2020-05-08T09:50:45-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 200 E WASHINGTON ST PO BOX 1739 APPLETON WI 549121739 990 2018-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 229 S MORRISON ST APPLETON WI 54911 KRISTINA SMITH TREASURER 9208322783 2020-04-20 1 MICHAEL VANDENHOGEN P00499282 9207318111 2020-04-20 67.137.57.251 2020-04-20 11:13:59 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E79D21E4507A5248C0687B32F12B27296D3A6C71 2018 2020-09-23 17:36:50Z LEE VOGEL MD 229 S MORRISON ST APPLETON WI 54911 7863326 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 5 5 58 8 0 0 5125433 5521785 2335077 2333033 0 78 0 8430 7460510 7863326 0 0 0 0 5975005 6035386 0 0 0 1524555 1533890 7499560 7569276 -39050 294050 912059 1608822 211522 614235 700537 994587 TO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES. 0 0 6973316 2341463 WE CONTINUE TO HOUSE AND TRAIN 21 FAMILY MEDICINE RESIDENTS. WE GRADUATED 6 RESIDENTS IN JUNE OF 2019 AND ADDED 7 NEW ONES. OUR CLINIC CONTINUES TO BE AN ORGANIZATION WHERE WE FOCUS ON COMMUNITY HEALTH. WE ARE ACTIVE IN MANY COMMUNITY ORGANIZATIONS SUCH AS THE FOX VALLEY MEMORY PROJECT, WEIGHT OF THE FOX VALLEY, THE ADVANCED CARE PLANNING PARTNERSHIP, AND THE REACH PROGRAM. LAST YEAR WE IMPLEMENTED INTEGRATED BEHAVIOR HEALTH INTO OUR DAILY PRACTICE. 6973316 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 58 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X SHELLY WELHOUSE 9205607160 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 LAWRENCE DONATELLE MD PAST DIRECTOR 2.00 X 0 0 0 MONICA HILT DIRECTOR 1.00 X 0 0 0 VICKY BARNTHOUSE RN PAST DIRECTOR 2.00 X 0 0 0 SARA MARQUARDT DIRECTOR 2.00 X 0 0 0 PETER ROLOFF MD DIRECTOR 1.00 X 0 0 0 LEE VOGEL MD CEO 65.00 X 250792 0 56679 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 55.00 X 244103 0 55167 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 55.00 X 214065 0 48379 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 55.00 X 216733 0 48982 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 217977 0 49263 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 227472 0 51409 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 55.00 X 219926 0 49703 1591068 0 359582 8 0 1 1 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 1718165 MEDICAL COLLEGE OF WISCONSIN AFFILIATED 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENT COMP. AND ASSESSMENTS 1619392 EDGEMED HEALTHCARE LLC 4800 T-REX AVENUE 2ND FLOOR BOCA RATON FL 33431 MEDICAL BILLING 133767 3 5345476 50140 126169 5521785 PATIENT SERVICES 621111 2228033 2228033 MEDICAL DIRECTOR & PRO 623110 105000 105000 2333033 78 78 8430 8430 8430 7863326 2341463 0 78 313005 227393 85612 4339810 4201644 138166 46707 43379 3328 1196381 1164379 32002 139483 129545 9938 110558 110558 27083 27083 190821 190821 156801 119665 37136 48684 48684 119361 102240 17121 99996 99996 121376 115307 6069 57632 57632 58853 58853 83877 83877 MEDICAL SUPPLIES 218039 218039 MAINTENANCE & REPAIRS 169022 169022 RECRUITMENT EXPENSES 34658 34658 DUES AND SUBSCRIPTIONS 24256 24256 12873 12873 7569276 6973316 595960 0 514455 1131458 50078 249750 293040 27134 34209 325503 225466 120720 100037 912059 1608822 211522 614235 211522 614235 X 700537 994587 700537 994587 912059 1608822 294050 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8721 131 8590 267362 209386 57976 49420 15949 33471 100037 X 0 0 0 0 0 0 0 0 0 LEE VOGEL MD CEO 250792 0 0 0 0 0 0 0 56679 0 307471 0 0 0 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 244103 0 0 0 0 0 0 0 55167 0 299270 0 0 0 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 214065 0 0 0 0 0 0 0 48379 0 262444 0 0 0 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 216733 0 0 0 0 0 0 0 48982 0 265715 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 217977 0 0 0 0 0 0 0 49263 0 267240 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 227472 0 0 0 0 0 0 0 51409 0 278881 0 0 0 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 219926 0 0 0 0 0 0 0 49703 0 269629 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, LAWRENCE DONATELLE, PETER ROLOFF, AND MONICA HILT HAVE A BUSINESS RELATIONSHIP. KATIE BALL, VICKY BARNTHOUSE, AND SARA MARQUARDT 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 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 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 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0