2019-05-02T10:16:01-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP 200 E WASHINGTON ST PO BOX 1739 APPLETON WI 549121739 990 2017-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 229 S MORRISON STREET APPLETON WI 54911 KRISTINA SMITH TREASURER 9208322783 2019-04-19 1 MIKE VANDEN HOGEN P00499282 9207318111 2019-04-19 74.142.163.66 2019-04-19 10:14:12 CD P 95FD3CD324D7C6C558223E34BD2EF05BB0413D65 08A19BA27D6E1667BD72E7594911BEF6CE06A07D 2017 2019-02-21 02:37:17Z LEE VOGEL MD 229 S MORRISON STREET APPLETON WI 54911 7460510 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 59 8 0 0 5039444 5125433 2468973 2335077 0 0 0 0 7508417 7460510 0 0 0 0 5670884 5975005 0 0 0 1688746 1524555 7359630 7499560 148787 -39050 966888 912059 227301 211522 739587 700537 TO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES. 0 0 6897469 2335077 WE CONTINUE TO HOUSE AND TRAIN 20 FAMILY MEDICINE RESIDENTS. WE GRADUATED 7 RESIDENTS IN JUNE OF 2018 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. THIS YEAR WE WERE ABLE TO HIRE A NEW TEAM MEMBER TO OUR BEHAVIORAL HEALTH TEAM, AND WE WILL ALSO BE ADDING A PSYCHOLOGIST TO PREPARE TO START AN INTEGRATIVE BEHAVIORAL HEALTH MODEL IN OUR CLINIC TO BETTER SERVE OUR PATIENTS. 6897469 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 22 0 59 1 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X SHELLY WELHOUSE 9209978414 229 S MORRISON STREET APPLETON WI 54911 KRISTINA SMITH DIRECTOR, TREASURER 2.00 X X 0 0 0 KATIE BALL DIRECTOR 1.00 X 0 0 0 GREGORY LONG MD PAST DIRECTOR 2.00 X 0 0 0 NORMA TURK MD PAST DIRECTOR 1.00 X 0 0 0 LAWRENCE DONATELLE MD DIRECTOR 2.00 X 0 0 0 MONICA HILT DIRECTOR 1.00 X 0 0 0 VICKY BARNTHOUSE RN DIRECTOR 2.00 X 0 0 0 SARA MARQUARDT DIRECTOR 2.00 X 0 0 0 LEE VOGEL MD CEO 65.00 X 244959 0 55361 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 55.00 X 235731 0 53275 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 55.00 X 210969 0 47679 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 55.00 X 213138 0 48169 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 213208 0 48185 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 228281 0 47072 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 55.00 X 217824 0 44708 1564110 0 344449 8 0 1 1 MEDICAL COLLEGE OF WISCONSIN AFFILIATED 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENT COMP. AND ASSESSMENTS 1917942 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 1700204 SCHENCK SC 200 E WASHINGTON STREET APPLETON WI 54911 BILLING AND ACCOUNTING 165289 3 4990640 30000 104793 5125433 PATIENT SERVICES 621111 2230077 2230077 MEDICAL DIRECTOR & PRO 623110 105000 105000 2335077 7460510 2335077 0 0 286947 205814 81133 4330452 4195626 134826 46268 43079 3189 1170572 1138860 31712 140766 131063 9703 89750 89750 27971 27971 205131 205131 130287 114818 15469 78075 78075 106912 98583 8329 97289 97289 131060 124507 6553 59185 59185 57423 57423 98031 98031 MEDICAL SUPPLIES 235591 235591 MAINTENANCE & REPAIRS 150458 150458 RECRUITMENT EXPENSES 31692 31692 DUES AND SUBSCRIPTIONS 12517 12517 13183 13183 7499560 6897469 602091 0 510883 514455 239452 249750 38947 27134 287333 166613 177606 120720 966888 912059 227301 211522 227301 211522 X 739587 700537 739587 700537 966888 912059 -39050 0 X 0 0 0 X 267362 155914 111448 19971 10699 9272 120720 X 0 0 0 0 0 0 0 0 0 LEE VOGEL MD CEO 244959 0 0 0 0 0 0 0 55361 0 300320 0 0 0 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 235731 0 0 0 0 0 0 0 53275 0 289006 0 0 0 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 210969 0 0 0 0 0 0 0 47679 0 258648 0 0 0 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 213138 0 0 0 0 0 0 0 48169 0 261307 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 213208 0 0 0 0 0 0 0 48185 0 261393 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 208281 0 20000 0 0 0 0 0 47072 0 275353 0 0 0 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 197824 0 20000 0 0 0 0 0 44708 0 262532 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, AND MONICA HILT HAVE A BUSINESS RELATIONSHIP. KATIE BALL, GREGORY LONG, NORMA TURK, 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