Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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| Yes | No | Yes | No | Yes | No | ||||
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| 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. | ||||||
| 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). | ||||||






| 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.") . | 9,535 | 16,475 | 11,824 | 5,307 | 11,259 | 54,400 |
| 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...... | 15,174,475 | 16,936,716 | 17,280,879 | 17,824,090 | 17,724,614 | 84,940,774 |
| 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. | 15,184,010 | 16,953,191 | 17,292,703 | 17,829,397 | 17,735,873 | 84,995,174 |
| 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.) | 84,995,174 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 15,184,010 | 16,953,191 | 17,292,703 | 17,829,397 | 17,735,873 | 84,995,174 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 179,447 | 203,807 | 223,226 | 259,321 | 247,705 | 1,113,506 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 179,447 | 203,807 | 223,226 | 259,321 | 247,705 | 1,113,506 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 15,363,457 | 17,156,998 | 17,515,929 | 18,088,718 | 17,983,578 | 86,108,680 |




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS | Form 990, Part III, Q 4A | Introduction Franciscan Villa was founded in 1966 as a non-profit, long term care provider. Franciscan Villa's campus is comprised of a 150-bed nursing home, a 64-unit memory care assisted living facility, a 39-unit frail elderly assisted living facility, and a 48-unit assisted living facility serving the needs of frail elderly and memory impaired residents. The organization also provides child day care services to the community. As a tax-exempt 501(c)(3) long term care facility, Franciscan Villa is committed to serving the needs of community members without regard to one's ability to pay. The Villa requires residents to demonstrate the ability to pay the facility fees and charges, which are set at a rate that is affordable to a significant segment of the elderly residing in the area. However, Franciscan Villa will not force a resident to move from the facility if the individual and/or the individual's family becomes unable to pay the facility charges. Franciscan Villa is also committed to the promotion of healthier communities. Franciscan Villa is proud of its Catholic heritage and its ability to provide direct and indirect support to the communities it serves. In total, over $2,095,000 in quantifiable community benefits were provided during FY 2011, an increase of 22.7% over the prior fiscal year. As a percent of net revenues, this equates to 11.6%. Benefits for the Poor Traditional Charity Care: Traditional charity care costs were nearly $40,000 during FY 2011. Fourteen (14) residents qualified for benefits under the organization's charity care policy, mostly for bed hold days not covered by the Family Care program, a county-based Medicaid-waiver program. Unpaid Cost of Medicaid and Other Social Programs: Franciscan Villa continues to provide services to Medicaid and Family Care recipients within its skilled nursing facility. Reimbursement rates under these programs fall well short of the actual cost of providing care. The $1,653,000 in unpaid cost of services provided during the year represents a significant contribution to the community. Of the total, Medicaid accounted for $874,000 and Family Care represented $779,000. Nearly 31,000 days of service were provided to Medicaid and Family Care residents within the nursing home, representing 64% of total days. Services are also provided to Family Care recipients within the organization's Francis House CBRF, Franciscan Courts RCAC, and Franciscan Gardens CBRF. Reimbursement rates are inadequate to cover the full cost of providing care. Within the Francis House, $162,000 in unpaid costs was incurred; Family Care accounted for 65% of total days within this facility. A total of $166,000 in unpaid costs was reported within Franciscan Courts; Family Care represented 58% of this facility's total days. And an estimated $58,000 in unpaid costs was incurred within the Franciscan Gardens; Family Care residents represented 38% of total days. The total of unpaid cost of Family Care recipients within the organization's assisted living facilities equaled $386,000. Direct Financial Support: Franciscan Villa made cash contributions of $1,000 in total to the following organizations: South Milwaukee Human Concerns - an organization which assists people in obtaining food, clothing, holiday assistance and referrals to other support groups. South Milwaukee/Oak Creek Interfaith - a neighborhood outreach program assisting elderly community residents. These outreach services may include transportation to medical appointments, grocery shopping, friendly visiting and information and assistance. These services are essential to helping an older adult continue living in his or her home. Other Support: Franciscan Villa coordinated its annual "Caring by Sharing" program. Under this initiative, employees sponsored 12 families (all employees of Franciscan Villa) and provided them with Christmas gifts that they would otherwise not be able to afford. Total Benefits for the Poor were $2,081,000 in Fiscal Year 2011. This represents 11.5% of total revenue. Benefits for the Broader Community Educational Support Services to the Community: Educational support activities were continued during Fiscal Year 2011, including the awarding of scholarships to two area high school students pursuing a career in healthcare and the free use of its facility by two local colleges as a nursing student clinical rotation site. Training and education was provided to professionals and community members at no cost on a variety of topics: Self Defense Techniques - The Franciscan Gardens chapel hosted an educational program on Self Defense. The instructor was Jeff Gendelman, president of JK Lee Black Belt academy. Mr. Gendelman shared various strategies to deescalate a situation verbally and techniques to protect oneself physically. Preventing Long Lie Times - Franciscan Villa partnered with Philips Life Line and Aurora Health Care to provide education to professionals working with the senior population on techniques to reduce long lie times. The program advocated for professionals to educate their clients on the importance of having a plan to help prevent falls. Ethics and Hospice and Palliative Care - This program was offered free of charge to professionals in partnership with Seasons Hospice. The program had a strong impact on participants based on feedback following the meeting. The case study format used during the meeting allowed professionals to interact with one another to discuss difficult ethical issues that arise in the health care work place. Personality Disorders - Franciscan Villa engaged Dr. Mark Eberhage, psychologist, to provide education to professionals on methods for dealing with personality disorders. Fall Prevention - An event was sponsored for seniors and family members to receive education on fall prevention strategies. Franciscan Villa again partnered with Philips Life Line and Aurora Health Care. Osteoporosis and Arthritis - Franciscan Villa worked with the Arthritis Foundation during Arthritis Awareness Month to help educate the public on osteoporosis and arthritis. Amy Parry, a physical therapist, provided the education. Other Services to the Community: Franciscan Villa again sponsored the annual Cookie Decorating Contest, a popular event for children and families at Heritage Days, a summer fund-raising festival of the Lions Club in South Milwaukee. About 75 children participated. The Villa provided representation on the Southeastern Wisconsin Chapter of the Alzheimer's Association's board of directors. In addition, Franciscan Villa made cash contributions to the Alzheimer's Association and provided a team of employees to participate in their annual "Memory Walk". The Villa again partnered with the South Milwaukee Performing Arts Center to present three free outdoor concerts during the summer on its campus for members of the community. Franciscan Villa also offered the use of its campus by Home Instead Senior Care to provide training to over 100 caregivers that tend to the needs of seniors within the local community. Cash and in-kind contributions were made to the following non-profit organizations: St. Rita's Parish South Milwaukee Chamber of Commerce Total Benefits for the Broader Community were approximately $14,000 in Fiscal Year 2011. Estimated Community Number Benefit of People Cost Served (in thousands) Community Benefit Provided to the Poor: Cost of Charity care provided 14 $ 40 Unpaid cost of Medicaid 95 874 Unpaid cost of Family Care 211 1,165 Financial Contributions 2 Cost of community benefit provided to the Poor $ 2,081 Community Benefit provided to the Broader community: Community Education $ 1 Health Professions Education 153 5 Community Building Activities 8 Support Groups Total Benefit for the broader community $ 14 Total cost of community benefit $ 2,095 |
| Executive Committee | Form 990, Part VI, Q. 1A | The executive committee consists of only directors of the corporation and is composed of the chairperson of the board, the vice chairperson of the board, and the president and chief executive officer, each of whom serve as ex officio voting members of the executive committee. The executive committee has the power to transact the routine business of the corporation in the interim periods between regularly scheduled meetings of the boards of directors, provided that their actions are consistent with any actions or policies of the board or the corporate member. All actions taken are contemporaneously documented and reported to the board at the earliest meeting. |
| members or shareholders | Form 990, Part VI, Q.6 | The sole member of the organization is catholic health iniatives, a colorado nonprofit corporation. |
| Electing Board Members | Form 990, Part VI, Q. 7A | The sole member has the power to appoint, replace or remove the members of the board of directors. |
| Governing Powers | Form 990, Part VI, Q 7B | The organization's corporate member is Catholic Health Initiatives ("CHI"). Pursuant to Section 5.4.1 of the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: - Substantial change in the mission or philosophy of Franciscan Villa of South Milwaukee. - Amendment of the corporate documents of Franciscan Villa of South Milwaukee. - Approve members of the Franciscan Villa of South Milwaukee board. - Removal of a member of the governing body of Franciscan Villa of South Milwaukee. - Approval of issuance of debt by Franciscan Villa of South Milwaukee. - Approval of participation of Franciscan Villa of South Milwaukee in a joint venture. - Approval of formation of a new corporation by Franciscan Villa of South Milwaukee - Approval of a merger involving Franciscan Villa of South Milwaukee. - Approval of the sale of all or substantially all of the assets of Franciscan Villa of South Milwaukee. - To require the transfer of assets by Franciscan Villa of South Milwaukee to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. - Adoption of long range and strategic plans for Franciscan Villa of South Milwaukee Pursuant to Section 5.5.2 of the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. |
| Review of Form 990 | Form 990, Part VI, Q 11B | Once the return is prepared, the return is reviewed by the Chief Financial Officer. The Chief Financial Officer presents the return to the Franciscan Villa of South Milwaukee's board at a board meeting, or an electronic copy of the return is sent to each board member by email for their review. Subsequent to providing the return to the board the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board. |
| Conflict of Interest Policy | Form 990, Part VI, Q. 12a | The Organization has adopted CHI's conflict of interest policy. However, the policy was not yet approved by the governing board at the end of the taxable year. |
| Procedures for Monitoring and Enforcing the COI Policy | Form 990, Part VI, Q. 12c | All board members are required to complete an annual conflict of interest disclosure statement. In addition, any board member with a conflict is required to declare the conflict before the beginning of each board or committee meeting. The entire board or committee determines whether the affected board member should be excluded from the meeting due to the disclosed conflict. |
| Whistleblower Policy | Form 990, Part VI, Q. 13 | The Organization did not yet have a board adopted Whistleblower policy in place as of the end of the tax year. However, the Organization makes reference to whistleblower protection within other organization policies and within their employee handbook. |
| Document Retention and destruction policy | Form 990, part VI, Q. 14 | The Organization has a document retention and destruction policy, however, the policy had not been adopted by the governing board as of the end of the tax year. |
| Process for Determining CEO's Compensation | Part 990, Part VI, Q. 15A | The organization's CEO's compensation is paid by CHI. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September, 2011. In addition, in December 2009, Hay Group completed a comprehensive review of all positions at the level of vice president and above to determine and validate appropriate compensation levels. |
| Process for Determining Compensation - Officers/Key employees | Part 990, Part VI, Q 15B | The process for determining the compensation of the other officers or key employees was the result of an independent compensation study conducted in November 2009. This study was then presented to and approved by the board in January 2010. |
| Public Inspection of Documents | Form 990, part VI, Q. 19 | The organization's financial statements are included in Catholic health initiatives' consolidated audited financial statements that are available at www.catholicheathinit.org or at www.dacbond.com. The Organization's governing documents and conflict of interest policy are available upon request from the administration department. In addition, the governing documents are available from the Wisconsin Secretary of State. |
| Estimate of Hours Devoted to Related Organizations | Form 990, Part VII | Compensation Reported on Form 990, Part VII was paid to these individuals by related organizations in exchange for the fulfillment of their duties as full-time, 60 hour-per-week employees. |
| Other changes in net assets or fund balances | Form 990, Part XI, Q. 5 | Franciscan Villa of South Milwaukee's other changes in net assets are as follows: Net unrealized gain/loss - $1,040,433 CHI connect depreciation - $ 90,435 Capital Resource pool contribution - $ (155,676) Total - $ 975,194 |
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