MOSAIC FAMILY HEALTH INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
MOSAIC FAMILY HEALTH INC (EIN 47-3298660)
Tax period
2023-07-01 to 2024-06-30
Filed
2025-05-12
IRS object ID
202541329349306074
Schema version
2023v6.0
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)
Return2025-05-12T17:21:32-05:00ReturnTs
Tax Period End2024-06-30TaxPeriodEndDt

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 Begin2023-07-01TaxPeriodBeginDt

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 Line1100 N ONEIDA STREETAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonLEE VOGEL MDPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone9208322783PhoneNum
Signature2025-05-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL VANDENHOGENPreparerPersonNm
PTINP00499282PTIN
Phone9207318111PhoneNum
Preparation2025-05-12PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Principal OfficerLEE VOGEL MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 N ONEIDA STREETAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$15,975,631GrossReceiptsAmt
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 Employee50TotalEmployeeCnt
Total Volunteers6TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,961,023PYContributionsGrantsAmt
CY Contributions Grants$13,305,277CYContributionsGrantsAmt
PY Program Service Revenue$2,440,441PYProgramServiceRevenueAmt
CY Program Service Revenue$2,571,949CYProgramServiceRevenueAmt
PY Investment Income$13,112PYInvestmentIncomeAmt
CY Investment Income$87,076CYInvestmentIncomeAmt
PY Other Revenue$180,000PYOtherRevenueAmt
CY Other Revenue$11,329CYOtherRevenueAmt
PY Total Revenue$8,594,576PYTotalRevenueAmt
CY Total Revenue$15,975,631CYTotalRevenueAmt
PY Grants And Similar Paid$10,310PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,505,576PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,188,055CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$7,752CYTotalFundraisingExpenseAmt
PY Other Expenses$1,763,609PYOtherExpensesAmt
CY Other Expenses$1,882,094CYOtherExpensesAmt
PY Total Expenses$8,279,495PYTotalExpensesAmt
CY Total Expenses$8,070,149CYTotalExpensesAmt
PY Revenues Less Expenses$315,081PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$7,905,482CYRevenuesLessExpensesAmt
Total Assets BOY$2,840,466TotalAssetsBOYAmt
Total Assets EOY$13,756,449TotalAssetsEOYAmt
Total Liabilities BOY$401,061TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,411,562TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,439,405NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$10,344,887NetAssetsOrFundBalancesEOYAmt
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$7,358,852ExpenseAmt
Revenue$2,583,278RevenueAmt
DescMOSAIC FAMILY HEALTH IS THE MEDICAL HOME OF THE FOX VALLEY FAMILY MEDICINE RESIDENCY PROGRAM - A 21 RESIDENT TRAINING PROGRAM AFFILIATED WITH THE MEDICAL COLLEGE OF WISCONSIN. WE TRAIN FAMILY PHYSICIANS FOR THE FOX VALLEY COMMUNITY AND NORTH EAST WISCONSIN, SPECIALIZING IN PROVIDING PHYSICIANS WITH FULL SCOPE OF PRACTICE SKILLS TO SERVE IN CRITICAL ACCESS HOSPITALS. OUR CARE SERVICES CONTINUE TO EXPAND AND INCLUDE AMBULATORY PRIMARY CARE FOR ALL AGES, INCLUDING MATERNAL AND INFANT CARE, INTEGRATED BEHAVIORAL HEALTH, MEDICATION ASSISTED ADDICTION TREATMENT, CARE IN SKILLED NURSING FACILITIES. A SPECIAL FOCUS IS CARE FOR THE VULNERABLE AND MARGINALIZED COMMUNITIES. WE SEEK FOR ALL PATIENTS, TO FLOURISH AND ARE INTENTIONALLY BUILDING A "HEALTH EQUITY HUB."Desc
Total Program Service Expenses$7,358,852TotalProgramServiceExpensesAmt
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 StmtYes (1)IndependentAuditFinclStmtInd
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 Outstanding0LoanOutstandingInd
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 Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee50EmployeeCnt
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 Line1JILLIAN WILSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9205607160PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 N ONEIDA STREETAddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54911ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 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
DIRECTOR (LEFT DEC 2023)1.00Yes (X)$0$0$0
MIKE BERGMANN
DIRECTOR1.00Yes (X)$0$0$0
MBONU IKEZUAGU MD
DIRECTOR1.00Yes (X)$0$0$0
SONAL CHANDRATRE
DIRECTOR (AS OF FEB 2024)1.00Yes (X)$0$0$0
LEE VOGEL MD
PRESIDENT/EXECUTIVE DIRECTOR65.00Yes (X)$254,244$0$57,968
ELIZABETH MENZEL MD
SECRETARY/PROGRAM DIRECTOR55.00Yes (X)$260,317$0$59,352
MEGAN EVERSON MD
ASSISTANT PROFESSOR55.00$233,793$0$53,305Yes (X)
ALLEN R LAST MD
ASSISTANT PROFESSOR55.00$233,793$0$53,305Yes (X)
KATHRYN JACOBE MD
ASSISTANT PROFESSOR55.00$231,815$0$52,854Yes (X)
DEBORAH SCHULTZ MD
ASSOCIATE PROFESSOR55.00$233,629$0$53,267Yes (X)
LAURA VERHAGEN DO
ASSISTANT PROFESSOR55.00$214,512$0$48,909Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,662,103TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$378,960TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K10IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MEDICAL COLLEGE OF WISCONSIN
8701 WATERTOWN PLANK ROADMILWAUKEEWI53226FACULTY COMP. AND ASSESSMENTS$2,224,205
WINC GME CONSORTIUM
425 WIND RIDGE DRWAUSAUWI54401RESIDENT WAGES$1,069,454
EDGEMED HEALTHCARE LLC
4800 T-REX AVENUE 2ND FLOORBOCA RATONFL33431MEDICAL BILLING & PRACTICE MGMT.$127,265
THEDACARE
1818 N MEADE STAPPLETONWI54911INFORMATION TECHNOLOGY SUPPORT$109,142
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Membership Dues$5,237,901MembershipDuesAmt
Government Grants$3,320,115GovernmentGrantsAmt
All Other Contributions$4,747,261AllOtherContributionsAmt
Total Contributions$13,305,277TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICES621110$2,397,532$2,397,532
MEDICAL DIRECTOR & PROFESSIONAL S623000$124,992$124,992
INSURANCE INCENTIVES621110$49,425$49,425
FieldValueIRS element (for citing)
Total Program Service Revenue$2,571,949TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$87,076TotalRevenueColumnAmt
Exclusion$87,076ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business621110BusinessCd
Total Revenue Column$11,329TotalRevenueColumnAmt
Related Or Exempt Func Income$11,329RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$11,329OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,975,631TotalRevenueColumnAmt
Related Or Exempt Func Income$2,583,278RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$87,076ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$323,517TotalAmt
Program Services$189,720ProgramServicesAmt
Management And General$126,045ManagementAndGeneralAmt
Fundraising$7,752FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,734,840TotalAmt
Program Services$4,618,930ProgramServicesAmt
Management And General$115,910ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$45,593TotalAmt
Program Services$42,927ProgramServicesAmt
Management And General$2,666ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$933,406TotalAmt
Program Services$922,089ProgramServicesAmt
Management And General$11,317ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$150,699TotalAmt
Program Services$141,886ProgramServicesAmt
Management And General$8,813ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$294,615TotalAmt
Program Services$294,615ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$35,361TotalAmt
Management And General$35,361ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$324,349TotalAmt
Management And General$324,349ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$122,448TotalAmt
Program Services$122,448ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$47,454TotalAmt
Management And General$47,454ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$134,686TotalAmt
Program Services$110,192ProgramServicesAmt
Management And General$24,494ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$99,324TotalAmt
Program Services$99,324ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$142,725TotalAmt
Program Services$135,589ProgramServicesAmt
Management And General$7,136ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$36,831TotalAmt
Program Services$36,831ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$18,811TotalAmt
Program Services$18,811ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$62,674TotalAmt
Program Services$62,674ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$341,883$341,883
MAINTENANCE & REPAIRS$161,818$161,818
DUES AND SUBSCRIPTIONS$42,315$42,315
RECRUITMENT EXPENSES$16,800$16,800

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,070,149TotalAmt
Program Services$7,358,852ProgramServicesAmt
Management And General$703,545ManagementAndGeneralAmt
Fundraising$7,752FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$997,529BOYAmt
EOY$1,704,651EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,245,214BOYAmt
EOY$6,036,483EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$367,428BOYAmt
EOY$150,255EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$182,727BOYAmt
EOY$255,494EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,301BOYAmt
EOY$47,764EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$5,884,457LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$322,655LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$46,267BOYAmt
EOY$5,561,802EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,840,466BOYAmt
EOY$13,756,449EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$284,679BOYAmt
EOY$572,891EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$111,382BOYAmt
EOY$2,838,671EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$401,061BOYAmt
EOY$3,411,562EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,239,108BOYAmt
EOY$2,530,112EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$200,297BOYAmt
EOY$7,814,775EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,439,405BOYAmt
EOY$10,344,887EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,840,466BOYAmt
EOY$13,756,449EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$7,905,482ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
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$2,853DepreciationAmt
Book Value$7,618BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$342,779OtherCostOrOtherBasisAmt
Depreciation$319,802DepreciationAmt
Book Value$22,977BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,531,207OtherCostOrOtherBasisAmt
Book Value$5,531,207BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,561,802TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$16,963,135TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$987,504DonatedServicesAndUseFcltsAmt
Revenue Not Reported$987,504RevenueNotReportedAmt
Revenue Subtotal$15,975,631RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$15,975,631TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$9,057,653TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$987,504DonatedServicesUseFcltsAmt
Expenses Not Reported$987,504ExpensesNotReportedAmt
Expenses Subtotal$8,070,149ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$8,070,149TotalExpensesPerForm990Amt

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
ELIZABETH MENZEL MD
SECRETARY/PROGRAM DIRECTOR$260,317$0$0$0$0$0$0$0$59,352$0$319,669$0$0$0
LEE VOGEL MD
PRESIDENT/EXECUTIVE DIRECTOR$254,244$0$0$0$0$0$0$0$57,968$0$312,212$0$0$0
MEGAN EVERSON MD
ASSISTANT PROFESSOR$233,793$0$0$0$0$0$0$0$53,305$0$287,098$0$0$0
ALLEN R LAST MD
ASSISTANT PROFESSOR$233,793$0$0$0$0$0$0$0$53,305$0$287,098$0$0$0
DEBORAH SCHULTZ MD
ASSOCIATE PROFESSOR$233,629$0$0$0$0$0$0$0$53,267$0$286,896$0$0$0
KATHRYN JACOBE MD
ASSISTANT PROFESSOR$231,815$0$0$0$0$0$0$0$52,854$0$284,669$0$0$0
LAURA VERHAGEN DO
ASSISTANT PROFESSOR$214,512$0$0$0$0$0$0$0$48,909$0$263,421$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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2KRISTINA SMITH, PETER ROLOFF, SONAL CHANDRATRE, 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 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 CEO 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 15THE CEO AND FACULTY ARE EMPLOYED BY MEDICAL COLLEGE OF WISCONSIN (MCW) 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
100 N ONEIDA 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 Org0GiftGrntCapContriFromOthOrgInd
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 OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.