2022-10-13T12:53:54-05:00 2021-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2021-01-01 391681547 FAMILY HEALTH CENTER OF MARSHFIELD INC FAMI 7152215700 1000 N OAK AVENUE MARSHFIELD WI 54449 GREG NYCZ EXECUTIVE DIRECTOR 7152215700 2022-10-10 1 GREG NYCZ 999009999 DAVID LOWENTHAL P00378651 3122071040 2022-10-10 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z GREG NYCZ 1000 N OAK AVENUE MARSHFIELD WI 54449 84391224 0 X WWW.FAMILYHEALTHCENTER.NET X 1990 WI THE MISSION OF FAMILY HEALTH CENTER OF MARSHFIELD, INC. IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTH CARE SERVICES FOR THE UNDERSERVED AND TO ENHANCE THE HEALTH OF OUR COMMUNITIES. 10 10 1 10 0 0 5151159 31609863 10364433 47896151 121538 427820 1500 6000 15638630 79939834 694814 3019642 0 0 56576 205595 0 0 0 16198008 62145333 16949398 65370570 -1310768 14569264 80344099 83844933 25136489 3399051 55207610 80445882 THE MISSION OF FAMILY HEALTH CENTER OF MARSHFIELD, INC. IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTH CARE SERVICES FOR THE UNDERSERVED AND TO ENHANCE THE HEALTH OF OUR COMMUNITIES. 0 0 57901859 3019642 47896151 IN TOTAL, FAMILY HEALTH CENTER OF MARSHFIELD, INC. (FHC) SERVED APPROXIMATELY 55,124 UNIQUE PATIENTS FOR THE 12 MONTHS ENDING DECEMBER 31, 2021 WHO WOULD NOT OTHERWISE RECEIVE CARE OR WOULD NEED TO OVERCOME SIGNIFICANT BARRIERS TO ACCESS CARE. FHC DOES THIS BY CONTRACTING FOR HEALTH CARE AND ADMINISTRATIVE STAFF TO PROVIDE CARE DIRECTLY TO PATIENTS WITHIN PROXIMITY TO THEIR COMMUNITIES, AND BY CONTRACTING FOR HEALTH CARE SERVICES FOR PATIENTS THROUGH A NETWORK OF HEALTH CARE PROVIDERS IN CENTRAL AND NORTHERN WISCONSIN. HEALTH CARE IS INCLUSIVE OF MEDICAL, ORAL, BEHAVIORAL AND VISION CARE. 57901859 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 45 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X AMANDA SPINDLER 7152215727 1000 N OAK AVENUE MARSHFIELD WI 54449 X ANTON ZIESLER PRESIDENT 1.00 0.00 X X 0 0 0 RONDA KOPELKE VICE PRESIDENT 1.00 0.00 X X 0 0 0 RITA KIRCHOFF TREASURER 1.00 0.00 X X 0 0 0 MARLA HEMKE SECRETARY 1.00 0.00 X X 0 0 0 CINDY KOCH BOARD MEMBER 1.00 0.00 X 0 0 0 SHERRY MOORE BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD KUMMEROW BOARD MEMBER 1.00 0.00 X 0 0 0 TENA QUACKENBUSH BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID BAXTER BOARD MEMBER 1.00 0.00 X 0 0 0 AUSTIN JIRSCHELE BOARD MEMBER 1.00 0.00 X 0 0 0 GREG NYCZ EXECUTIVE DIRECTOR 40.00 0.00 X 191895 0 9838 191895 0 9838 1 0 1 0 0 12535744 19073804 315 31609863 NET PATIENT SERVICE REVENUE 621400 43589167 43589167 PHARMACY REVENUE 621400 4006730 4006730 PREPAID HEALTH SERVICE REVENUE 621400 274923 274923 MISC OTHER OP REVENUE 621400 25331 25331 47896151 404963 404963 6000 0 6000 6000 6000 4474247 4451185 205 23062 -205 22857 22857 79939834 47896151 0 433820 X 11883 11883 3007759 3007759 201733 201733 -7760 -7760 11622 11622 74185 74185 37177 37177 43873281 37098809 6774472 12265 12265 523716 441211 82505 133475 84768 48707 1542376 1380300 162076 25548 19377 6171 89240 75041 14199 183670 183670 1751875 1751875 2370 2370 CAPITATION 7977289 7977289 MEDICAL SUPPLIES 5574512 5560931 13581 MISC OTHER OP EXPENSES 466453 416410 50043 BAD DEBT RECOVERY -122099 -122099 65370570 57901859 7468711 0 7583730 10845296 1006597 0 1175862 1814323 23341001 26523351 883005 1005948 161970 110375 51862157 26579013 27024277 25283144 18844418 16698902 323239 1563594 80344099 83844933 10456728 1739683 3083915 263923 11595846 1395445 25136489 3399051 X 55207610 80445882 55207610 80445882 80344099 83844933 X 14569264 -682777 11351785 X 0 1 X 1 1 1 X 9263655 9002617 14218719 5151159 31609863 69246013 9263655 9002617 14218719 5151159 31609863 69246013 12930335 56315678 908721 933203 591880 116973 410963 2961740 72207753 248632365 0.77990 0.90450 X PART II: BECAUSE OF THE SHORT YEAR-END FILING, THE COLUMNS IN SCHEDULE A PART II CORRESPOND TO THE FOLLOWING TAX YEARS: 2017 = FYE 9/30/18 2018 = FYE 9/30/19 2019 = FYE 9/30/20 2020 = SHORT YEAR-END 12/31/20 2021 = FYE 12/31/21 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 0 0 0 0 0 FORM 990 SCH C PART II-B FAMILY HEALTH CENTER OF MARSHFIELD, INC. (FHC) MAY OFFER RECOMMENDATIONS CONCERNING LEGISLATION OR REGULATIONS BEING CONSIDERED THAT HAVE A RELATIONSHIP TO THE ORGANIZATION'S OPERATIONS. 1513971 1513971 30637660 10103649 20534011 795049 414469 380580 18696090 15904622 2791468 219387 156273 63114 25283144 X 76334423 -682779 -682779 77017202 37177 2885455 2922632 79939834 62447938 205 205 62447733 37177 2885660 2922837 65370570 PART X, LINE 2: FAMILY HEALTH CENTER OF MARSHFIELD, INC. (FHC) IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. FHC IS, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. AS OF DECEMBER 31, 2021 AND 2020, FHC HAD NO UNRELATED BUSINESS INCOME. IF THERE WERE UNRELATED BUSINESS INCOME, FHC WOULD APPLY FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. FHC DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 AND 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 3,007,759. BAD DEBT -122,099. LOSS ON FIXED ASSETS -205. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON FIXED ASSETS 205. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 3,007,759. BAD DEBT -122,099. 1 CHARITY CARE ASSISTANCE TO INDIVIDUALS 6919 3007759 PART I, LINE 2: FAMILY HEALTH CENTER PROVIDES CHARITY CARE FOR MEDICAL, DENTAL, AND MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES TO ELIGIBLE PATIENTS THROUGH A COMMUNITY HEALTH ACCESS PROGRAM, A PREPAID HEALTH SERVICES PROGRAM AND FINANCIAL ASSISTANCE BASED ON A SLIDING FEE DISCOUNT SCHEDULE. PATIENTS ARE ABLE TO APPLY FOR CHARITY CARE REGARDLESS OF AGE, GENDER, HEALTH CONDITIONS, RACE/ETHNICITY, CITIZENSHIP STATUS, ETC. IT IS THE GOAL OF OUR HEALTH CENTER TO ELIMINATE ALL BARRIERS, INCLUDING FINANCIAL, TO CARE FOR OUR AT-RISK POPULATIONS. OUR PROGRAMS ARE BOARD APPROVED AND BASED ON MANY FACTORS INCLUDING PATIENT INPUT. X X X X 0 0 0 0 0 0 0 0 0 GREG NYCZ EXECUTIVE DIRECTOR 187881 0 0 0 4014 0 0 0 9838 0 201733 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE MARSHFIELD CLINIC HEALTH SYSTEM TAX DEPARTMENT, THE FHC EXECUTIVE DIRECTOR AND FHC DIRECTOR OF FINANCE SHALL REVIEW THE COMPLETED FORM 990. AFTER THEIR REVIEW AND PRIOR TO FILING FORM 990 WITH THE IRS, A FINAL COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES WILL BE SHARED WITH THE FHC BOARD OF DIRECTORS IN ELECTRONIC OR PAPER FORM FOR REVIEW AND FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C FHC HAS ADOPTED A CONFLICT OF INTEREST POLICY. EACH DIRECTOR, OFFICER, AND OTHER PERSON WHO IS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER DECISIONS OF FHC IS REQUIRED TO ANNUALLY COMPLETE AND SIGN A DISCLOSURE STATEMENT THAT IS PART OF THE POLICY. THEY MUST ALSO DISCLOSE THE EXISTENCE OF A POTENTIAL CONFLICT AND ALL MATERIAL FACTS TO THE GOVERNING BOARD AS SOON AS THE PERSON HAS KNOWLEDGE THAT A POTENTIAL CONFLICT MAY OCCUR. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS OF FHC IS RESPONSIBLE FOR THE EXECUTIVE DIRECTOR'S ANNUAL EVALUATION AND MERIT CHANGES. THE FHC PERSONNEL COMMITTEE CONDUCTS THE PROCESS RELATED TO THESE ACTIVITIES AND MAKES A RECOMMENDATION TO THE FULL BOARD FOR APPROVAL. THE FHC PERSONNEL COMMITTEE UTILIZES A HUMAN RESOURCE REPRESENTATIVE WHO PROVIDES THEM WITH SALARY SURVEY INFORMATION RELEVANT TO THE POSITION. THE FHC PERSONNEL COMMITTEE ALSO UTILIZES RECOMMENDATIONS FROM THE MARSHFIELD CLINIC HEALTH SYSTEM INDEPENDENT COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 FHC DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,098,809. MANAGEMENT AND GENERAL EXPENSES 6,774,472. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,873,281. FORM 990, PART IX, LINE 5: ALL PERSONNEL SERVICES FOR FHC ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. AND MARSHFIELD CLINIC HEALTH SYSTEM, INC. WITH THE EXCEPTION OF THE EXECUTIVE DIRECTOR. MARSHFIELD CLINIC, INC. AND MARSHFIELD CLINIC HEALTH SYSTEM, INC. FILE ALL CORRESPONDING FEDERAL PAYROLL FORMS. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM MARSHFIELD CLINIC, INC 11,351,785. 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