2025-05-14T16:03:27-05:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 200 EAST WASHINGTON STREET APPLETON WI 549115481 990 2023-07-01 391327215 FOX VALLEY FAMILY PRACTICE RESIDENCY INC APPLETON FOXV 9205607160 100 N ONEIDA STREET APPLETON WI 54911 JON KESTER PRESIDENT 9205607160 2025-05-13 1 1 MICHAEL VANDENHOGEN P00499282 9207318111 2025-05-13 2023 2025-03-06 01:10:19Z X JON KESTER 100 N ONEIDA STREET APPLETON WI 54911 81790 0 X N/A X 1979 WI TO EQUIP, MAINTAIN, AND LEASE AN EDUCATIONAL FACILITY TO A FAMILY MEDICINE RESIDENCY PROGRAM. 6 6 0 6 0 0 393000 21000 60000 60000 549 790 0 0 453549 81790 105500 0 0 0 0 0 0 0 0 291424 240657 396924 240657 56625 -158867 2193879 2106422 0 0 2193879 2106422 X TO CONSTRUCT AND EQUIP AN EDUCATION FACILITY FOR LEASE TO MOSAIC FAMILY HEALTH, INC. FOR OPERATION OF THE CLINICAL HOME OF THE FOX VALLEY FAMILY MEDICINE RESIDENCY PROGRAM, AFFILIATED WITH THE MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS; TO BE THE RECIPIENT OF CONTRIBUTIONS TO FACILITATE THE PURCHASE OF REAL ESTATE, CONSTRUCTION OF A BUILDING AND PURCHASE OF EQUIPMENT RELATING TO FAMILY MEDICINE RESIDENCY TRAINING; TO FURTHER FACILITATE THE ACQUISITION OF REAL ESTATE, CONSTRUCTION OF A CLINIC BUILDING AND PURCHASES OF EQUIPMENT, AS A MODEL CLINIC FOR THE FAMILY MEDICINE RESIDENTS AND FAMILY MEDICINE RESIDENCY TRAINING; AND TO WORK WITH LEADERSHIP AND MEMBERS OF MOSAIC FAMILY HEALTH, INC. TO ASSIST WITH MANAGEMENT OF FACILITIES TO SUPPORT THE MISSION OF THE FOX VALLEY FAMILY MEDICINE RESIDENCY. 0 0 118230 0 60000 PROVIDED A WELL EQUIPPED MEDICAL FACILITY FOR USE BY MOSAIC FAMILY HEALTH, INC., A FAMILY MEDICINE RESIDENCY PROGRAM. THE RENT CHARGED TO MOSAIC WAS WELL BELOW FAIR MARKET RENT. MOSAIC USED THE MEDICAL FACILITY FOR ITS CHARITABLE AND EDUCATIONAL PURPOSES. 118230 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X JILLIAN WILSON 9205607160 100 N ONEIDA STREET APPLETON WI 54911 X BRET SALSCHEIDER DIRECTOR 0.10 X 0 0 0 LEE MARIE VOGEL MD DIRECTOR 0.10 X 0 0 0 KRISTINA SMITH DIRECTOR 0.10 X 0 0 0 JANINE BUFFO MD DIRECTOR 0.10 X 0 0 0 DON HIETPAS DIRECTOR 0.10 X 0 0 0 JON KESTER PRESIDENT/TREASURER 0.10 X X 0 0 0 0 0 0 0 0 0 0 0 21000 21000 RENTAL INCOME 531120 60000 60000 60000 790 790 81790 60000 0 790 X 115576 115576 6851 6851 39065 39065 79165 79165 240657 118230 122427 0 176118 82626 60689 61479 12000 4437625 3069732 1447059 1367893 510013 582424 2193879 2106422 0 0 X 2193879 2106422 2193879 2106422 2193879 2106422 X -158867 71410 X 0 0 0 X X 1 MOSAIC FAMILY HEALTH INC 473298660 3 1 0 118230 1 0 118230 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 12G(VI) THE ORGANIZATION PROVIDES SUPPORT TO MOSAIC FAMILY HEALTH, INC. BY RENTING A MEDICAL FACILITY TO THE ORGANIZATION AT RATES WELL BELOW MARKET RATES. THE ORGANIZATION INCURRED $118,230 OF EXPENSES IN PROVIDING THIS PROGRAM. PART IV, SECTION D, LINE 3: THE ORGANIZATION AND THE SUPPORTED ORGANIZATION HAVE SIMILAR MEMBERS ON EACH OF THEIR RESPECTIVE BOARD OF DIRECTORS. PART IV, SECTION E, LINE 2A: THE ORGANIZATION PROVIDED ALL OF ITS PROPERTY AND EQUIPMENT (MEDICAL FACILITY) TO MOSAIC FAMILY HEALTH, INC. THROUGH AN OPERATING LEASE AT AN AMOUNT WELL BELOW FAIR MARKET RENT. MOSAIC USED THE MEDICAL FACILITY FOR ITS CHARITABLE AND EDUCATIONAL PURPOSES. LEASING ITS PROPERTY AND EQUIPMENT IS THE ORGANIZATION'S ONLY ACTIVITY. PART IV, SECTION E, LINE 2B: IF THE ORGANIZATION DID NOT PROVIDE A LEASE TO MOSAIC FAMILY HEALTH, INC., MOSAIC WOULD NEED TO LEASE OR PURCHASE ANOTHER FACILITY TO CARRY OUT ITS CHARITABLE AND EDUCATIONAL PURPOSES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 510013 1000 76932 5521 582424 493252 1000 20075 4314 510013 559174 1000 -61890 5032 493252 572266 1000 166926 175000 6018 559174 585183 1000 -8183 5734 572266 1.00000 0.00000 0.00000 1 0 259788 259788 3932224 2843071 1089153 141016 129953 11063 104597 96708 7889 1367893 BENEFICIAL INTEREST IN ASSETS AT COMMUNITY FOUNDATION 582424 582424 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED FOR THE GENERAL SUPPORT OF THE ORGANIZATION AND TO ASSIST ITS SUPPORTED ORGANIZATION - MOSAIC FAMILY HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. 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 CONFLICT OF INTEREST QUESTIONAIRES ARE FILLED OUT EACH YEAR AND SIGNED. THE BOARD OF DIRECTORS THEN REVIEW THE FORMS FOR POSSIBLE CONFLICTS. ANY PERSONS ASSOCIATED WITH THE RESIDENCY DEEMED IN CONFLICT OF INTEREST WITH A MATTER REQUIRING BOARD ACTION SHALL NOT BE PRESENT DURING BOARD DISCUSSION OF THE MATTER UNLESS FOR CLARIFICATION OF SUCH MATTER; NOR SHALL THEY BE INVOLVED IN ANY VOTE OR WRITTEN CONSENT ADOPTING OR APPROVING OF THE TRANSACTION. ABSENCE DURING DISCUSSION AND VOTE SHALL BE RECORDED IN BOARD MINUTES. 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. FORM 990, PART IX, LINE 11G RELOCATION PROJECT EXPENSE: PROGRAM SERVICE EXPENSES 39,065. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,065. FORM 990, PART XI, LINE 9: RETURN ON BENEFICIAL INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION 71,410. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATION DOES NOT COMPENSATE A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICER OR KEY EMPLOYEE. MOSAIC FAMILY HEALTH INC 100 N ONEIDA STREET APPLETON WI 54911 473298660 PROVIDE PRIMARY CARE AND MEDICAL EDUCATION SERVICES WI 501(C)(3) 3 N/A 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0