Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 5,384,184 | 73,088 | 44,765 | 2,148,738 | 1,845,042 | 9,495,817 |
| 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...... | 30,381,380 | 30,515,531 | 31,236,735 | 33,186,075 | 34,205,704 | 159,525,425 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 35,765,564 | 30,588,619 | 31,281,500 | 35,334,813 | 36,050,746 | 169,021,242 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 169,021,242 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 35,765,564 | 30,588,619 | 31,281,500 | 35,334,813 | 36,050,746 | 169,021,242 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 517 | 658 | 649 | 742 | 541 | 3,107 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 517 | 658 | 649 | 742 | 541 | 3,107 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 2,249,549 | 2,384,781 | 1,981,232 | 1,934,554 | 2,441,911 | 10,992,027 |
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 81,326 | 84,169 | 66,722 | 54,414 | 62,845 | 349,476 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 38,096,956 | 33,058,227 | 33,330,103 | 37,324,523 | 38,556,043 | 180,365,852 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
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| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
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| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| SUPPORT SCHEDULE EXPLANATION | OTHER INCOME IS A COMBINED TOTAL OF PATIENT SCREENING PAYMENTS, GIFT SHOP REVENUE, OTHER NON PATIENT SERVICES, AND OTHER MISCELLANEOUS INCOME. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
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| SCHEDULE O (SPSA CONTINUED) (1 OF 3) | STATEMENT OF PROGRAM ACCOMPLISHMENTS (CONTINUED FROM PT III) Wheaton Franciscan Transitional Care Facilities (Southeast Wisconsin) Franciscan Woods, a 120-bed skilled care nursing home and the Terrace at St. Francis, an 81-bed skilled care nursing home, both offer transitional care. "Transitional Care" bridges the gap between hospital and home, and is designed for people who need care for a few days or weeks after discharge from the hospital but are not yet fully able to resume their normal routine. Transitional Care is grouped under the term "Skilled Nursing" as it can involve the provision of complex patient care services including intravenous (IV) medications, feeding tubes, intravenous nutrition, blood transfusions, dialysis, and post-operative recovery. The skilled nurses are also trained in cancer care, palliative care, respiratory, rehabilitative care, and wound care. Transitional care through Wheaton Franciscan Healthcare offers advantages that no other provider can match. Hospital-based medical directors and consulting specialists provide extensive physician involvement. Outstanding clinical care is provided by teams of specially educated nurses, therapists, and other health care professionals. The integrated health care network ensures ready access to hospital, home health, outpatient, physician, and care management services. Spiritual support is offered to all patients and their loved ones, and comprehensive education helps prepare patients and their families for continued progress after discharge. The Transitional Care program is fortunate to receive support for various enrichment programs from the Wheaton Franciscan Healthcare-Circle of Life Foundation. Circle of Life Foundation programs of community impact are listed below. Wheaton Franciscan Healthcare-Pharmacy Enterprises Wheaton Franciscan Healthcare- Pharmacy Enterprises comprises four separate service lines that provide a unique form of pharmacy care in southeastern Wisconsin. Wheaton Franciscan Pharmacy has six full-service outpatient and clinic pharmacies in Wheaton Franciscan Healthcare hospitals and clinics in the Milwaukee metropolitan area. Annually, these pharmacies fill over 170,000 prescriptions. The Pharmacy staff takes great pride in their clinical excellence for both patients and physicians, along with individual patient service and support. The pharmacy's novel Hospital Discharge Program assists patients by filling their discharge prescriptions before going home with bedside delivery and consultations by the pharmacist. The same pharmacist makes follow-up phone calls to the patient at home for questions, monitoring, or access to medications. Wheaton Franciscan Pharmacy staff works diligently to help patients with special needs and financial challenges. Wheaton Franciscan Infusion Pharmacy is also a provider of complex IV therapy and specialty drugs administered in the home setting. Infusion Pharmacy partners with Wheaton Franciscan Home Health and Hospice to provide high quality in-home services to patients of all ages, allowing patients to remain in the comfort of their home during recovery. Infusion Pharmacy provides pharmacy service to all six counties in southeastern Wisconsin, including the Wheaton Franciscan Transitional and Extended Care facilities, Franciscan Woods, The Terrace at St Francis, and Lakeshore Manor. The pharmacy focuses on administration methods and devices for antibiotics, inotropic, oncology, pain management, and TPN therapies. The pharmacy partners with Wheaton Franciscan Home Health and Hospice throughout Southeast Wisconsin. Wheaton Franciscan Congregate Living Pharmacy provides specialized pharmacy services to Transitional and Extended Care facilities, Assisted Living Facilities, Group Homes, and Convents in southeastern Wisconsin. The pharmacy filled over 90,000 prescriptions to 1,800 residents in 2014. The pharmacy provides novel and tailored dispensing systems to these varied settings. The pharmacists have specialized training in senior care pharmacy, which promotes a greater degree of clinical intervention and systems support for the resident, facility, nurse, physician, and family. Wheaton Franciscan Pharmacy-Contract Pharmacy Management provides both 340B Program technical resources and oversight to Wheaton Franciscan Pharmacy Enterprises, along with managing a network of Non-Wheaton Franciscan Healthcare contract 340B pharmacies in southeastern Wisconsin and Iowa. All of the Wheaton Franciscan Pharmacy Enterprise locations serve financially challenged patients and all locations contribute to the community health benefit by services to the poor and services to the community (non-billable services, Charity Care, Health Professional Education, and Financial Contributions). All of the savings generated from the Wheaton Franciscan Healthcare 340B Contract Pharmacy Program are given to the hospital to support indigent care programs. Wheaton Franciscan Home Heath & Hospice Wheaton Franciscan Home Health & Hospice is a full-service home care and hospice agency with offices in Milwaukee and Racine. More than 7,400 patients from throughout Southeast Wisconsin received home health and hospice care last year through the agency. More than 107,000 home health visits are provided each year to patients ranging in age from newborn to 105. Registered nurses provide 59% of home visits; 30% are provided by therapists (physical, occupational, and speech); 10% are provided by Home Health Aides/Homemaker Companions; and 1% is provided by medical social workers. Wheaton Franciscan Home Health also offers flu vaccinations at multiple locations throughout the community. Wheaton Franciscan Home Health delivers high quality, in-home services enabling individuals to remain in the comfort of their homes during illness and recovery. Individuals who benefit from Wheaton Franciscan Home Health include children who suffer from congenital health problems, asthma or juvenile diabetes; adults dealing with injuries or degenerative diseases; expectant mothers managing complications of pregnancy; cancer patients requiring IV therapy; and seniors who need medical assistance and care to remain in their own homes. Other specialty programs include the in-home falls prevention program; heart failure disease management; newborn phototherapy; pediatric therapy; maternal/child program; mental health; chemotherapy; case management/coordination; and bath service. Wheaton Franciscan Hospice combines outstanding medical care with compassion and support for patients and their families. Hospice is not a place; it is a compassionate manner of caring for those who cannot be cured, providing comfort and enhancing quality of life with a holistic approach that includes the patient, family, and close friends. Wheaton Franciscan Hospice offers a full range of hospice services tailored to meet the needs of the individual. Care is delivered by a team that includes the family caregiver, physician, nurses, social workers, spiritual care staff, home health aides, and volunteers. Other health care professionals such as dietitians or physical therapists may also be involved. Follow-up bereavement counseling is provided to the family for up to one year. Nursing support is available over the phone or in-home visits as needed, 24 hours a day, seven days a week. Hospice settings include the patient's home, one of three Wheaton Franciscan Healthcare transitional care facilities, and Wheaton Franciscan Healthcare hospitals. In each venue, care is coordinated by the same hospice team, providing continuity of care when a change of setting is required. In FY15 Wheaton Franciscan Hospice provided more than 29,000 hospice days of care to 931 patients and their families. Most Home Health and Hospice care provided is reimbursed by private insurance, HMOs, and government programs, if qualifying and eligibility criteria are met. These sources do not completely cover the costs of care, particularly for hospice services, and reimbursement does not provide funds for other quality-of-life needs. Support from the Circle of Life Foundation helps offset some funding shortfalls, but Home Health and Hospice programs are in need of continuing financial support. Wheaton Franciscan Healthcare - Circle of Life Foundation Wheaton Franciscan Healthcare - Circle of Life Foundation was established in 2004 to support vital programs that bring care, comfort and hope to people of all ages, races, and denominations across the continuum of care. The Foundation and the programs it supports are not bound by geography or a specific hospital service area and touch more than 48,000 lives in seven Southeast Wisconsin counties each year. Specific examples of how Wheaton Franciscan Healthcare - Circle of Life Foundation helps meet the needs of the community include: -Wheaton Franciscan Home Health: Wheaton Franciscan Home Health brings its exceptional health care into patients' homes, including burn and wound care; asthma o |
| SCHEDULE O (2 OF 3) | Part V Line 1a and Part VII Section B Line 1-2: Wheaton Franciscan Healthcare streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC are now reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be 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 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 and top 5 independent contractors reported. PART VI LINE 6-8(B) Wheaton Franciscan Healthcare-Pharmacy Enterprises & Franciscan Woods Inc. has one member which holds several reserved powers over Wheaton Franciscan Healthcare-Pharmacy Enterprises & Franciscan Woods Inc. 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. Part VI Line 10a and 10b: 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. Part VI, Section B, Line 11a and 11b 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 income statement and balance sheet items, and 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 Accounting focus their review on consistency of reporting between all returns, accuracy of tax related information, and narrative explanation 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/or Schedule J, may be selected for review by outside bond counsel, a community benefit associate, and/or the compensation committee respectfully. The board has also asked for formal presentations on various 990 topics over the years. This decision will vary from year to year, again based on many factors. Once all levels of review have been completed, the Tax Manager 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. 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 efiling, the full board is provided access to all 990's throughout their assigned region via an online portal. Additionally, as a courtesy, any individual who is listed on any 990 as a reportable individual, will also receive access to the portal, where they can view the 990 if they so choose, prior to it being filed with the IRS. 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, as well as reportable individuals, are provided access to all 990's within that region via an online portal prior to efiling. |
| SCHEDULE 0 (3 OF 3) | Part VI Section B Line 12a, 12b, and 12c The organization has a Conflict of Interest policy. Under that policy, if at any time, an officer or director becomes aware that the board may discuss or act upon any transaction or arrangement which may have any bearing of any kind upon, or may relate in any manner to, a financial interest of the individual , the financial interest must be disclosed. All associates of the organization must disclose a potential conflict of interest at the time it arises (or beforehand if not in existence at the time of hire). The disclosures are reviewed and a determination is made as to whether a conflict of interest exists and how it might be managed. Additionally, 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. Non-responders are reminded of their outstanding disclosure requirement automatically through the software system. 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. 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) 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. 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 in committee representations, 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. Disclosure Statement Related to Forms 5471 Under the constructive ownership rules of Internal Revenue Code Sections 958(a) and (b), the taxpayer is required to file Forms 5471, Information Return of US persons with respect to certain foreign corporations, as a category 4 and/or 5 filer with respect to Wheaton Franciscan Insurance Company, FEIN #98-0691609. These filing requirements are or will be satisfied through the filing of Forms 5471 with respect to the foreign corporation on the taxpayer's behalf by the US taxpayers identified below who have the same filing requirement. Taxpayer name: Wheaton Franciscan Services, Inc. Address: 26 w171 Roosevelt Road, Wheaton IL 60187 FEIN number of US Tax return with which form 5471 was filed: 36-3262111 IRS Service Center where US Tax return was or will be filed: e-filed |
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