2026-05-14T09:02:47-05:00 2025-06-30 410746749 CLIFTONLARSONALLEN LLP 100 W LAWRENCE STREET SUITE 500 APPLETON WI 54911 990 2024-07-01 391327215 FOX VALLEY FAMILY PRACTICE RESIDENCY INC APPLETON FOXV 9205607160 100 N ONEIDA STREET APPLETON WI 54911 JON KESTER PRESIDENT 9205607160 2026-05-13 1 0 MICHAEL VANDENHOGEN P00499282 9207318111 2026-05-13 2024 2025-03-06 01:10:19Z JON KESTER 100 N ONEIDA STREET APPLETON WI 54911 1341365 0 X N/A X 1979 WI TO EQUIP, MAINTAIN, AND LEASE AN EDUCATIONAL FACILITY TO A FAMILY MEDICINE RESIDENCY PROGRAM. X 4 4 0 5 0 0 21000 11000 60000 30000 790 -8768 0 0 81790 32232 0 1208426 0 0 0 0 0 0 0 240657 170450 240657 1378876 -158867 -1346644 2106422 776395 0 0 2106422 776395 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 1 1345411 1208426 30000 PROVIDED A WELL EQUIPPED MEDICAL FACILITY FOR USE BY MOSAIC FAMILY HEALTH, INC. (MOSAIC), A FAMILY MEDICINE RESIDENCY PROGRAM THROUGH DECEMBER 2024. THE RENT CHARGED TO MOSAIC WAS WELL BELOW FAIR MARKET RENT. MOSAIC USED THE MEDICAL FACILITIES FOR ITS CHARITABLE AND EDUCATIONAL PURPOSES. ALSO, DONATED EQUIPMENT AND FURNITURE TO MOSAIC FOR ITS NEW MEDICAL FACILITY. 1345411 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 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 LEFT JAN 2025 DIRECTOR 0.10 X 0 0 0 JANINE BUFFO MD 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 11000 11000 RENTAL INCOME 531120 30000 30000 30000 365 365 1300000 1309133 -9133 -9133 -9133 32232 30000 0 -8768 1208426 1208426 24924 24924 40562 40562 8541 8541 3315 3315 33862 33862 59246 59246 1378876 1345411 33465 0 82626 491406 61479 11694 12000 3000 165095 0 1367893 165095 582424 105200 2106422 776395 0 0 X 2106422 776395 2106422 776395 2106422 776395 X -1346644 16617 X 0 0 0 X X 1 MOSAIC FAMILY HEALTH INC 473298660 3 1 0 1345411 1 0 1345411 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 AND GRANTING THE ORGANIZATION EQUIPMENT AND FURNITURE FOR A NEW MEDICAL FACILITY. THE ORGANIZATION INCURRED $1,345,411 OF EXPENSES IN PROVIDING THIS PROGRAM. PART I, SECTION D, LINE3: THE ORGANIZATION AND THE SUPPORTED ORGANIZATION HAVE MEMBERS ON EACH OF THEIR RESPECTIVE BOARD OF DIRECTORS AND IN MANAGEMENT. 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 THROUGH DECEMBER 31, 2024. THE ORGANIZATION DONATED EQUIPMENT AND FURNITURE FOR MOSAIC'S NEW MEDICAL FACILITY. MOSAIC USED THE LEASED AND NEW MEDICAL FACILITIES FOR ITS CHARITABLE AND EDUCATIONAL PURPOSES. LEASING AND DONATING PROPERTY AND EQUIPMENT TO MOSAIC 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 HAVE HAD TO LEASE OR PURCHASE ANOTHER FACILITY TO CARRY OUT ITS CHARITABLE AND EDUCATIONAL PURPOSES. IF THE ORGANIZATION DID NOT DONATE EQUIPMENT AND FURNITURE TO MOSAIC FAMILY HEALTH, INC., MOSAIC WOULD HAVE HAD TO PURCHASE THE EQUIPMENT AND FURNITURE TO CARRY OUT ITS CHARITABLE AND EDUCATIONAL PURPOSES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 582424 1000 17919 494841 1302 105200 510013 1000 76932 5521 582424 493252 1000 20075 4314 510013 559174 1000 -61890 5032 493252 572266 1000 166926 175000 6018 559174 1.00000 1 0 165095 165095 165095 BENEFICIAL INTEREST IN ASSETS AT COMMUNITY FOUNDATION 105200 105200 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. 1 MOSAIC FAMILY HEALTH INC 100 N ONEIDA STREET APPLETON WI 54911 473298660 501(C)(3) 0 1208426 COST BASIS ON DONATION DATE EQUIPMENT AND FURNITURE FURNISH NEW CLINIC 1 0 PART I, LINE 2: GRANTS WERE PROVIDED TO THE ORGANIZATION'S SUPPORTED ORGANIZATION. THE TWO ORGANIZATIONS HAVE REGULAR COMMUNICATIONS. GRANT EQUIPMENT AND FURNITURE TO SUPPORTED ORGANIZATION. 2025-03-26 1208426 COST BASIS ON DATE ASSETS DONATED 473298660 MOSAIC FAMILY HEALTH INC 100 N ONEIDA STREET APPLETON WI 54911 501(C)(3) 0 0 0 0 FORM 990, PART III, LINE 3 THE ORGANIZATION CANCELED ITS BUILDING LEASE WITH MOSAIC FAMILY HEALTH, INC. (MOSAIC) IN DECEMBER 2024 WHEN MOSAIC MOVED INTO ITS NEWLY CONSTRUCTED MEDICAL FACILITY. THE ORGANIZATION CONTINUED TO SUPPORT MOSAIC BY DONATING EQUIPMENT AND FURNITURE TO MOSAIC FOR USE IN ITS NEW MEDICAL FACILITY. 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 XI, LINE 9: RETURN ON BENEFICIAL INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION 16,617. 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 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0