2022-05-12T11:54:39-05:00 2021-06-30 410746749 CLIFTONLARSONALLEN LLP 200 EAST WASHINGTON STREET PO BOX 1739 APPLETON WI 54912 990 2020-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 229 S MORRISON ST APPLETON WI 54911 KRISTINA SMITH TREASURER 9208322783 2022-05-11 1 KRISTINA SMITH 999009999 MICHAEL VANDENHOGEN P00499282 9207318111 2022-05-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z LEE VOGEL MD 229 S MORRISON ST APPLETON WI 54911 8416729 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 59 7 0 0 5583380 6171789 2244067 2244935 24 5 0 0 7827471 8416729 0 0 0 0 6066400 6172799 0 0 0 1570927 1620976 7637327 7793775 190144 622954 2450594 2181775 1265863 307090 1184731 1874685 TO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES. 0 0 7204090 2244935 WE CONTINUE TO HOUSE AND TRAIN 21 FAMILY MEDICINE RESIDENTS. WE GRADUATED 7 RESIDENTS IN JUNE OF 2021 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. 7204090 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 59 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X SUSAN GOLDEN 9205607090 229 S MORRISON ST APPLETON WI 54911 KRISTINA SMITH DIRECTOR, TREASURER 2.00 X X 0 0 0 KATIE BALL DIRECTOR 1.00 X 0 0 0 SARA MARQUARDT DIRECTOR 2.00 X 0 0 0 PETER ROLOFF MD DIRECTOR 1.00 X 0 0 0 JENNIFER FRANK MD DIRECTOR 1.00 X 0 0 0 TOM NICHOLS DIRECTOR 1.00 X 0 0 0 MONICA HILT PAST DIRECTOR 1.00 X 0 0 0 LEE VOGEL MD CEO 65.00 X 254357 0 57485 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 55.00 X 251328 0 56800 ALLEN R LAST MD ASSISTANT PROFESSOR 55.00 X 221947 0 50160 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 55.00 X 217973 0 49262 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 220872 0 49917 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 232260 0 52491 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 55.00 X 219671 0 49646 1618408 0 365761 9 0 1 1 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 2134106 MEDICAL COLLEGE OF WISCONSIN AFFILIATED 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENCY COMP. AND ASSESSMENTS 1745445 EDGEMED HEALTHCARE LLC 4800 T-REX AVENUE 2ND FLOOR BOCA RATON FL 33431 MEDICAL BILLING & PRACTICE MGMT. 121255 3 5319999 599331 252459 6171789 PATIENT SERVICES 621111 2090549 2090549 MEDICAL DIRECTOR & PRO 623110 105000 105000 INSURANCE INCENTIVES 621111 49386 49386 2244935 5 5 8416729 2244935 0 5 310610 225381 85229 4549729 4392369 157360 46985 43359 3626 1109505 1074059 35446 155970 143933 12037 208429 208429 35219 35219 179980 179980 217367 189131 28236 34368 34368 92949 81348 11601 117541 117541 131668 125085 6583 20384 20384 26855 26855 75821 75821 MEDICAL SUPPLIES 221065 221065 MAINTENANCE & REPAIRS 147382 147382 RECRUITMENT EXPENSES 42788 42788 DUES AND SUBSCRIPTIONS 25401 25401 43759 43759 7793775 7204090 589685 0 1996506 1503044 50102 50107 311962 311716 237193 10174 11272 320130 251933 82096 68197 2450594 2181775 459913 307090 327738 0 478212 0 1265863 307090 X 1184731 1571156 303529 1184731 1874685 2450594 2181775 622954 67000 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10471 1132 9339 309659 250801 58858 68197 X 0 0 0 0 0 0 0 0 0 LEE VOGEL MD CEO 254357 0 0 0 0 0 0 0 57485 0 311842 0 0 0 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 251328 0 0 0 0 0 0 0 56800 0 308128 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 232260 0 0 0 0 0 0 0 52491 0 284751 0 0 0 ALLEN R LAST MD ASSISTANT PROFESSOR 221947 0 0 0 0 0 0 0 50160 0 272107 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 220872 0 0 0 0 0 0 0 49917 0 270789 0 0 0 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 219671 0 0 0 0 0 0 0 49646 0 269317 0 0 0 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 217973 0 0 0 0 0 0 0 49262 0 267235 0 0 0 FORM 990, PART VII, LINE 5 THE 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. FORM 990, PART VI, SECTION A, LINE 2 KRISTINA SMITH, MONICA HILT, PETER ROLOFF, AND TOM NICHOLS HAVE A BUSINESS RELATIONSHIP. KATIE BALL, SARA MARQUARDT, AND JENNIFER FRANK, M.D. HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE 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 7A THE 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 7B THE 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 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED AND APPROVED BY THE TREASURER PRIOR TO FILING. A COPY OF THE 990 IS ALSO SENT TO EACH OF THE BOARD MEMBERS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS DISCLOSE POSSIBLE CONFLICTS OF INTERESTS AND THE BOARD OF DIRECTORS REVIEW 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 INTEREST. FORM 990, PART VI, SECTION B, LINE 15 A TEAM OF BOARD MEMBERS REVIEW SALARIES AGAINST MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) STANDARDS AND WORK WITH SPECIALISTS TO HELP DETERMINE SALARIES TO BE AT A COMPETITIVE MARKET VALUE. THE DELIBERATION AND DECISION ARE DOCUMENTED IN MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FOX VALLEY FAMILY PRACTICE RESIDENCY INC APPLETON 229 S MORRISON STREET APPLETON WI 54911 391327215 EQUIP AND MAINTAIN EDUCATIONAL FACILITY FOR LEASE TO RESIDENCY PROGRAM. WI 501(C)(3) LINE 12C, III-FI N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0