2017-11-08T15:43:35-06:00 2017-06-30 391173131 SCHENCK SC 200 E WASHINGTON ST PO BOX 1739 APPLETON WI 549121739 990 2016-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 229 S MORRISON STREET APPLETON WI 54911 KRISTINA SMITH TREASURER 9208322783 2017-11-07 MIKE VANDEN HOGEN P00499282 9207318111 74.142.163.66 2017-11-07 09:26:49 CS P A5345BC4DE5C4E78ED984795A38A35ED142D6D46 9475B8F64D5A719E781C043AAC9DC26B2B2E8E16 2016 2018-03-14 21:41:22Z LEE VOGEL MD 229 S MORRISON STREET APPLETON WI 54911 7508417 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 54 6 0 0 5091025 5039444 2183775 2468973 0 0 0 0 7274800 7508417 0 0 0 0 5067492 5670884 0 0 0 1616508 1688746 6684000 7359630 590800 148787 916381 966888 325581 227301 590800 739587 CARING FOR PATIENTS, DISCOVERING KNOWLEDGE, TEACHING PHYSICIANS, AND SERVING THE COMMUNITY. 0 0 6788638 2468973 WE CONTINUE TO HOUSE AND TRAIN 21 FAMILY MEDICINE RESIDENTS. WE GRADUATED 7 RESIDENTS IN JUNE OF 2017 AND ADDED 7 NEW ONES. OUR CLINIC CONTINUED TO GROW AND TO BE A PLACE THAT WAS ABLE TO SERVE MANY PATIENTS WHO HAD INSURANCE UNDER THE ACCOUNTABLE CARE ACT. WE CONTINUE TO SERVE SOME OF THE MOST VULNERABLE PATIENTS IN OUR COMMUNITY AND ARE ABLE TO HELP THEM MEET MANY OF THEIR BASIC NEEDS WITH ASSISTANCE FROM OUR IN-HOUSE CARE MANAGER. IN OCTOBER OF 2016 WE HIRED A DIRECTOR OF ADVANCE CARE PLANNING WHICH IS LEADING THE EFFORT IN THE FOX VALLEY WORKING WITH MANY LARGE ORGANIZATIONS AND THE 2 HOSPITALS TO PROMOTE ADVANCE CARE PLANNING IN OUR COMMUNITY. THIS PROGRAM IS BEING FUNDED BY MANY DIFFERENT ORGANIZATIONS. 6788638 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 5 0 54 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 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 DIRECTOR 2.00 X 0 0 0 NORMA TURK MD 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 LEE VOGEL MD CEO 65.00 X 231209 0 46242 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 55.00 X 225400 0 45080 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 55.00 X 209355 0 41871 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 55.00 X 257944 0 46589 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 217088 0 41574 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 126298 0 24737 MICHELLE WELHOUSE DIRECTOR OF OPERATIONS 55.00 X 100046 0 35016 1367340 0 281109 7 0 1 1 MEDICAL COLLEGE OF WISCONSIN AFFILIATED 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENT COMP. AND ASSESSMENTS 1558673 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 1371553 SCHENCK SC 200 E WASHINGTON STREET APPLETON WI 54911 BILLING AND ACCOUNTING 145091 3 4787141 19375 232928 5039444 PATIENT SERVICES 621111 2363973 2363973 MEDICAL DIRECTOR & PRO 623110 105000 105000 2468973 7508417 2468973 0 0 145643 87697 57946 4290704 4166589 124115 43218 40244 2974 1057091 1022408 34683 134228 124991 9237 164436 164436 35846 35846 187613 187613 189891 137344 52547 50711 50711 90205 82127 8078 106988 106988 132469 125846 6623 61729 61729 619 619 57237 57237 124501 124501 MEDICAL SUPPLIES 283117 283117 MAINTENANCE AND REPAIRS 163637 163637 DUES AND SUBSCRIPTIONS 17701 17701 RECRUITMENT EXPENSES 15221 15221 6825 6825 7359630 6788638 570992 0 301310 510883 40000 306445 239452 36217 38947 286796 109190 232409 177606 916381 966888 325581 227301 325581 227301 X 550800 739587 40000 0 590800 739587 916381 966888 148787 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 267362 102442 164920 19434 6748 12686 177606 X 0 0 0 0 0 0 0 0 0 LEE VOGEL MD CEO 231209 0 0 0 0 0 0 0 46242 0 277451 0 0 0 ALLEN R LAST MD SECRETARY/PROGRAM DIRECTOR 225400 0 0 0 0 0 0 0 45080 0 270480 0 0 0 DEBORAH SCHULTZ MD ASSOICIATE PROFESSOR 209355 0 0 0 0 0 0 0 41871 0 251226 0 0 0 ELIZABETH MENZEL MD ASSISTANT PROFESSOR 232944 0 25000 0 0 0 0 0 46589 0 304533 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 217088 0 0 0 0 0 0 0 41574 0 258662 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 101298 0 25000 0 0 0 0 0 24737 0 151035 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 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 EXECUTIVE DIRECTOR, 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 EXECUTIVE DIRECTOR, 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