related Or Exempt Func Income$2,620,441RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$13,112ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$10,310TotalAmt
Program Services$10,310ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$317,805TotalAmt
Program Services$231,376ProgramServicesAmt
Management And General$84,879ManagementAndGeneralAmt
Fundraising$1,550FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,775,138TotalAmt
Program Services$4,661,632ProgramServicesAmt
Management And General$113,506ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$46,201TotalAmt
Program Services$43,713ProgramServicesAmt
Management And General$2,488ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,216,505TotalAmt
Program Services$1,197,593ProgramServicesAmt
Management And General$18,912ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$149,927TotalAmt
Program Services$141,853ProgramServicesAmt
Management And General$8,074ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$225,065TotalAmt
Program Services$225,065ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$29,024TotalAmt
Management And General$29,024ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$234,062TotalAmt
Management And General$234,062ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$233,994TotalAmt
Program Services$193,583ProgramServicesAmt
Management And General$40,411ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$81,479TotalAmt
Management And General$81,479ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$117,423TotalAmt
Program Services$94,586ProgramServicesAmt
Management And General$22,837ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$105,334TotalAmt
Program Services$105,334ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$143,353TotalAmt
Program Services$136,183ProgramServicesAmt
Management And General$7,170ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$22,339TotalAmt
Program Services$22,339ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$24,861TotalAmt
Program Services$24,861ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$48,507TotalAmt
Program Services$48,507ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$237,192$237,192
MAINTENANCE & REPAIRS$173,520$173,520
DUES AND SUBSCRIPTIONS$34,290$34,290
RECRUITMENT EXPENSES$29,788$29,788

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$23,378TotalAmt
Program Services$23,378ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,279,495TotalAmt
Program Services$7,635,103ProgramServicesAmt
Management And General$642,842ManagementAndGeneralAmt
Fundraising$1,550FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,006,305BOYAmt
EOY$997,529EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$50,112BOYAmt
EOY$1,245,214EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$91,448BOYAmt
EOY$367,428EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$218,944BOYAmt
EOY$182,727EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$10,609BOYAmt
EOY$1,301EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$350,111LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$303,844LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$66,160BOYAmt
EOY$46,267EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,443,578BOYAmt
EOY$2,840,466EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$319,254BOYAmt
EOY$284,679EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$111,382EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$5,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$319,254BOYAmt
EOY$401,061EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,065,991BOYAmt
EOY$2,239,108EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$58,333BOYAmt
EOY$200,297EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,124,324BOYAmt
EOY$2,439,405EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,443,578BOYAmt
EOY$2,840,466EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$315,081ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (1)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS Audited0FSAuditedInd
Audit Committee0AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,471OtherCostOrOtherBasisAmt
Depreciation$2,279DepreciationAmt
Book Value$8,192BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$339,640OtherCostOrOtherBasisAmt
Depreciation$301,565DepreciationAmt
Book Value$38,075BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$46,267TotalBookValueLandBuildingsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
LEE VOGEL MD
CEO$254,244$0$0$0$0$0$0$0$57,968$0$312,212$0$0$0
ELIZABETH MENZEL MD
SECRETARY/PROGRAM DIRECTOR$252,170$0$0$0$0$0$0$0$57,495$0$309,665$0$0$0
LAURA VERHAGEN DO
ASSISTANT PROFESSOR$228,893$0$0$0$0$0$0$0$52,188$0$281,081$0$0$0
KATHRYN JACOBE MD
ASSISTANT PROFESSOR$225,433$0$0$0$0$0$0$0$51,399$0$276,832$0$0$0
ALLEN R LAST MD
ASSISTANT PROFESSOR$225,097$0$0$0$0$0$0$0$51,322$0$276,419$0$0$0
DEBORAH SCHULTZ MD
ASSOCIATE PROFESSOR$220,402$0$0$0$0$0$0$0$50,252$0$270,654$0$0$0
MEGAN EVERSON MD
ASSISTANT PROFESSOR$217,421$0$0$0$0$0$0$0$49,572$0$266,993$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, PART VII, LINE 5FormAndLineReferenceDesc
ExplanationTHE INDIVIDUALS LISTED ON SCHEDULE J ARE PAID BY MEDICAL COLLEGE OF WISCONSIN, AN UNRELATED ORGANIZATION. THE ORGANIZATION MAKES PAYMENTS TO MEDICAL COLLEGE OF WISCONSIN FOR WAGES, BENEFITS, AND OTHER ASSESSMENTS.ExplanationTxt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonLEE VOGELPersonNm
Relationship With OrgOFFICERRelationshipWithOrgTxt
Loan PurposeREFUNDLoanPurposeTxt
Loan To OrganizationYes (X)LoanToOrganizationInd
Original Principal$5,000OriginalPrincipalAmt
Balance Due$5,000BalanceDueAmt
Default0DefaultInd
Board Or Committee Approval0BoardOrCommitteeApprovalInd
Written Agreement0WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$5,000TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2KRISTINA SMITH, PETER ROLOFF, AND MIKE BERGMANN HAVE A BUSINESS RELATIONSHIP AS THEY ARE OFFICERS/EMPLOYEES OF THE SAME MEMBER ORGANIZATION. KATIE BALL, SARA MARQUARDT, AND MBONU IKEZUAGU HAVE A BUSINESS RELATIONSHIP AS THEY ARE OFFICERS/EMPLOYEES OF THE SAME MEMBER ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS 2 CORPORATE MEMBERS. THE CORPORATE MEMBERS HAVE THE RIGHT TO APPOINT AND REMOVE DIRECTORS AND DETERMINE THE NUMBER OF DIRECTORS, TO APPROVE THE APPOINTMENT OF AND REMOVAL OF THE CEO, TO APPROVE AMENDMENTS TO THE ORGANIZATIONS GOVERNING DOCUMENTS, AND APPROVE OTHER ACTIONS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION HAS 2 CORPORATE MEMBERS. THE CORPORATE MEMBERS HAVE THE RIGHT TO APPOINT AND REMOVE DIRECTORS AND DETERMINE THE NUMBER OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION HAS 2 CORPORATE MEMBERS. THE CORPORATE MEMBERS HAVE THE RIGHT TO APPOINT AND REMOVE DIRECTORS AND DETERMINE THE NUMBER OF DIRECTORS, TO APPROVE THE APPOINTMENT OF AND REMOVAL OF THE CEO, TO APPROVE AMENDMENTS TO THE ORGANIZATIONS GOVERNING DOCUMENTS, AND APPROVE OTHER ACTIONS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE 990 IS FIRST REVIEWED BY THE CEO, TREASURER AND OTHER MEMBERS OF THE FINANCE COMMITTEE. AFTER THEIR REVIEW AND APPROVAL, A COPY OF THE 990 IS SENT TO EACH BOARD MEMBER. THE BOARD THEN VOTES TO APPROVE THE 990. WITH BOARD APPROVAL, THE TREASURER SIGNS THE RETURN AND A COPY IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, THE BOARD OF DIRECTORS COMPLETES AND SIGNS A CONFLICT OF INTEREST QUESTIONNAIRE. DURING THE YEAR, DIRECTORS AND OFFICERS DISCLOSE POSSIBLE CONFLICTS OF INTERESTS TO THE BOARD AND THE BOARD REVIEWS THE ISSUES TO DETERMINE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. IF THERE IS A CONFLICT OF INTEREST, THAT INDIVIDUAL IS NOT PERMITTED TO VOTE IN REGARDS TO THE ITEM OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15EXECUTIVE DIRECTOR AND FACULTY ARE EMPLOYED BY MEDICAL COLLEGE OF WISCONSIN AND THEIR COMPENSATION IS CONSISTENT WITH MCW DEPARTMENT OF FAMILY MEDICINE FACULTY AND LEADERSHIP COMPENSATION. FACULTY AND LEADERSHIP COMPENSATION CORRIDORS ARE DETERMINED BY MCW / DEPARTMENT LEADERSHIP AND COMPENSATION COMMITTEE, USING COMPENSATION SURVEYS BY INDEPENDENT CONSULTANTS ENGAGED BY MCW, AS WELL AS BY MOSAIC'S ACCOUNTING FIRM, CLA TO ENSURE INPUT FROM INDEPENDENT ANALYSIS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
FOX VALLEY FAMILY PRACTICE RESIDENCY INC APPLETON
229 S MORRISON STREETAPPLETONWI54911391327215EQUIP AND MAINTAIN EDUCATIONAL FACILITY FOR LEASE TO RESIDENCY PROGRAM.WI501(C)(3)LINE 12C, III-FIN/A0
GOLD CROSS AMBULANCE SERVICES INC
1055 WITTMANN DRIVEMENASHAWI54952391702433AMBULANCE SERVICESWI501(C)(3)LINE 10N/A0
CATALPA HEALTH INC
4635 W COLLEGE AVENUEAPPLETONWI54914454681563CHILDREN'S MENTAL HEALTHWI501(C)(3)LINE 3N/A0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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