2021-11-29T13:57:39-06:00 2020-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH MINNEAPOLIS MN 55402 990 2020-10-01 391681547 FAMILY HEALTH CENTER OF MARSHFIELD INC FAMI 7152215700 1000 N OAK AVENUE MARSHFIELD WI 54449 GREG NYCZ EXECUTIVE DIRECTOR 7152215700 2021-11-29 1 GREG NYCZ 999009999 MONROE J GIERL P01413237 6123055000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z GREG NYCZ 1000 N OAK AVENUE MARSHFIELD WI 54449 17554419 0 X WWW.FAMILYHEALTHCENTER.NET X 1990 WI SEE SCHEDULE O. THE MISSION OF FAMILY HEALTH CENTER OF MARSHFIELD, INC. IS TO PROVIDEACCESS TO HIGH QUALITY HEALTH CARE SERVICES FOR THE UNDERSERVED AND TOENHANCE THE HEALTH OF OUR COMMUNITIES. 10 10 1 10 0 0 14218719 5151159 44344513 10364433 825351 121538 6000 1500 59394583 15638630 3171859 694814 0 0 199242 56576 0 0 0 61195876 16198008 64566977 16949398 -5172394 -1310768 80148727 80344099 23677926 25136489 56470801 55207610 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 15226685 694814 10364433 IN TOTAL, FAMILY HEALTH CENTER OF MARSHFIELD, INC. (FHC) SERVED APPROXIMATELY 20,634 UNIQUE PATIENTS FOR THE 3 MONTHS ENDING DECEMBER 31, 2020 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. 15226685 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 0 0 1 44 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 ANTON ZIESLER PRESIDENT 1.00 0.00 X X 0 0 0 SHERRY MOORE 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 ROBERT WILTROUT BOARD MEMBER 1.00 0.00 X 0 0 0 RONDA KOPELKE 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 ROBERT TWOBEARS EX-OFFICIO BOARD MEMBER 1.00 0.00 X 0 0 0 MARTY ANDERSON EX-OFFICIO BOARD MEMBER 1.00 40.00 X 0 227978 44767 RODERICK KOEHLER MD EX-OFFICIO BOARD MEMBER 1.00 40.00 X 0 439798 46777 GREG NYCZ EXECUTIVE DIRECTOR 40.00 0.00 X 196071 0 8595 196071 667776 100139 1 0 1 0 0 143000 5008041 118 5151159 NET PATIENT SVC REV 621400 9493922 9493922 PHARMACY REVENUE 621400 790143 790143 PREPAID HEALTH SVC REV 621400 75285 75285 MISC OTHER OP REV 621400 5083 5083 10364433 115473 115473 1500 0 1500 1500 1500 1921854 1915789 6065 6065 6065 15638630 10364433 0 123038 X 90 90 694724 694724 53996 53996 2119 2119 461 461 13000 13000 9607 9607 11953880 10386873 1567007 5095 5095 156891 147738 9153 40860 31973 8887 352031 308379 43652 14607 14507 100 13853 11722 2131 81706 81706 462476 462476 12271 12271 CAPITATION 1788207 1788207 0 MEDICAL SUPPLIES 1168500 1159800 8700 BAD DEBT 90988 90988 MISC OTHER OP EXPENSES 34036 30136 3900 16949398 15226685 1722713 0 8824197 7583730 892199 1006597 819639 1175862 21893790 23341001 0 0 0 0 0 0 888954 883005 162431 161970 51867625 24843348 27445895 27024277 18879570 18844418 0 0 0 0 0 0 342052 323239 80148727 80344099 10306829 10456728 0 0 1737700 3083915 0 0 0 0 0 0 11633397 11595846 0 0 23677926 25136489 X 56470801 55207610 0 0 56470801 55207610 80148727 80344099 -1310768 47577 0 X 0 1 X 1 1 1 X 8895359 9263655 9002617 14218719 5151159 46531509 0 0 0 0 0 0 0 0 0 0 8895359 9263655 9002617 14218719 5151159 46531509 1375273 45156236 841383 908721 933203 591880 116973 3392160 0 0 0 0 0 49923669 286684586 0.90450 0.66940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 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 30624586 9328747 21295839 794762 369295 425467 18714919 15001543 3713376 219387 143763 75624 27024277 X 14890880 47568 47568 14843312 9606 785712 795318 15638630 16154080 0 16154080 9606 785712 795318 16949398 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, 2020 AND SEPTEMBER 30, 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 A COMPANY'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, 2020 OR SEPTEMBER 30, 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 694,724. BAD DEBT 90,988. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 694,724. BAD DEBT 90,988. 1 CHARITY CARE ASSISTANCE TO INDIVIDUALS 2777 694724 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 0 0 0 0 0 0 0 0 0 RODERICK KOEHLER MD EX-OFFICIO BOARD MEMBER 0 416379 0 8481 0 14938 0 21519 0 25258 0 486575 0 0 MARTY ANDERSON EX-OFFICIO BOARD MEMBER 0 207423 0 9369 0 11186 0 16715 0 28052 0 272745 0 0 GREG NYCZ EXECUTIVE DIRECTOR 186509 0 3642 0 5920 0 0 0 8595 0 204666 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 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 IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,386,873. MANAGEMENT AND GENERAL EXPENSES 1,567,007. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,953,880. 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