Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
EHS Home Health Care Service inc
Employer identification number
36-2913108
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
26,397
34,882
1,016,906
4,890
30,572
1,113,647
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
26,095,893
28,021,590
30,973,835
39,542,562
47,484,902
172,118,782
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
26,122,290
28,056,472
31,990,741
39,547,452
47,515,474
173,232,429
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
173,232,429
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
26,122,290
28,056,472
31,990,741
39,547,452
47,515,474
173,232,429
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
169,581
167,968
43,995
65,680
36,870
484,094
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
169,581
167,968
43,995
65,680
36,870
484,094
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
0
0
0
0
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
0
805
1,553
571
12,660
15,589
13
Total support (Add lines 9, 10c, 11 and 12.).
26,291,871
28,225,245
32,036,289
39,613,703
47,565,004
173,732,112
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
99.712 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.601 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.279 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.398 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
EHS Home Health Care Service inc
Employer identification number
36-2913108
Identifier
Return Reference
Explanation
Form 990, Part I, Line 4
Advocate Health Care is an integrated delivery system including not-for-profit community hospitals, which have community boards. EHS Home Health Care Service, Inc. is a home health care organization, who supports Advocate Health Care and its affiliates. The EHSHHCS board is comprised mostly of Advocate employees. This board structure has not changed significantly since the organization applied for exempt status. EHSHHCS is subject to the policies and procedures of Advocate Health Care and oversight by the Advocate Health Care Network community board members. Program Service Accomplishments Form 990, Part III, Question 4A IN KEEPING WITH ITS COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, EHSHHC, INC. PROVIDES THE FOLLOWING SERVICES WHERE THERE IS A NEED, REGARDLESS OF THE PATIENTS' ABILITY TO PAY: - FREE CARE AND/OR SUBSIDIZED CARE - CARE TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW COST - HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY SUCH AS NUTRITIONAL COUNSELING AND MATERNAL CHILD PROGRAMS. EHSHHC MADE 265,884 HOME CARE VISITS DURING 2010. THESE VISITS CONSISTED OF 151,245 NURSING VISITS, 92,770 PHYSICAL THERAPY VISITS, 9,931 OCCUPATIONAL THERAPY VISITS, 8,132 HOME HEALTH AID VISITS, 2,121 SPEECH THERAPY VISITS, AND 1,685 MEDICAL SOCIAL WORKER VISITS.
Part IV, Line 2
As Gail Hasbrouck and James Doheny are either directors or officers of wholly owned Advocate entities, they are deemed to have a business relationship pursuant to the instructions for Form 990. As Gail Hasbrouck, James Doheny, and Karen Lambert are either directors or officers of wholly owned Advocate entities, they are deemed to have a business relationship pursuant to the instructions for Form 990. As Gail Hasbrouck, James Doheny, and Denise Keefe are either directors or officers of wholly owned Advocate entities, they are deemed to have a business relationship pursuant to the instructions for Form 990. As Gail Hasbrouck, James Doheny, Denise Keefe, and Keith Rancine are either directors or officers of wholly owned Advocate entities, they are deemed to have a business relationship pursuant to the instructions for Form 990. Description of Classes of Members or Stockholders Form 990, Part VI, Question 6 BYLAWS PROVIDE FOR CORPORATE MEMBERS. Description of Classes of Persons and the Nature of Their Rights Form 990, Part VI, Question 7a EHS HOME HEALTH CARE SERVICE, INC. HAS CORPORATE MEMBERS WHO ELECT ITS DIRECTORS.
Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights
Form 990, Part VI, Question 7b
THERE ARE RESERVE POWERS IDENTIFIED IN THE BYLAWS THAT REQUIRE THE APPROVAL OF THE CORPORATE MEMBERS.
Describe the Process used by Management &/or Governing Body to Review 990
Form 990, Part VI, Question 11B
The Form 990 was reviewed by the senior management team of EHSHHCS. A member of accounting management and the Ernst & Young tax executive director coordinated the review. The finalized Form 990 was posted for the Board of Directors to review prior to filing.
Description of Process to Monitor Transactions for Conflicts of Interest
Form 990, Part VI, Question 12c
VICE PRESIDENT AND CHIEF COMPLIANCE OFFICER SENDS THE CORPORATION'S CODE OF BUSINESS CONDUCT AND CONFLICT OF INTEREST POLICY TO ITS INTERESTED PERSONS, INCLUDING MEMBERS OF ADVOCATE'S BOARD OF DIRECTORS OR GOVERNING COUNCILS, OFFICERS, ASSOCIATES, VOLUNTEERS AND MEDICAL STAFF MEMBERS. ALL PARTIES ARE REQUIRED TO READ AND PROVIDE A DISCLOSURE STATEMENT TO THE VICE PRESIDENT AND CHIEF COMPLIANCE OFFICER WHO SUMMARIZES THE DISCLOSURES AND PROVIDES A SUMMARY OF THE DISCLOSURES TO THE MANAGEMENT AND AUDIT COMMITTEE FOR REVIEW. THE SUMMARIES ARE THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER.
Offices & Positions for Which Process was Used, & Year Process was Begun
Form 990, Part VI, Question 15a & 15b
EXECUTIVE COMPENSATION AT ADVOCATE HEALTH CARE NETWORK AND SUBSIDIARIES IS BASED ON A BOARD OF DIRECTORS' APPROVED STRATEGY THAT GUIDES THE CORPORATION IN ESTABLISHING COMPENSATION OPPORTUNITIES FOR EXECUTIVES, MANAGERS, PROFESSIONALS AND ALL EMPLOYEES. IN THIS STRATEGY, SPECIFIC MARKET COMPARISONS ARE IDENTIFIED AND THE DESIRED LEVEL OF COMPETITIVENESS IN THOSE MARKETS SPECIFIED. IN ADDITION, THE LINKAGE OF EXECUTIVE PAY TO PERFORMANCE IS ARTICULATED AND HOW THIS RELATIONSHIP IS TO BE MAINTAINED IS OUTLINED. TO SUPPORT AND IMPLEMENT THE COMPENSATION STRATEGY, FIVE BASIC ELEMENTS ARE UTILIZED. THESE ELEMENTS ARE: - A SOLID, RELIABLE AND TESTED JOB EVALUATION METHODOLOGY, - ACCURATE, QUALITY AND RELEVANT COMPENSATION SURVEY INFORMATION, - A CONSISTENT ANNUAL PROCESS FOR UPDATING THE COMPENSATION LEVELS, - AN ACTIVE BOARD REVIEW PROCESS INCLUDING REVIEW BY A COMPENSATION COMMITTEE THAT ENSURES COMPLIANCE WITH THE COMPENSATION STRATEGY AND ON-GOING REVIEW OF THE PERFORMANCE OF THE ORGANIZATION, AND - ACTIVE, EXTERNAL REVIEW AND AUDITING OF COMPENSATION BY EXTERNAL INDEPENDENT CONSULTANTS.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public
Form 990, Part VI, Question 19
THE ORGANIZATION MAKES ITS FINANCIALS AVAILABLE TO THE PUBLIC THROUGH THE FOLLOWING WEBSITES: - DACBOND.COM (DIGITIAL ASSURANCE CERTIFICATION LLC) - EMMA.MSRB.ORG (ELECTRONIC MUNICIPAL MARKET ACCESS) - THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.
HOURS PER WEEK FOR RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A
Ben Grigaliunas is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. He generally works 40 hours per week. Approximately 4 hours of his regular work week are spent providing services to related organizations. Gail D. Hasbrouck is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. She generally works 40 hours per week. Approximately 5 hours of her regular work week are spent providing services to related organizations. Karen Lambert is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. She generally works 40 hours per week. Approximately 1 hour of her regular work week is spent providing services to EHS Home Health Care Service, Inc. Lois Elia is an employee of Advocate Health & Hospitals Corporation and is a director of EHS Home Health Care Service, Inc. She generally works 40 hours per week. Approximately 1 hour of her regular work week is spent providing services to EHS Home Health Care Service, Inc. Marty Manning is an employee of Advocate Network Services and is an officer of EHS Home Health Care Service, Inc. He generally works 40 hours per week. Approximately 1 hour of his regular work week is spent providing services to EHS Home Health Care Service, Inc. Rowena Brown-Evans is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. She generally works 40 hours per week. Approximately 1 hour of her regular work week is spent providing services to EHS Home Health Care Service, Inc. James Doheny is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. He generally works 40 hours per week. Approximately 7 hours of his regular work week are spent providing services to related organizations. Mary Matthews is an employee of Advocate Health & Hospitals Corporation and is an officer of EHS Home Health Care Service, Inc. She generally works 40 hours per week. Approximately 3 hours of her regular work week are spent providing services to related organizations.
RECONCILIATION OF NET ASSETS
FORM 990, PART XI, QUESTION 5
NET UNREALIZED GAIN (LOSS) ON INVESTMENTS $91,144 FAIR VALUE OF NET ASSET ACQUIRED $39,890 ___________ TOTAL $131,034
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.