2017-08-11T15:02:57-05:00 2016-09-30 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2015-10-01 391681547 Family Health Center of Marshfield Inc % Lisa Ramminger FAMI 7152215720 1000 North Oak Avenue Marshfield WI 54449 GREG NYCZ Executive Director 7152215720 2017-08-15 true MONROE J GIERL P01413237 6123055000 2017-08-15 2015 2021-01-29 14:40:06Z Greg Nycz 1000 North Oak Avenue Marshfield WI 54449 116953272 false X www.familyhealthcenter.net X 1990 WI SEE SCHEDULE O. 10 10 1 13 0 24189609 26424071 76268817 82258495 926539 845492 0 0 101384965 109528058 0 0 0 0 208317 204623 0 0 0 91192316 99902183 91400633 100106806 9984332 9421252 110601197 130112365 35725042 45238925 74876155 84873440 X SEE SCHEDULE O false false 94012251 82258495 In total, FHC serves approximately 87,100 unique patients annually that would not otherwise receive care or would need to overcome significant barriers to access care. We do this by contracting for health care, dental care, and administrative staff to provide care directly to our patients within proximity to their communities, and by contracting for health care services for our patients through a network of health care providers in central and northern Wisconsin. Health care is inclusive of medical, behavioral, and vision care. 94012251 true true false false false false false false false false true true false false false true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 152 0 true 1 true false false false false false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true true true true false false X Lisa Ramminger 7152215720 1000 N Oak Avenue Marshfield WI 54449 Marty Anderson EX-OFFICIO BOARD MEMBER 1.0 40.0 X 0 106446 33858 Roderick Koehler MD EX-OFFICIO BOARD MEMBER 1.0 40.0 X 0 327703 49576 Sherry Moore President 1.0 0.0 X X 0 0 0 Anton Ziesler Vice President 1.0 0.0 X X 0 0 0 Robert Wiltrout Treasurer 1.0 0.0 X X 0 0 0 Jean Schwanebeck Secretary 1.0 0.0 X X 0 0 0 David L Samter Board Member 1.0 0.0 X 0 0 0 Nora Ritter Board Member 1.0 0.0 X 0 0 0 Janine Schiszek Board Member 1.0 0.0 X 0 0 0 Jean Frenzel Board Member 1.0 0.0 X 0 0 0 Marla Hemke Board Member 1.0 0.0 X 0 0 0 Mithoor Bhat Board Member 1.0 0.0 X 0 0 0 Robert TwoBears EX-OFFICIO BOARD MEMBER 1.0 0.0 X 0 0 0 Greg Nycz Executive Director 40.0 0.0 X 193867 0 7546 193867 434149 90980 1 false true false Scherrer Construction Company 601 Blackhawk Dr PO box 740 BURLINGTON WI 53105 Construction 840073 Fresh N Kleen 36743 157th Ave STANLEY WI 54768 Cleaning Service 494766 Dental Clinic of Marshfield 306 W McMillan PO Box 929 MARSHFIELD WI 54449 Health Care Services 288164 Architectural Design Group LLC 800 Wisconsin St Mailbox 2 EAU CLAIRE WI 547033521 Architecture 163296 4 7499569 18924502 26424071 Prepaid Health Service Revenue 621498 420399 420399 Medical Service Revenue 621498 44517328 44517328 Dental Service Revenue 621498 32838449 32838449 Pharmacy Service REvenue 621498 3981929 3981929 Fees/contract fm Gvt Agencies 621498 113640 113640 386750 386750 82258495 873451 873451 0 0 0 0 0 7391245 6010 7366576 58638 24669 -52628 -27959 -27959 0 0 0 0 109528058 82258495 845492 X 0 0 0 0 187980 3760 184220 0 0 0 16643 333 16310 0 0 40553 40553 44494 44494 0 0 29230 29230 83909269 78015244 5894025 670 670 1465716 1465716 163263 163263 0 1122816 1122816 251014 251014 0 0 412556 412556 0 2162416 2162416 0 Medical Services 8314328 8314328 PHARMACY PHARMACEUTICALS 1985858 1985858 100106806 94012251 6094555 0 69843 73848 19443600 15553896 572568 1050241 35420543 43496108 0 0 0 0 0 0 789142 686785 345392 264073 45758439 16415388 26893066 29343051 0 0 27067043 39644363 0 0 0 0 0 0 110601197 130112365 25091935 35588681 0 0 414406 292213 0 0 0 0 0 0 10218701 9358031 0 0 0 0 35725042 45238925 X 74876155 84873440 0 0 0 0 74876155 84873440 110601197 130112365 9421252 576033 X false true X true true true X 21287630 24787244 17621348 24189609 26424071 114309902 0 0 21287630 24787244 17621348 24189609 26424071 114309902 79008091 35301811 1354252 -411907 679101 831171 873451 3326068 0 0 117635970 474463462 0.30009 0.28610 X Form Sch A Part II Line 17a There are two requirements that FHC must fulfill in order to satisfy the Facts-and-Circumstances Test set forth in Treas. Reg. 1.170A-9T(f)(3)(ii). First, FHC must derive at least 10 percent of its support from governmental units or from direct or indirect contributions from the general public, or a combination of both. By receiving over 25 percent of its support from the government units and the public, FHC has satisfied this requirement. Second, FHC must maintain a continuous and bonafide fundraising program or carry on programs designed to attract support from governmental units or other public charities described in IRC Section 170(b)(1)(A)(i) through (vi). FHC does maintain a concerted and bonafide grant writing and application program as the major part of its fundraising efforts. FHC's activities directly benefit the medically underserved in a large area of northern Wisconsin, which permits FHC to receive substantial governmental support. FHC also maintains a close relationship with Marshfield Clinic, a non-profit that is exempt from tax under IRC section 501(c)(3) and classified as a public charity under IRC section 170(b)(1)(A)(iii). Marshfield Clinic provides a substantial portion of FHC's support in recognition of the need to provide health care services to the poor in Marshfield Clinic's extensive service area. The following additional facts and circumstances further demonstrates that FHC is properly classified as a publicly supported organization under IRC section 509(a)(1) and 170(b)(1)(A)(vi): 1) Charity Care: FHC is a community health center program. In collaboration with Marshfield Clinic, FHC offers a discounted prepaid health care services program that provides low income individuals with doctor visits, prescription drugs, and dental care. 2) Governing Body: FHC's governing body consists of 10 voting members who uniquely represent the public's health care interests. the majority of FHC's board members represent individuals being served in terms of demographic factors such as race, ethnicity, and sex. 3)Breadth Support Sources: The overwhelming majority of FHC's support is derived from other public charities and Federal and State government. 4) Broad Appeal to the Public: FHC's programs appeal to a broad spectrum of the public and its health care needs. FHC's services directly provide for the benefit of the general public on a continuing basis. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1066531 1066531 23858270 6120983 17737287 778998 174121 604877 15938478 10120284 5818194 4116162 4116162 29343051 US GOVERNMENT OBLIGATIOINS 10020475 F CORPORATE BONDS 24403434 F ASSET & MORTGAGE-BACKED SEC. 1456075 F COMMINGLED BOND FUNDS 3499957 F ACCRUED INVESTMENT INCOME 264422 F 39644363 0 0 X 110017778 576033 324407 52628 953068 109064710 463348 463348 109528058 100020493 324407 52628 377035 99643458 463348 463348 100106806 Form Sch D Part X Line 2 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 both September 30, 2016 and 2015, FHC had no unrelated business income. Form Sch D, Part XI and XII Part XI, Line 2d and Part XII, Line 2d: Net gain/loss on disposal of assets. Part XI,Line 4b and Part XII, Line 4b: Provision for Bad Debts. X X false false false false false false false false false Greg Nycz Executive Director 183925 4397 5545 0 0 7585 0 201452 0 0 0 Roderick Koehler MD EX-OFFICIO BOARD MEMBER 316875 8017 2811 0 30062 0 20759 0 378524 0 0 N/A Form 990 Part I Line 1 THE MISSION OF FHC IS TO IMPROVE ACCESS TO PRIMARY CARE SERVICES FOR THE MEDICALLY UNDERSERVED AND TO ENHANCE THE HEALTH OF OUR COMMUNITIES. THE PURPOSE IS TO OPERATE UNDER 42 USC SECTION 254C, WHICH SERVES MEDICALLY UNDERSERVED POPULATIONS. Form 990 Part III Line 1 The mission of FHC is to improve access to primary care services for the medically underserved and to enhance the health of our communities. The purpose of FHC is the operation of a community health center established under 42 USC section 254c and the associated regulations, which serves medically underserved populations on a not-for-profit basis. Medically underserved populations are identified by the Secretary of the U.S. Department of Health & Human Services, are defined as those who experience financial, geographic, or cultural barriers to health care. Form 990 Part IV Line 24a Family Health Center of Marshfield, Inc. (FHC) is part of the Marshfield Clinic Health System obligated group. The obligated group is responsible for outstanding financed debt obligations, however, FHC has not participated in any proceeds from the borrowings. All bond financing related to the obligated group is disclosed on the 990 of Marshfield Clinic. Form 990 Part VI Line 3 Family Health Center (FHC) has an agreement with Marshfield Clinic (Clinic) for the Clinic to provide administrative, medico-administrative, and managerial services as are reasonably necessary for efficient administration and operation of FHC's programs and according to the annual grant work plan. The cost of this agreement is included in Part IX, Line 11g. Form 990 Part VI Line 11b THE MARSHFIELD CLINIC HEALTH SYSTEM CHIEF FINANCIAL OFFICER AND THE MARSHFIELD CLINIC HEALTH SYSTEM CONTROLLER AND THE FAMILY HEALTH CENTER OF MARSHFIELD, INC DIRECTOR OF FINANCE SHALL REVIEW THE COMPLETED FORM 990. AFTER THEIR REVIEW AND PRIOR TO FILING FORM 990 WITH THE IRS, THE FINANCE DIRECTOR OF FHC WILL PROVIDE TO EACH MEMBER OF THE FHC BOARD OF DIRECTORS A DRAFT COPY OF THE FORM 990 FOR ADDITIONAL INPUT FROM THE FHC BOARD. A FINAL COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES WILL BE SHARED WITH FHC BOARD OF DIRECTORS IN ELECTONIC OR PAPER FORM PRIOR TO FILING THE RETURN. Form 990 Part VI Line 12c FHC has adopted a Conflict of Interest Policy. Each Director, Officer, Ex-Officio Board Member, and Executive Director whom are 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. A covered person 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 Line 15a Executive director position. The fhc board of directors 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(s) 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 Line 19 Documents are available to the public by contacting the Director of Finance or the Executive Director. Additional Information Fhc provides assistance to individuals or families currently enrolled in the fhc prepaid health services program and the fhc community health access program who can show evidence of hardship case. The program fee payment assistance for the prepaid health services program is a maximum of three months per calendar year. The community health access program is a one time payment that covers a six month period. Each case is reviewed and approved by the fhc assistant director with the assistance of the fhc finance director and fhc patient assistance manager. fhc provided $1,024.00 in program fee assistance in fiscal year 2016. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-PROGRAM TOTAL FEES:77894957 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-MANAGEMENT TOTAL FEES:5894025 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SUPPLIES TOTAL FEES:120287 MARSHFIELD CLINIC HERITAGE FNDTN INC 1000 N OAK AVE MARSHFIELD WI 54449 391865942 HONOR INDVDLS WI 501(C)(3) 11-TYPE 1 NA false FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 NA false LAKEVIEW MEDICAL CENTER INC 1700 W STOUT ST RICE LAKE WI 54868 390837206 HOSPITAL WI 501(C)(3) 3 MCHS false VOLUNTEER PARTNERS OF LAKEVIEW MED CTR 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) 11,III-O NA false MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) 11,TYPE III NA false MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) 3 MCHS false SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPHS AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS false MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) 3 MCHS false MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) 3 MCHS false THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI NA RELATED 0 0 false 0.00000 MCIS INC 1701 N FIG AVE MARSHFIELD WI 54449 472138889 IT SERVICES WI MCHS C Corp 0 0 0.00000 false false false true false false false false true false false true false false false false true true false false SECURITY HEALTH PLAN OF WISCONSIN INC P 197822 COST Form Sch R Part I Note 1: Marshfield Clinic, Inc. (a 501(c)3 organization), is the parent organization of Family Health Center, Inc. (See Note 8) Note 2: Marshfield Clinic Health System, Inc. (a 501(c)3 organization), is the parent company of the following organizations: Marshfield Clinic, Inc. Lakeview Medical Center, Inc. Security Health Plan of Wisconsin, Inc. Flambeau Hospital, Inc. (see note 5 below) MCIS, Inc. MCHS Hospitals, Inc. Marshfield Clinic Health System Foundation, Inc. Note 3: The following companies are subsidiaries of Marshfield Clinic, Inc., and are related to Family Health Center, Inc. through brother/sister relationships: Marshfield Food Safety, LLC (see note 7 below) Marshfield Clinic Heritage Foundation Diagnostic & Treatment Center, LLC (see note 4 below) Note 4: Marshfield Clinic, Inc. owns a 50% interest in the Diagnostic & Treatment Center, LLC. Those results are reported on the books and records of Marshfield Clinic, Inc. Note 5: Marshfield Clinic Health System, Inc. owns a 50% interest in Flambeau Hospital, inc. Those results are reported on the books and records of Marshfield Clinic Health System, Inc. Note 6: Volunteer Partners of Lakeview Medical Center, Inc., is a supporting organization of Lakeview Medical Center, Inc. Note 7: Marshfield Food Safety, Inc. is a 100% owned subsidiary of Marshfield Clinic, Inc. and is treated as a disregarded entity of Marshfield Clinic, Inc. for tax purposes. Note 8: Marshfield Clinic, Inc. is the sole corporate (non-voting) member of Family Health Center of Marshfield, Inc. Marshfield Clinic, Inc. does not have the authority to appoint board members and therefore is not considered to have control (as defined for 990 reporting purposes) over Family Health Center of Marshfield, Inc. Note 9: Security Administrative Services, LLC is a 100% owned subsidiary of Security Health Plan of Wisconsin, Inc. and is treated as a disregarded entity of Security Health Plan of Wisconsin, Inc. for tax purposes.