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
2011
Open to Public Inspection
Name of the organization
Wheaton Franciscan Services Inc
Employer identification number
36-3262111
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
CALUMET MEDICAL CENTER
390905385
03
No
Yes
Yes
0
(2)
MERCY MEDICAL CENTER OF OSKOSH INC
390806268
03
No
Yes
Yes
0
(3)
NETWORK HEALTH SYSTEM INC
391127163
03
No
Yes
Yes
0
(4)
ST ELIZABETH HOSPITAL INC
390816818
03
No
Yes
Yes
2,579,645
(5)
WFH - ALL SAINTS INC
391264986
03
No
Yes
Yes
41,240,808
(6)
WHEATON FRANCISCAN HOME HEALTH AND HOSPICE INC
391559428
03
No
Yes
Yes
309,132
(7)
WHEATON FRANCISCAN MEDICAL GROUP INC
391791586
03
No
Yes
Yes
10,200,876
(8)
WFH PHARMACY ENT & FRAN WOODS INC
391613624
09
No
Yes
Yes
701,100
(9)
WFH - ST FRANCIS INC
390907740
03
No
Yes
Yes
15,275,832
(10)
WHEATON FRANCISCAN INC
390816857
03
No
Yes
Yes
52,460,136
(11)
WFH - TERRACE AT ST FRANCIS INC
391486775
09
No
Yes
Yes
125,112
(12)
WFH - FRANKLIN INC
562592868
03
No
Yes
Yes
2,348,316
(13)
MARIANJOY REHABILITATION HOSPITAL AND CLINICS INC
362680776
03
No
Yes
Yes
11,091,143
(14)
REHABILITATION MEDICINE CLINIC INC
363236791
03
No
Yes
Yes
0
(15)
CANTICLE MINISTRIES INC
364091836
07
No
Yes
Yes
0
(16)
RUSH OAK PARK HOSPITAL INC
362183812
03
No
Yes
Yes
0
(17)
SET MINISTRIES INC
391618277
09
No
Yes
Yes
0
(18)
ST CATHERINES HOSPITAL INC
390855075
03
No
Yes
Yes
0
(19)
UPENDO VILLAGE NFP
331007368
09
No
Yes
Yes
0
(20)
COVENANT MEDICAL CENTER INC
421264647
03
No
Yes
Yes
46,068,497
(21)
MERCY HOSPITAL OF FRANCISCAN SISTERS INC
421178403
03
No
Yes
Yes
0
(22)
NE IOWA REAL ESTATE INVESTMENTS LTD
421207432
0
No
Yes
Yes
0
(23)
SARTORI MEMORIAL HOSPITAL INC
420758901
03
No
Yes
Yes
0
(24)
ASSISI HOMES-BATAVIA APARTMENTS INC
363914084
09
No
Yes
Yes
0
(25)
ASSISI HOMES-COLONY PARK INC
364039278
09
No
Yes
Yes
0
(26)
ASSISI HOMES-CONSTITUTION HOUSE INC
364049150
09
No
Yes
Yes
0
(27)
ASSISI HOMES-JEFFERSON COURT INC
391771526
09
No
Yes
Yes
0
(28)
ASSISI HOMES-KENOSHA INC
391814815
09
No
Yes
Yes
0
(29)
ASSISI HOMES-SAXONY INC
391790498
09
No
Yes
Yes
0
(30)
ASSISI HOMES OF GURNEE INC
363942336
09
No
Yes
Yes
0
(31)
ASSISI HOMES OF ILLINOIS INC
363803443
09
No
Yes
Yes
0
(32)
ASSISI HOMES OF NEENAH INC
363767250
09
No
Yes
Yes
0
(33)
CANTICLE PLACE INC
363957850
09
No
Yes
Yes
0
(34)
CATHERINE MARIAN HOUSING INC
391657098
09
No
Yes
Yes
0
(35)
CLARE GARDENS
237200039
09
No
Yes
Yes
0
(36)
CLARE OF ASSISI HOMES-WESTMINSTER INC
742740978
09
No
Yes
Yes
0
(37)
DAYSPRING VILLA INC
363933908
09
No
Yes
Yes
0
(38)
FRANCIS HEIGHTS INC
840626174
09
No
Yes
Yes
0
(39)
FRANCISCAN SENIORS KENOSHA INC
391821568
09
No
Yes
Yes
0
(40)
MARIAN HOUSING CENTER INC
391515867
09
No
Yes
Yes
0
(41)
MARIAN PARK
362750105
09
No
Yes
Yes
0
(42)
RIDGEWAY PLACE INC
421416064
09
No
Yes
Yes
0
(43)
STARVED ROCK-LASALLE MANOR INC
363796933
09
No
Yes
Yes
0
(44)
VILLA MARIA INC
841347868
09
No
Yes
Yes
0
(45)
VILLA ST CLARE INC
391769395
09
No
Yes
Yes
0
Total
182,400,597
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
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.
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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.).
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
Wheaton Franciscan Services Inc
Employer identification number
36-3262111
Identifier
Return Reference
Explanation
SUPPLEMENTAL INFORMATION TO FORM 990
SCHEDULE O
FORM 990, Part V, Ln 1a and Part VII, Section B, Lns 1-2 Effective for calendar year 2011 1099-MISC reporting, Wheaton Franciscan Healthcare streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC were reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but possibly no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. FORM 990, Part VI, Section A, Line 4 Effective June 30, 2012, Clara Pfaender Fund, Inc, was merged with and into Wheaton Franciscan Services, Inc. (WFSI) with WFSI being the surviving corporation. FORM 990, PART VI, LNS 6-8b WFSI has two members which hold several reserved powers over WFSI. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. FORM 990, PART VI, Section B, Line 10a and b Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of health care and housing providers, controlled under a common parent organization Wheaton Franciscan Services, Inc. Some of these organizations are exempt through the Catholic Group Ruling and other organizations have a stand-alone exemption (IRS determination) letter. As such, these related affiliates have certain policies and procedures that were adopted at the parent level, but are applicable to the entire controlled group of organizations. All policy and procedure matters are handled in a manner to ensure that all activities are consistent with the organization's overall exempt purposes. Please see Schedule R for a full listing of all related affiliate organizations. FORM 990, PART VI, SECTION, LINE 11a and b Affiliates of Wheaton Franciscan Healthcare use a multiple-level review process on all Federal and State information and tax returns to ensure accurate and timely filing for all organizations. Under the direction of the Tax Manager, the Accounting Department prepares Forms 990, 990-T, and associated state filings. When complete, the return is first reviewed by the Accounting Director, who focuses on the income statement and balance sheet items, and all schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Accounting, the return is provided to the Tax Department, where the Tax Manager and Vice President of Treasury and Risk Management focus their review on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule K, Schedule H, and Schedule J, may be selected for review by outside bond counsel, a community benefit associate, and/or the compensation committee respectfully and as needed. This decision will vary from year to year, again based on many factors. The Tax Department, upon completion of all levels of review, will schedule an appointment with the Senior Vice President and CFO, who will perform a review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors. The parent organization, Wheaton Franciscan Services, Inc. has designated that the Audit Committee review the parent return in certain years, where the 990 is explained at a high level by management representatives, and any questions or concerns that the Committee has can be addressed. At a later date and prior to efling, the full board is provided access to all 990's throughout the system via an online portal. A similar process exists at the regional holding company levels - a 990 is selected for review in certain years by the Finance and Operations Committee. Similarly, the 990 is explained at a high level, and Committee questions or concerns are addressed. Members of the full board are provided access to all 990's within that region prior to efiling via an online portal. FORM 990 PART VI, SECTION B, LINE 12a, b, c As part of an annual process, conflict of interest questions are sent out to all Officers, Directors, and other individuals in key positions using software designed to capture this information. The responses are analyzed in order to determine information on potential conflicts, as well as information on business and family relationships for purposes of answering certain questions on IRS Form 990. Responses to these questions are reviewed by the Vice President of Compliance and the Manager of Tax Compliance, and follow up action, if any, are documented within the software. After an approximate 3 and again at 6 weeks, names of all non responders are compiled, and these individuals receive either an email or letter reminding them to complete the information. Responses to questions continue to be reviewed and documented throughout this time period. Approximately 1 month prior to the filing deadline of IRS Form 990, responses to date are compiled. Any response requiring disclosure is entered into the information return. The remaining non responder names are determined, and a letter, along with the actual Conflict of Interest Policy, is sent to the Chairperson of each board. The letter outlines the current non responders, as well as any Officer or Board member that has disclosed a financial interest that might pose a potential conflict of interest. Depending upon the nature of the financial interest and work done by the board, several actions may be considered - the board member with a financial interest would need to voluntarily excuse him or herself from the deliberations and/or voting on such a matter; or, if necessary, the board would determine that the subject's financial interest was an actual conflict of interest, in which case the board member would be informed by the board Chairperson that he or she would not be allowed to vote in any such matters due to this real or perceived conflict of interest. Minutes of the board meeting would document this decision process, and reflect whatever action(s) are ultimately taken. The board chairperson is also required to discuss with non responders the repercussions of not responding, and require the board member to complete the annual conflict of interest disclosure questions before being allowed to continue in any board matters. If the board member refuses, the Chairperson has the authority to determine the appropriate action, including, but not limited to prohibiting them from participating in deliberations, preventing them from voting, and/or removing them as a board member. FORM 990, PART VI, SECTION B, LINE 15a and b The compensation of the CEO of Wheaton Franciscan Services Inc. (WFSI) and other officers and key employees of the filing organization is reviewed and approved on an annual basis by the Executive Committee of the WFSI Board of Directors, an independent board, acting in a manner consistent with its conflicts of interest policy. The board's decision is informed by an opinion on market comparable compensation data provided to the board by an independent compensation expert. The organization maintains contemporaneous documentation of the substantiation of the deliberation and decision by the board.
SUPPLEMENTAL INFORMATION FOR FORM 990 (CONTINUED)
SCHEDULE O
FORM 990, PART VI, SECTION C, LINE 19 Affiliates of Wheaton Franciscan Healthcare and Franciscan Ministries provide upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. Requests for information are considered on a case-by-case basis, and this process is outlined in our Public Disclosure Policy. As part of the requirements for tax exempt bond financing, the consolidated financial statements of Wheaton Franciscan Services, Inc. (#36-3262111), the parent corporation of Wheaton Franciscan Healthcare and Franciscan Ministries affiliates are required to be provided each quarter to the Municipal Securities Rule Making Board (MSRB). The vehicle used to accomplish this is through an external website (http://emma.msrb.org/) referred to as "EMMA" (Electronic Municipal Market Access System). The financial statements are uploaded each quarter to the website, and along with other information provided at the bond's inception, are available for viewing by the general public. Form 990, Part VII, Column B Wheaton Franciscan Healthcare and Franciscan Ministries are a controlled group of related healthcare and housing organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. FORM 990, PART IX, LINES 8-9 Certain employee benefits for affiliated organizations are centrally managed by Wheaton Franciscan Services, Inc. and are reflected on Lines 8 and 9. The salary expense for these associates is reflected on the information return for the affiliated organizations. Form 990, Part XI, Line 5 FY12 Excess Rev over Exp-Unrealized Loss ( 11,946,009) Reverse PL/GL premiums paid ( 3,813,200) Deduction for PL/GL claims paid 1,436,266 Chg in Eq Tnfr Pension (151,425,986) Chg in Eq Tnfr-Unconsol Affiliates 28,368,623 Chg in Investment-Unconsol Affiliates (26,285,304) Rounding 4 Other Changes in Net Assets or Fund Balances ($163,665,606) SCHEDULE K, PART I, COLUMN F - DESCRIPTION OF PURPOSE Ln A Proceeds were used to construct, renovate and equip health care facilities used by the borrower and certain related corporations, to refund series 1991 bonds, to establish a debt service reserve fund and to pay certain costs in connection with the issuance of the series 2003A bonds. Ln B Proceeds were used to construct, renovate and equip health care facilities used by the borrower and certain related corporations and to pay certain costs in connection with the issuance of the series 2003B bonds. Ln C Proceeds were used to construct, renovate and equip health care facilities used by the borrower and certain related corporations, to refund variable rate demand revenue bonds, series 1997, to establish a debt service reserve fund and to pay certain costs in connection with the issuance of the series 2006A bonds. Ln D Proceeds were used to refund a portion of revenue and refunding bonds, series 2002, to establish a debt service reserve fund and to pay certain costs in connection with the issuance of the series 2006B bonds. Ln E Proceeds were used to refinance the $50,000,000 of The Wisconsin Heart Hospital LLC taxable variable rate demand revenue bonds, series 2003, to pay or reimburse the borrower or one of its related corporations for the payment of the costs of certain projects and to pay certain costs in connection with the issuance of the series 2007 bonds. SCHEDULE K, PART II, LINE 3 - TOTAL PROCEEDS OF ISSUE WHEATON FRANCISCAN SERVICES INC HAS REPORTED THE TOTAL PROCEEDS OF EACH BOND ISSUE AS TOTAL SALES PROCEEDS (PAR VALUE PLUS ANY PREMIUM OR LESS ANY DISCOUNT) PLUS ALL INVESTMENT INCOME EARNED. Schedule K, Part V Wheaton Franciscan Services, Inc.'s post issuance bond compliance policy is currently in draft form. It contains language outlining identification and correction of tax exempt bond compliance through the voluntary closing agreement program. This policy is expected to be finalized in the upcoming fiscal year.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.