2024-05-07T15:39:05-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 200 EAST WASHINGTON STREET APPLETON WI 549115481 990 2022-07-01 473298660 MOSAIC FAMILY HEALTH INC MOSA 9208322783 229 S MORRISON ST APPLETON WI 54911 KRISTINA SMITH TREASURER 9208322783 2024-05-07 1 KRISTINA SMITH 999009999 0 MICHAEL VANDENHOGEN P00499282 9207318111 2024-05-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LEE VOGEL MD 229 S MORRISON ST APPLETON WI 54911 8594576 0 X WWW.MOSAICFAMILYHEALTH.ORG X 2015 WI OPERATE A MEDICAL CLINIC AND FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 51 6 0 0 5457090 5961023 2500023 2440441 5 13112 0 180000 7957118 8594576 13592 10310 0 0 6017299 6505576 0 0 1550 1676588 1763609 7707479 8279495 249639 315081 2443578 2840466 319254 401061 2124324 2439405 TO PROVIDE FULL-SCOPE FAMILY MEDICINE SERVICES WHILE TRAINING FUTURE PHYSICIANS AND IMPROVING THE OVERALL HEALTH OF THE FOX CITIES. 0 0 7635103 10310 2620441 WE CONTINUE TO HOUSE AND TRAIN 21 FAMILY MEDICINE RESIDENTS. WE GRADUATED 7 RESIDENTS IN JUNE OF 2023 AND ADDED 7 NEW ONES. OUR CLINIC CONTINUES TO BE AN ORGANIZATION WHERE WE FOCUS ON COMMUNITY HEALTH AND SUPPORT AND EMPLOY THE REACH PROGRAM COORDINATORS AND ADVANCED CARE PLANNING PARTNERSHIP DIRECTOR. OUR FACULTY PHYSICIANS REMAIN ACTIVE IN TEACHING AND RESEARCH. 7635103 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 51 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 SUSAN GOLDEN 9205607090 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 SARA MARQUARDT DIRECTOR 2.00 X 0 0 0 PETER ROLOFF MD DIRECTOR 1.00 X 0 0 0 MIKE BERGMANN DIRECTOR 1.00 X 0 0 0 MBONU IKEZUAGU DIRECTOR 1.00 X 0 0 0 LEE VOGEL MD CEO 65.00 X 254244 0 57968 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 55.00 X 252170 0 57495 KATHRYN JACOBE MD ASSISTANT PROFESSOR 55.00 X 225433 0 51399 ALLEN R LAST MD ASSISTANT PROFESSOR 55.00 X 225097 0 51322 MEGAN EVERSON MD ASSISTANT PROFESSOR 55.00 X 217421 0 49572 LAURA VERHAGEN DO ASSISTANT PROFESSOR 55.00 X 228893 0 52188 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 55.00 X 220402 0 50252 1623660 0 370196 11 0 1 1 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 FACULTY COMP. AND ASSESSMENTS 1868761 WINC GME CONSORTIUM 425 WIND RIDGE DR WAUSAU WI 54401 RESIDENT WAGES 1021018 MEDICAL COLLEGE OF WISCONSIN AFFILIATED 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENCY COMP. AND ASSESSMENTS 597533 EDGEMED HEALTHCARE LLC 4800 T-REX AVENUE 2ND FLOOR BOCA RATON FL 33431 MEDICAL BILLING & PRACTICE MGMT. 144574 THEDACARE 1818 N MEADE ST APPLETON WI 54911 INFORMATION TECHNOLOGY SUPPORT 116418 5 5393715 105500 69472 392336 5961023 PATIENT SERVICES 621110 2277282 2277282 MEDICAL DIRECTOR & PRO 623000 124992 124992 INSURANCE INCENTIVES 621110 38167 38167 2440441 13112 13112 ASSESSMENT CREDIT 621110 180000 180000 180000 8594576 2620441 0 13112 10310 10310 317805 231376 84879 1550 4775138 4661632 113506 46201 43713 2488 1216505 1197593 18912 149927 141853 8074 225065 225065 29024 29024 234062 234062 233994 193583 40411 81479 81479 117423 94586 22837 105334 105334 143353 136183 7170 22339 22339 24861 24861 48507 48507 MEDICAL SUPPLIES 237192 237192 MAINTENANCE & REPAIRS 173520 173520 DUES AND SUBSCRIPTIONS 34290 34290 RECRUITMENT EXPENSES 29788 29788 23378 23378 8279495 7635103 642842 1550 2006305 997529 50112 1245214 91448 367428 218944 182727 10609 1301 350111 303844 66160 46267 2443578 2840466 319254 284679 0 111382 0 5000 319254 401061 X 2065991 2239108 58333 200297 2124324 2439405 2443578 2840466 315081 0 X 1 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10471 2279 8192 339640 301565 38075 46267 X 0 0 0 0 0 0 0 0 0 LEE VOGEL MD CEO 254244 0 0 0 0 0 0 0 57968 0 312212 0 0 0 ELIZABETH MENZEL MD SECRETARY/PROGRAM DIRECTOR 252170 0 0 0 0 0 0 0 57495 0 309665 0 0 0 LAURA VERHAGEN DO ASSISTANT PROFESSOR 228893 0 0 0 0 0 0 0 52188 0 281081 0 0 0 KATHRYN JACOBE MD ASSISTANT PROFESSOR 225433 0 0 0 0 0 0 0 51399 0 276832 0 0 0 ALLEN R LAST MD ASSISTANT PROFESSOR 225097 0 0 0 0 0 0 0 51322 0 276419 0 0 0 DEBORAH SCHULTZ MD ASSOCIATE PROFESSOR 220402 0 0 0 0 0 0 0 50252 0 270654 0 0 0 MEGAN EVERSON MD ASSISTANT PROFESSOR 217421 0 0 0 0 0 0 0 49572 0 266993 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. LEE VOGEL OFFICER REFUND X 5000 5000 0 0 0 5000 FORM 990, PART VI, SECTION A, LINE 2 KRISTINA SMITH, PETER ROLOFF, AND MIKE BERGMANN 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, TREASURER 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, THE TREASURER 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 EXECUTIVE DIRECTOR AND FACULTY ARE EMPLOYED BY MEDICAL COLLEGE OF WISCONSIN 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 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 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 0 0 1 0 0 0 0