2026-05-11T15:20:21-05:00 2025-06-30 410746749 CLIFTONLARSONALLEN LLP 100 W LAWRENCE STREET SUITE 500 APPLETON WI 54911 990 2024-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 100 N ONEIDA STREET APPLETON WI 54911 MIKE BERGMANN BOARD CHAIR 9208322783 2026-05-11 1 0 MICHAEL VANDENHOGEN P00499282 9207318111 2026-05-11 2024 2025-03-06 01:10:19Z LEIF ELSMO 100 N ONEIDA STREET APPLETON WI 54911 16384302 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 87 8 0 0 13305277 13693137 2571949 2618123 87076 38092 11329 21287 15975631 16370639 0 0 0 0 6188055 6231334 0 0 7752 1882094 2584892 8070149 8816226 7905482 7554413 13756449 19368289 3411562 1468989 10344887 17899300 X TO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES. 0 0 8018065 2639410 MOSAIC FAMILY HEALTH IS THE MEDICAL HOME OF THE FOX VALLEY FAMILY MEDICINE RESIDENCY PROGRAM - A 21 RESIDENT TRAINING PROGRAM AFFILIATED WITH THE MEDICAL COLLEGE OF WISCONSIN. WE TRAIN FAMILY PHYSICIANS FOR THE FOX VALLEY COMMUNITY AND NORTH EAST WISCONSIN, SPECIALIZING IN PROVIDING PHYSICIANS WITH A FULL SCOPE OF PRACTICE SKILLS TO SERVE IN CRITICAL ACCESS HOSPITALS. WE HAVE GRADUATED 261 RESIDENTS, AND WITH APPROXIMATELY 70% PRACTICING IN WISCONSIN, WE HAVE CREATED PHYSICIANS WHO HAVE CARED FOR APPROXIMATELY 325,000 WISCONSIN CITIZENS OVER THE YEARS IN A MULTITUDE OF VISITS AND SETTINGS, INCLUDING CLINICS, HOSPITALS, NURSING HOMES AND HOMES. OUR CARE SERVICES CONTINUE TO EXPAND AND INCLUDE AMBULATORY PRIMARY CARE FOR ALL AGES, INCLUDING MATERNAL AND INFANT CARE, INTEGRATED BEHAVIORAL HEALTH, MEDICATION ASSISTED ADDICTION TREATMENT, CARE IN SKILLED NURSING FACILITIES. A SPECIAL FOCUS IS CARE FOR THE VULNERABLE AND MARGINALIZED COMMUNITIES. WE SEEK FOR ALL PATIENTS, TO FLOURISH AND ARE INTENTIONALLY BUILDING A "HEALTH EQUITY HUB." MOSAIC HAS BECOME A CRITICAL COMPONENT OF THE HEALTHCARE FABRIC OF THE FOX VALLEY COMMUNITY. WITH 30% MEDICAID AND 30% MEDICARE PATIENT POPULATION (OF APPROXIMATELY 6,000 PATIENTS) WE ARE AN ESSENTIAL SAFETY NET CLINIC, AND CONTINUOUSLY IN NEED OF DONOR AND COMMUNITY SUPPORT TO MEET OUR MISSIONS. 8018065 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 9 0 1 87 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 WI X JILLIAN WILSON 9205607160 100 N ONEIDA STREET APPLETON WI 54911 KRISTINA SMITH DIRECTOR, TREASURER (LEFT JAN 2025) 2.00 X X 0 0 0 KATIE BALL DIRECTOR 1.00 X 0 0 0 SARA MARQUARDT DIRECTOR 2.00 X 0 0 0 MIKE BERGMANN DIRECTOR (LEFT NOV 2024) 1.00 X 0 0 0 MBONU IKEZUAGU MD DIRECTOR 1.00 X 0 0 0 SONAL CHANDRATRE DIRECTOR (LEFT NOV 2024) 1.00 X 0 0 0 GRETCHEN WAGNER MD DIRECTOR (AS OF JUNE 2025) 1.00 X 0 0 0 SRIRAM DARISETTY MD DIRECTOR (AS OF NOV 2024) 1.00 X 0 0 0 JACQUELINE FOWLER DIRECTOR (AS OF FEB 2025) 1.00 X 0 0 0 KELSEY KIERNERT DIRECTOR (FEB-JUNE 2025) 1.00 X 0 0 0 LEE VOGEL MD PRESIDENT/EXECUTIVE DIRECTOR 65.00 X 254244 0 57968 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 55.00 X 268223 0 61155 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 234386 0 53440 ALLEN R LAST MD ASSISTANT PROFESSOR 55.00 X 234857 0 53547 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 240573 0 54851 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 55.00 X 233630 0 53268 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 55.00 X 230142 0 52472 1696055 0 386701 9 0 1 1 THE BOLDT COMPANY 2525 N ROEMER RD APPLETON WI 54911 CONSTRUCTION SERVICES 8268022 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 2008075 WINC GME CONSORTIUM 425 WIND RIDGE DR WAUSAU WI 54401 RESIDENT WAGES 1474137 CLIFTONLARSONALLEN LLP 100 W LAWENCE ST SUITE 500 APPLETON WI 54911 ACCOUNTING SERVICES 152730 MEDUSIND 6100 WATERFORD DISTRICT DRIVE MIAMI FL 33126 MEDICAL BILLING & PRACTICE MANAGEMENT 148454 8 5458399 1208426 6094059 932253 1208426 13693137 PATIENT SERVICES 621110 2456281 2456281 MEDICAL DIRECTOR & PROFESSIONAL S 623000 124992 124992 INSURANCE INCENTIVES 621110 36850 36850 2618123 51755 51755 13663 -13663 -13663 -13663 21287 21287 21287 16370639 2639410 0 38092 326136 191946 126438 7752 4649913 4473517 176396 43556 39893 3663 940505 928892 11613 271224 257956 13268 346756 346756 32408 32408 339644 339644 168108 168108 27698 27698 167227 141195 26032 92841 92841 176014 167213 8801 22984 22984 342302 327251 15051 67539 67539 MEDICAL SUPPLIES 536287 536287 MAINTENANCE & REPAIRS 187946 178549 9397 DUES AND SUBSCRIPTIONS 50329 50329 RECRUITMENT EXPENSES 26809 26809 8816226 8018065 790409 7752 1704651 1747118 6036483 1252824 150255 1798108 255494 204502 47764 41659 14722780 398702 5561802 14324078 13756449 19368289 572891 1468989 2838671 0 3411562 1468989 X 2530112 16222902 7814775 1676398 10344887 17899300 13756449 19368289 7554413 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13307778 190495 13117283 1415002 208207 1206795 14324078 17073767 703127 1 703128 16370639 0 16370639 9519353 703127 703127 8816226 0 8816226 PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1. X 0 0 0 0 0 0 0 0 0 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 268223 0 0 0 0 0 0 0 61155 0 329378 0 0 0 LEE VOGEL MD PRESIDENT/EXECUTIVE DIRECTOR 254244 0 0 0 0 0 0 0 57968 0 312212 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 240573 0 0 0 0 0 0 0 54851 0 295424 0 0 0 ALLEN R LAST MD ASSISTANT PROFESSOR 234857 0 0 0 0 0 0 0 53547 0 288404 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 234386 0 0 0 0 0 0 0 53440 0 287826 0 0 0 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 233630 0 0 0 0 0 0 0 53268 0 286898 0 0 0 ALICE BOSHOVEN MD ASSISTANT PROFESSOR 230142 0 0 0 0 0 0 0 52472 0 282614 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. X PROPERTY & EQUIPMENT 1 1208426 FMV AT DONATION 0 0 0 0 PART I, COLUMN (B): REPRESENTS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART V, LINE 2A: THE ORGANIZATION DIRECTLY EMPLOYED 51 EMPLOYEES WHO WERE REPORTED ON ITS 2024 FORM W-3. IN ADDITION, THE ORGANIZATION'S CEO AND FACULTY TOTALING 8 FOR 2024 WERE REPORTED AS EMPLOYEES OF MEDICAL COLLEGE OF WISCONSIN UNDER FEIN 39-0806261. THE ORGANIZATION'S RESIDENTS TOTALING 28 FOR 2024 WERE REPORTED AS EMPLOYEES OF WINC GME CONSORTIUM UNDER FEIN 85-0632686. THE COMPENSATION PAID MEDICAL COLLEGE OF WISCONSIN AND WINC GME CONSORTIUM FOR THESE EMPLOYEES IS INCLUDED IN THE FORM 990, PART VII SECTION B. FORM 990, PART VI, SECTION A, LINE 2 KRISTINA SMITH, SONAL CHANDRATRE, KELSEY KIENERT, GRETCHEN WAGNER, MIKE BERGMANN, SRIRAM DARISETTY AND JACQUELINE FOWLER HAVE A BUSINESS RELATIONSHIP AS THEY ARE OFFICERS/EMPLOYEES OF THE SAME MEMBER ORGANIZATION. KATIE BALL, SARA MARQUARDT, AND MBONU IKEZUAGU HAVE A BUSINESS RELATIONSHIP AS THEY ARE OFFICERS/EMPLOYEES OF THE SAME MEMBER ORGANIZATION. 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 A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS FIRST REVIEWED BY THE CEO AND OTHER MEMBERS OF THE FINANCE COMMITTEE. AFTER THEIR REVIEW AND APPROVAL, A COPY OF THE 990 IS SENT TO EACH BOARD MEMBER. THE BOARD THEN VOTES TO APPROVE THE 990. WITH BOARD APPROVAL, AN OFFICER SIGNS THE RETURN AND A COPY IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE BOARD OF DIRECTORS COMPLETES AND SIGNS A CONFLICT OF INTEREST QUESTIONNAIRE. DURING THE YEAR, DIRECTORS AND OFFICERS DISCLOSE POSSIBLE CONFLICTS OF INTERESTS TO THE BOARD AND THE BOARD REVIEWS THE ISSUES 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 ITEM OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND FACULTY ARE EMPLOYED BY MEDICAL COLLEGE OF WISCONSIN (MCW) AND THEIR COMPENSATION IS CONSISTENT WITH MCW DEPARTMENT OF FAMILY MEDICINE FACULTY AND LEADERSHIP COMPENSATION. FACULTY AND LEADERSHIP COMPENSATION CORRIDORS ARE DETERMINED BY MCW / DEPARTMENT LEADERSHIP AND COMPENSATION COMMITTEE, USING COMPENSATION SURVEYS BY INDEPENDENT CONSULTANTS ENGAGED BY MCW, AS WELL AS BY MOSAIC'S ACCOUNTING FIRM, CLA TO ENSURE INPUT FROM INDEPENDENT ANALYSIS. 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 100 N ONEIDA 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 GOLD CROSS AMBULANCE SERVICES INC 1055 WITTMANN DRIVE MENASHA WI 54952 391702433 AMBULANCE SERVICES WI 501(C)(3) LINE 10 N/A 0 CATALPA HEALTH INC 4635 W COLLEGE AVENUE APPLETON WI 54914 454681563 CHILDREN'S MENTAL HEALTH WI 501(C)(3) LINE 3 N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 0