Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 07-01-2015 , and ending 07-31-2016
BCheck if applicable:
CName of organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
% ELIZABETH A RITTER
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3070 NORTH 51ST STREET STE 406
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MILWAUKEE, WI53210
D Employer identification number

39-1559428
E Telephone number

G Gross receipts $ 23,035,610
F Name and address of principal officer:
BERNARD SHERRY
400 W RIVER WOODS PARKWAY
GLENDALE,WI53212
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.wfhealthcare.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:  
L Year of formation: 1986
M State of legal domicile: WI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE HOME HEALTH AND HOSPICE SERVICES TO RESIDENTS OF SOUTHEAST WISCONSIN.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 4
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 263
6 Total number of volunteers (estimate if necessary) ............. 6 30
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 41,348 51,396
9 Program service revenue (Part VIII, line 2g) ......... 21,700,469 22,994,027
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 602 -10,082
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 12,880 269
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 21,755,299 23,035,610
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 14,029,762 15,786,165
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 6,818,534 6,805,998
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 20,848,296 22,592,163
19 Revenue less expenses. Subtract line 18 from line 12....... 907,003 443,447
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 8,752,044 0
21 Total liabilities (Part X, line 26)............. 2,437,953 0
22 Net assets or fund balances. Subtract line 21 from line 20..... 6,314,091 0
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: AS A MEMBER OF WHEATON FRANCISCAN HEALTHCARE, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF JESUS WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL-BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 21,670,155 including grants of $ 0 ) (Revenue $ 22,994,296 )
WHEATON FRANCISCAN HEALTHCARE IN SOUTHEAST WISCONSIN Wheaton Franciscan Healthcares service to Southeast Wisconsin dates back to 1879 when the Franciscan Sisters began operating a health care ministry out of a small house. Five years later they opened their first hospital in Milwaukee St. Joseph. Over the next 100 years, the Sisters known as the Wheaton Franciscans after 1947 expanded their Milwaukee health care ministry and, in 1993, partnered with the Felician Sisters. Through the union of numerous separate but common functions including Boards of Directors, medical groups, and corporate services, Wheaton Franciscan Healthcare has created a fully integrated region that allows it to share best practices and create cost efficiencies. WHEATON FRANCISCAN HEALTHCARE IN SOUTHEAST WISCONSIN LIST OF ENTITIES Hospitals Wheaton Franciscan, Inc. (Elmbrook Memorial, Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital, and St. Joseph Campuses) Wheaton Franciscan Healthcare - All Saints (Spring Street and Wisconsin Ave Campuses) Wheaton Franciscan Healthcare - St. Francis Wheaton Franciscan Healthcare Franklin Midwest Orthopedic Specialty Hospital (joint venture) Wheaton Franciscan Medical Group More than 300 physicians in 50 specialty and primary care locations across SE Wisconsin. Transitional & Extended Care Wheaton Franciscan Healthcare - Franciscan Woods Wheaton Franciscan Healthcare - Lakeshore Manor Wheaton Franciscan Healthcare - The Terrace at St. Francis Outpatient Centers Wheaton Franciscan Brown Deer Campus Wheaton Franciscan Wauwatosa Campus Wheaton Franciscan Healthcare - St. Francis Medical Arts Pavilion Wheaton Franciscan Healthcare St. Francis Outpatient Center Service Lines Wheaton Franciscan Cancer Care Wheaton Franciscan Women and Infants Wheaton Franciscan Diabetes Care Wheaton Franciscan Heart Care Wheaton Franciscan Mental Health and Addiction Care Wheaton Franciscan Orthopedic Care Wheaton Franciscan Rehabilitation Services Wheaton Franciscan Senior Care Midwest Orthopedic Specialty Services Restore Integrated Work Injury Solutions Home Health & Hospice Wheaton Franciscan Home Health Wheaton Franciscan Hospice Wheaton Franciscan Medical Equipment Team Pharmacy Wheaton Franciscan Pharmacy (multiple locations) Laboratory Wheaton Franciscan Laboratory Philanthropic Foundations Wheaton Franciscan Healthcare - All Saints Foundation Wheaton Franciscan Healthcare - Circle of Life Foundation Wheaton Franciscan Healthcare - Foundation for St. Francis and Franklin Wheaton Franciscan - Elmbrook Memorial Foundation Wheaton Franciscan - St. Joseph Foundation WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT IN SOUTHEAST WISCONSIN / 2016 Charity Care: $17,397,237. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on actual costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $46,504,102. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $1,049,972. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $1,467,639. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $10,392,557. Health professions education is defined as direct costs incurred for accredited training and education programs for physicians, nurses, allied health professionals and technicians (does not include ongoing education for staff). Community Building Activities: $98,698. Community building activities are defined as programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental issues. Costs for these activities include cash and in-kind donations. Community Benefit Operations: $31,963. Community benefit operations are defined as costs associated with dedicated staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations. Research: $74,940. Research is defined as costs incurred for health-related research, such as medical equipment testing, controlled studies of therapeutic protocols, and studies of health care delivery methods. Subsidized Health Services: $2,716,513. Subsidized health services are defined as the negative margin for clinical services that are provided despite a financial loss because of an identified community need that would need to be met by the government or another not-for-profit if it was not offered. The financial losses are so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. TOTAL BENEFIT TO THE COMMUNITY IN SOUTHEAST WISCONSIN FOR 2016: $79,733,621. 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 7,000 patients from throughout Southeast Wisconsin received home health and hospice care last year through the agency. More than 104,000 home health visits are provided each year to patients ranging in age from newborn to 107. Registered nurses provide 60% of home visits; 30% are provided by therapists (physical, occupational, and speech); 10% are provided by Home Health Aides/Homemaker Companions/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 can include the patients home, one of three Wheaton Franciscan Healthcare transitional care facilities, and/or 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 FY16 Wheaton Franciscan Hospice provided more than 32,000 hospice days of care to 890 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.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet21,670,155
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III .............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI....................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........Click to see attachment
32
Yes
 
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
263
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
10
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
4
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletELIZABETH A RITTER400 WEST RIVER WOODS PARKWAY   MILWAUKEE,WI53212 (414) 465-3542
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Mark Charbogian......................................................................
Director
 1.0
.................
40.0 		X           0 221,240 53,170
(2) Linda Czernicki......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(3) James Gresham......................................................................
President / Chair - Director
 1.0
.................
40.0 		X   X       0 352,659 125,165
(4) Jason Kayzar......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(5) Suresh Misra MD......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(6) Rick Romanshek......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(7) Jonathan Sohn......................................................................
V Chair/ Treasurer - Director
 1.0
.................
40.0 		X   X       0 817,514 107,541
(8) Patricio Viernes MD......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(9) David Ward......................................................................
Director
 1.0
.................
1.0 		X           0 0 0
(10) Kari Klasen......................................................................
Secretary
 1.0
.................
40.0 		    X       0 110,447 28,412
(11) Remilekun Adebogun......................................................................
Registered Nurse
 40.0
.................
1.0 		        X   108,702 0 30,140
(12) Elizabeth Burnett......................................................................
Registered Nurse
 40.0
.................
1.0 		        X   112,159 0 20,391
(13) Christine Geary......................................................................
Registered Nurse
 40.0
.................
1.0 		        X   116,498 0 10,634
(14) Aaron Gilling......................................................................
Physical Therapist
 40.0
.................
1.0 		        X   108,856 0 12,605
(15) Christine Najdowski......................................................................
Registered Nurse
 40.0
.................
1.0 		        X   107,374 0 42,682
(16) Sharon Povlich......................................................................
Vp-Home Hlth & Hospice-Se Wi
 1.0
.................
40.0 		          X 0 190,478 26,716


Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 553,589 1,692,338 457,456
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet8
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MEDICAL STAFFING SOLUTIONS INC,
PO BOC 101
RICE LAKE,WI54868 		MEDICAL STAFFING 775,381
ALL ABOUT STAFFING INC,
PO BOX 742697
ATLANTA,GA30374 		MEDICAL STAFFING 411,220
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet2
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 51,396
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 51,396
Program Service RevenueAmt Business Code
2a PATIENT SERVICES REVENUE 900099 22,856,975 22,856,975    
b PATIENT LIFE ALERT SYSTEM REVENUE 900099 137,052 137,052    
c
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 22,994,027
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 739     739
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss)......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory -10,821  
b Less: cost or other basis and sales expenses    
c Gain or (loss) -10,821  
d Net gain or (loss).....MediumBullet -10,821     -10,821
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a OTHER MISC REVENUES 900099 269 269    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 269
12 Total revenue. See Instructions......MediumBullet 23,035,610 22,994,296   -10,082
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 0      
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 12,463,444 12,463,444    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 541,520 541,520    
9 Other employee benefits ....... 1,877,889 1,877,889    
10 Payroll taxes ........... 903,312 903,312    
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 1,049 1,049    
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 1,525,040 1,525,040    
12 Advertising and promotion .... 0      
13 Office expenses ....... 380,812 380,812    
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 59,823 59,823    
17 Travel ............ 610,721 610,721    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 33,715 33,715    
23 Insurance ... 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MANAGEMENT FEES 1,385,411 463,403 922,008  
b BAD DEBT 194,800 194,800    
c PURCHASED SERVICES 1,039,129 1,039,129    
d MEDICAL SUPPLIES 1,522,284 1,522,284    
e All other expenses 53,214 53,214    
25 Total functional expenses. Add lines 1 through 24e 22,592,163 21,670,155 922,008 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 500 1 0
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 3,840,216 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net .... 0 7 0
8 Inventories for sale or use ........ 0 8 0
9 Prepaid expenses and deferred charges ...... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation 10b   125,172 10c  
11 Investments—publicly traded securities . 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 4,786,156 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 8,752,044 16 0
Liabilities 17 Accounts payable and accrued expenses ..... 2,437,953 17 0
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.. 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 0 25 0
26 Total liabilities. Add lines 17 through 25.. 2,437,953 26 0
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 6,314,091 27 0
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 6,314,091 33 0
34 Total liabilities and net assets/fund balances ........ 8,752,044 34 0
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
23,035,610
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
22,592,163
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
443,447
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
6,314,091
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-6,757,538
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
0
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
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
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
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 (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      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
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
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
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		  
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		  
9 Distributable amount for 2015 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-2015 		(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2016. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
  		Employer identification number
39-1559428
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
  		Employer identification number

39-1559428
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a)
No.from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
  		Employer identification number

39-1559428
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................    
c Total lobbying expenditures (add lines 1a and 1b) .......................................................................    
d Other exempt purpose expenditures .........................................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ..............................................................................................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2015


Schedule C (Form 990 or 990-EZ) 2015
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
Yes
 
1,049
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
1,049
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
SCHEDULE C SUPPLEMENTAL INFORMATION Schedule C Part II-B Line 1i: Wheaton Franciscan Healthcare was part of a controlled group of healthcare organizations through late in the fiscal year, when most of the entities were transferred to new parent organizations. These entities were related through these respective dates, through a common parent organization, Wheaton Franciscan Services, Inc.. Certain entities within this controlled group engaged in limited lobbying activities that benefited each organization collectively. For calendar year 2015, Wheaton Franciscan Healthcare employed two individuals whose responsibilities included oversight and management of lobbying activities for these organizations the Senior Vice President of Strategic Initiatives and the Director of Government Relations and Advocacy. The Senior Vice President provided strategic oversight for the department and participated in visits with key elected officials when appropriate. The Director provides on-the-ground support, served as the first point of contact for elected officials, and executed on legislative lobbying activities that supported the strategic interests of the organization. These lobbying activities approximated 50% of total annual salary for the Director and no more than 15% for the Senior Vice President. A benefits factor of 25% was added, and the total was allocated amongst the organizations that received the benefit of these services. The lobbying activities included advocacy efforts related to public policy proposals such as: changes to Medicare and Medicaid funding; federal or state legislation that may impact the organization; participating in and coordinating visits with elected officials at all levels of government (local, state and federal); mobilizing grassroots efforts on behalf of the organization on issues of interest; coordinating advocacy activities in conjunction with relevant trade associations; and providing internal awareness on specific state related legislative issues when the need arises. The portion of direct expenses related to annual employee business travel to Washington DC or other locations, in order to lobby for issues important to healthcare providers and patients, have been included if applicable. Finally, any trade association dues containing a percentage portion allocable to lobbying activities, has been identified, and added or estimated as appropriate. Wheaton Franciscan Home Health and Hospice, Inc. #39-1559428 $1,049
Schedule C (Form 990 or 990EZ) 2015


Additional Data


Software ID:  
Software Version:  

Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Mark CharbogianDirector (i)

(ii)		 0
-------------
163,131 		0
-------------
56,200 		0
-------------
1,909 		0
-------------
30,074 		0
-------------
23,096 		0
-------------
274,410 		0
-------------
0
2James GreshamPresident / Chair - Director (i)

(ii)		 0
-------------
242,120 		0
-------------
89,500 		0
-------------
21,039 		0
-------------
121,300 		0
-------------
3,865 		0
-------------
477,824 		0
-------------
0
3Christine NajdowskiRegistered Nurse (i)

(ii)		 107,223
-------------
0 		0
-------------
0 		151
-------------
0 		31,530
-------------
0 		11,152
-------------
0 		150,056
-------------
0 		0
-------------
0
4Sharon PovlichVp-Home Hlth & Hospice-Se Wi (i)

(ii)		 0
-------------
148,896 		0
-------------
38,500 		0
-------------
3,082 		0
-------------
17,303 		0
-------------
9,413 		0
-------------
217,194 		0
-------------
0
5Jonathan SohnV Chair/ Treasurer - Director (i)

(ii)		 0
-------------
481,735 		0
-------------
318,300 		0
-------------
17,479 		0
-------------
76,964 		0
-------------
30,577 		0
-------------
925,055 		0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.

bullet Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet Attach to Form 990 or 990-EZ.
bulletInformation about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number
39-1559428
Part I
Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity




















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2015)

Schedule N (Form 990 or 990-EZ) (2015)
Page 2
Part I
Liquidation, Termination, or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......
4a
 
 
b
If "Yes," did the organization provide such notice? .....................
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? .....................
6a
 
 
b
If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?
6b
 
 
c
If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Net Asset Transfer 07-31-2016 6,719,897 Book Value 47-1704527 ASCENSION HEALTH AT HOME LLC
6363 S FIDDLERS GREEN CIRCLE 14TH
GREENWOOD VILLAGE,CO80111 		N/A
















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .....................
2a
 
No
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
No
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? .....................
2d
 
No
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
Schedule N(Form 990 or 990-EZ) (2015)

Schedule N (Form 990 or 990-EZ) (2015)
Page 3
Part III
Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE N SUPPLEMENTAL INFORMATION Effective 08/01/2016, Wheaton Franciscan Home Health and Hospice, Inc. was converted to an LLC and transferred to Ascension Health at Home LLC.
Schedule N (Form 990 or 990-EZ) (2015)



Additional Data


Software ID:  
Software Version:  


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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
Return Reference Explanation
Schedule O Supplemental Information: Part IV Lines 12a-12b and Part XII Lines 2a-2c: Effective March 1, 2016, Wheaton Franciscan Healthcare organizations in the SE WI region were transferred to Ascension Health. As such, all SE WI organization have been included in the consolidated Ascension audit report for the period March 1, 2016 June 30, 2016, and we have therefore answered NO, YES accordingly. 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 990s that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990s of the organization(s) reporting number of 1099s, there may be a disproportionate share of 1099s reported as compared with the actual expenses and top 5 independent contractors reported. Part VI Section A Line 6-8b: Wheaton Franciscan Home Health and Hospice, Inc. has one member which holds several reserved powers over the entity. These reserved powers include, but are not limited to, the election of members of the governing body and election of the board chair, approval of certain financial expenditures in accordance with policy, and approval of strategic plans; these approvals are based on recommendations from the governing body. Part VI Section B Lines 11a and 11b: Ministries that were affiliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 used a multiple-level review process on all IRS Forms 990 to ensure accurate and timely filing for all organizations. Under the direction of the Tax Manager, the Accounting Departments in each region prepare Forms 990, 990-T, and associated state filings. When complete, the return is first reviewed by a Senior-Level (or higher) associate in the Finance Department, 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 Finance, the return is provided to the Tax Department, where the Tax Manager concentrates primarily 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 H or Schedule J may be reviewed by committees, such as the Community Benefit Team or the Compensation Committee in selected years. 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 (or the designated employee in the applicable region) will schedule an appointment with the signer of the 990. This is normally a Senior Vice President or CFO of the applicable region, who will perform an additional, normally high level review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors, who at a later date but prior to efiling, are provided access to all 990s 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. Part VI Section B Lines 12a 12c: The organization has a Conflict of Interest policy which states that if at any time, an officer or a director become 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 any time one arises. 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 questionnaires 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 and other disclosures required to be made on IRS Forms 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, is 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 lists 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 first, 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. If not, the board may, if necessary, determine that the subjects 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: Ministries that were affiliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 provided 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. During fiscal 2016, all ministries were transferred to new parent organizations and all organizations are currently working on policy review and implementation in order to adopt and streamline existing policies to those of the new parent. Part VII Column B: Ministries that were affiliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 operated as a controlled group of related healthcare 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. Form 990 Part XI Line 9: FICA expense for accrued PTO balance sheet liability was adjusted, resulting in a decrease in net assets of $37,641. Additionally, effective 7/31/16 the net asset value of Wheaton Franciscan Home Health & Hospice, Inc. was transferred to Ascension Health at Home. This transfer resulted in a decrease in net assets of $6,719,897. 37,641 + 6,719,897 = 6,757,538 Disclosure Statement Related to Forms 5471: Information return of US persons with respect to certain foreign corpora
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
WHEATON FRAN HOME HEALTH & HOSPICE INC
 
Employer identification number

39-1559428
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Wheaton Franciscan Services Inc (4)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
36-3262111 		PARENT CORP IL 501(c)(3) 11 - III-FI NA
 
 
No
(2)Ascension Health Alliance (2)
PO Box 45998

St Louis,MO63145
45-3358926 		National Heal MO 501(c)(3) 11-I NA
 
 
No
(3)Ascension Health (2)
PO Box 45998

St Louis,MO63145
31-1662309 		National Heal MO 501(c)(3) 11-I Ascension He
 
 
No
(4)WFH - Southeast Wisconsin Inc (2)
400 WEST RIVER WOODS PARKWAY

GLENDALE,WI53212
39-1568865 		HOLDING CO IL 501(c)(3) 11 - III-FI WFSIAscensi
 
 
No
(5)WFH - All Saints Inc (2)
3801 SPRING STREET

RACINE,WI53405
39-1264986 		HOSPITAL WI 501(c)(3) 3 WFH-SE WI
 
 
No
(6)WFH - All Saints Foundation Inc (2)
3805B SPRING STREET

RACINE,WI53405
39-1570877 		FOUNDATION WI 501(c)(3) 11 - I (7) WFH-AS INC
 
 
No
(7)Vlntrs in Pnrshp w WFH-All Saints (2)
3807 SPRING STREET

RACINE,WI53405
93-0838390 		FOUNDATION WI 501(c)(3) 11 - III-NF WFH-AS INC
 
 
No
(8)WFH - Circle of Life Foundation (2)
4300 WEST BROWN DEER RD STE 250

BROWN DEER,WI53223
56-2426294 		FOUNDATION WI 501(c)(3) 11 - I WFH-PE
 
 
No
(9)WF Medical Group Inc (2)
400 WEST RIVER WOODS PARKWAY

GLENDALE,WI53212
39-1791586 		MED GROUP WI 501(c)(3) 3 WFH-SE WI
 
 
No
(10)WF - Elmbrook Memorial Fndn Inc (2)
19333 WEST NORTH AVENUE

BROOKFIELD,WI53045
39-2028808 		FOUNDATION WI 501(c)(3) 11 - I WF INC
 
 
No
(11)WF Laboratories Inc (2)
3237 SOUTH 16TH STREET

MILWAUKEE,WI53215
39-1701402 		LABORATORY WI 501(c)(3) 9 WFH-SE WI
 
 
No
(12)WFH - Pharmacy Ent & Fran Woods (2)
19525 WEST NORTH AVENUE

BROOKFIELD,WI53005
39-1613624 		PHARMACY WI 501(c)(3) 9 WFH-SE WI
 
 
No
(13)WFH - St Francis Inc (2)
3237 SOUTH 16TH STREET

MILWAUKEE,WI53215
39-0907740 		HOSPITAL WI 501(c)(3) 3 WFH-SE WI
 
 
No
(14)WF - St Joseph Foundation Inc (2)
5000 WEST CHAMBERS STREET

MILWAUKEE,WI53210
39-1636804 		FOUNDATION WI 501(c)(3) 11 - I WF INC
 
 
No
(15)Wheaton Franciscan Inc (2)
5000 WEST CHAMBERS STREET

MILWAUKEE,WI53210
39-0816857 		HOSPITAL WI 501(c)(3) 3 WFH-SE WI
 
 
No
(16)WFH - Fndn for St Francis & Franklin (2)
3237 SOUTH 16TH STREET

MILWAUKEE,WI53215
32-0135258 		FOUNDATION WI 501(c)(3) 11 - I WFH-SFH
 
 
No
(17)WFH - Elmbrook Memorial Auxiliary (2)
19333 WEST NORTH AVENUE

BROOKFIELD,WI53045
39-6068950 		AUXILIARY WI 501(c)(3) 11 - III-FI WF INC
 
 
No
(18)WFH - Terrace at St Francis Inc (2)
3200 SOUTH 20TH STREET

MILWAUKEE,WI53215
39-1486775 		NURSING HOME WI 501(c)(3) 9 WFH-SE WI
 
 
No
(19)WFH - Franklin Inc (2)
10101 SOUTH 27TH STREET

FRANKLIN,WI53132
56-2592868 		HOSPITAL WI 501(c)(3) 3 WFH-SE WI
 
 
No
(20)Metro Physicians Inc (2)
400 WEST RIVER WOODS PARKWAY

GLENDALE,WI53212
94-3436893 		MED GROUP WI 501(c)(3) 3 WFMG
 
 
No
(21)Marianjoy Inc (1)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
36-3483589 		HOLDING CO IL 501(c)(3) 11 - III-FI WFSI
 
 
No
(22)Marianjoy Foundation Inc (1)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
35-2165613 		FOUNDATION IL 501(c)(3) 7 MJ HOSP
 
 
No
(23)Marianjoy Rehab Center Auxiliary (1)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
36-3896976 		AUXILIARY IL 501(c)(3) 11 - I MJ HOSP
 
 
No
(24)Marianjoy Rehab Hospital & Clinics (1)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
36-2680776 		REHAB HOSPITA IL 501(c)(3) 3 MARIANJOY
 
 
No
(25)Rehabilitation Medicine Clinic (1)
26 W 171 ROOSEVELT RD

WHEATON,IL60187
36-3236791 		MEDICAL GRP IL 501(c)(3) 3 MARIANJOY
 
 
No
(26)WF Sisters Fndn (fka OSF) (4) (6)
PO Box 667

WHEATON,IL601870667
39-1471463 		HOLDING CO WI 501(c)(3) 11 - III-FI WFSI
 
 
No
(27)Canticle Ministries Inc (4) (7)
PO Box 667

WHEATON,IL601870667
36-4091836 		HOUSING/ADVCY IL 501(c)(3) 7 OSF SVCS INC
 
 
No
(28)Fran Sisters Charitable Fund of CO (5)
2626 OSCEOLA STREET

DENVER,CO80212
84-0733072 		AUXILIARY CO 501(c)(3) 7 OSF SVCS INC
 
 
No
(29)SET Ministry Inc (9)
2977 NORTH 50TH STREET

MILWAUKEE,WI53210
39-1618277 		SOCIAL WORK WI 501(c)(3) 9 OSF SVCS INC
 
 
No
(30)St Catherines Hospital Inc (4) (26)
9555 76TH STREET

PLEASANT PRAIRIE,WI53158
39-0855075 		HOSPITAL WI 501(c)(3) 3 OSF SVCS INC
 
 
No
(31)UHS Inc (4) (8) (26)
6308 EIGHTH AVENUE

KENOSHA,WI53143
39-1956749 		HOSPITAL WI 501(c)(3) 3 NONE
 
 
No
(32)Upendo Village NFP (4)
PO Box 667

WHEATON,IL601870667
33-1007368 		HIV SUPPORT IL 501(c)(3) 9 OSF SVCS INC
 
 
No
(33)WF Healthcare - Iowa Inc (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1177001 		HOLDING CO IA 501(c)(3) 11 - III-FI WFSI
 
 
No
(34)Covenant Foundation Inc (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1295784 		FOUNDATION IA 501(c)(3) 9 COV MED CTR
 
 
No
(35)Covenant Medical Center Inc (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1264647 		HOSPITAL IA 501(c)(3) 3 WFH-IOWA
 
 
No
(36)Mercy Hospital of Fran Sisters Inc (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1178403 		HOSPITAL IA 501(c)(3) 3 WFH-IOWA
 
 
No
(37)NE Iowa Real Estate Invsts (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1207432 		HOLDING CO IA 501(c)(2) N/A WFH-IOWA
 
 
No
(38)Sartori Health Care Foundation Inc (3)
3421 WEST NINTH STREET

WATERLOO,IA50702
42-1240996 		FOUNDATION IA 501(c)(3) 11 - I SARTORI HOSP
 
 
No
(39)Sartori Memorial Hospital Inc (3)
515 COLLEGE STREET

CEDAR FALLS,IA50613
42-0758901 		HOSPITAL IA 501(c)(3) 3 WFH-IOWA
 
 
No
(40)Franciscan Ministries Inc (4)
26W171 ROOSEVELT ROAD

WHEATON,IL601870667
36-3259684 		HOLDING CO IL 501(c)(3) 11 - III-FI WFSI
 
 
No
(41)Assisi Homes - Batavia Aprtmnts (4)
1259 EAST WILSON STREET

BATAVIA,IL60510
36-3914084 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(42)Assisi Homes - Colony Park Inc (4)
550 EAST THORNHILL DRIVE

CAROL STREAM,IL60188
36-4039278 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(43)Assisi Homes - Cnstn House Inc (4)
401 NORTH CONSTITUTION DRIVE

AURORA,IL60506
36-4049150 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(44)Assisi Homes - Jefferson Court Inc (4)
415 EAST KNAPP STREET

MILWAUKEE,WI53202
39-1771526 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(45)Assisi Homes - Kenosha Inc (4)
1860 27TH AVENUE

KENOSHA,WI53140
39-1814815 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(46)Assisi Homes - Saxony Inc (4)
1876 22ND AVENUE

KENOSHA,WI53140
39-1790498 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(47)Assisi Homes of Gurnee Inc (4)
3495 WEST GRAND AVENUE

GURNEE,IL60031
36-3942336 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(48)Assisi Homes of Illinois Inc (4)
2126 WEST ROOSEVELT ROAD

WHEATON,IL60187
36-3803443 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(49)Assisi Homes of Neenah Inc (4)
210 BYRD AVENUE

NEENAH,WI54946
36-3767250 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(50)Canticle Place Inc (4)
26W171 ROOSEVELT ROAD

WHEATON,IL601870667
36-3957850 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(51)Catherine Marian Housing Inc (4)
806 SOUTH WISCONSIN AVENUE

RACINE,WI53403
39-1657098 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(52)Clare Gardens Inc (4)
2626 OSCEOLA STREET

DENVER,CO80212
23-7200039 		HOUSING CO 501(c)(3) 9 FMI
 
 
No
(53)Clare of Assisi Homes - Westminster (4)
2451 WEST 82ND PLACE

WESTMINSTER,CO80031
74-2740978 		HOUSING CO 501(c)(3) 9 FMI
 
 
No
(54)Dayspring Villa Inc (4)
3777 WEST 26TH AVENUE

DENVER,CO80211
36-3933908 		HOUSING CO 501(c)(3) 9 FMI
 
 
No
(55)Francis Heights Inc (4)
2626 OSCEOLA STREET

DENVER,CO80212
84-0626174 		HOUSING CO 501(c)(3) 9 FMI
 
 
No
(56)Franciscan Ministries Comm Fndn (4) (27)
26W171 ROOSEVELT ROAD

WHEATON,IL601870667
36-4456204 		FOUNDATION IL 501(c)(3) 11 - I FMI
 
 
No
(57)Marian Housing Center Inc (4)
4105 SPRING STREET

RACINE,WI53405
39-1515867 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(58)Marian Park Inc (4)
2126 WEST ROOSEVELT ROAD

WHEATON,IL60187
36-2750105 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(59)Ridgeway Place Inc (4)
155 EAST RIDGEWAY AVENUE

WATERLOO,IA50702
42-1416064 		HOUSING IA 501(c)(3) 9 FMI
 
 
No
(60)Villa Maria Inc (4)
2461 WEST 82ND PLACE

WESTMINSTER,CO80031
84-1347868 		HOUSING CO 501(c)(3) 9 FMI
 
 
No
(61)Alexandria Manor Inc (4) (24)
600 East Jackson St Unit M-50

Alexandria,IN46001
47-5177987 		HOUSING IN 501(c)(3) 9 FMI
 
 
No
(62)Indianapolis Manor 1 Inc (4) (10)
7950 Harcourt Rd

Indianapolis,IN46260
47-5178092 		HOUSING IN 501(c)(3) 9 FMI
 
 
No
(63)Kokomo Manor Inc (4) (11)
510 Elk Dr

Kokomo,IN46902
47-5189624 		HOUSING IN 501(c)(3) 9 FMI
 
 
No
(64)Indianapolis Manor 2 Inc (4) (12)
1840 Perkins Ave

Indianapolis,IN46203
47-5178185 		HOUSING IN 501(c)(3) 9 FMI
 
 
No
(65)Paducah Ministries 1 Inc (4) (13)
650 College Ave 77

Paducah,KY42001
47-5203278 		HOUSING KY 501(c)(3) 9 FMI
 
 
No
(66)Princeton Ministries 4 Inc (4) (14)
655 Grace Court

Princeton,KY42445
47-5202983 		HOUSING KY 501(c)(3) 9 FMI
 
 
No
(67)Richardson Ministries Inc (4) (15)
500 Rockingham Lane

Richardson,TX75080
47-5202868 		HOUSING TX 501(c)(3) 9 FMI
 
 
No
(68)Effingham Ministries Inc (4) (16)
512 Hendelmeyer

Effingham,IL62401
47-5190275 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(69)Moline Ministries 1 Inc (4) (17)
4201 22nd Street

Moline,IL61265
47-5216971 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(70)Moline Ministries 2 Inc (4) (18)
4201 22nd Street

Moline,IL61265
47-5217175 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
(71)Lake Wales Ministries Inc (4) (19)
504 South 4th Street

Lake Wales,FL33853
47-5190723 		HOUSING FL 501(c)(3) 9 FMI
 
 
No
(72)Pendleton Ministries 2 Inc (4) (20)
950 Cherry St G-1

Pendleton,SC29670
47-5247951 		HOUSING SC 501(c)(3) 9 FMI
 
 
No
(73)Tucson Ministries Inc (4) (21)
4131 North Western Winds Drive

Tucson,AZ85705
47-5239406 		HOUSING AZ 501(c)(3) 9 FMI
 
 
No
(74)Phoenix Ministries 3 Inc(4) (22)
7220 North 27th Ave

Phoenix,AZ85051
47-5217326 		HOUSING AZ 501(c)(3) 9 FMI
 
 
No
(75)Davenport Ministries Inc (4) (23)
7218 Hillandale Rd Apt 1

Davenport,IA52806
47-5227048 		HOUSING IA 501(c)(3) 9 FMI
 
 
No
(76)Villa St Clare Inc (4) (25)
130 BYRD AVENUE

NEENAH,WI54946
39-1769395 		HOUSING WI 501(c)(3) 9 FMI
 
 
No
(77)Assisi Homes - La Salle Manor Inc (4)
26W171 ROOSEVELT ROAD

WHEATON,IL601890795
80-0623447 		HOUSING IL 501(c)(3) 9 FMI
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Wheaton Franciscan Enterprises Inc (2)

400 WEST RIVER WOODS PARKWAY
GLENDALE,WI53212
39-1985204 		HOLDING CO WI WF HOLDINGS INC
  		C CORP         No
(2) Wheaton Franciscan Holdings Inc (2)

400 WEST RIVER WOODS PARKWAY
GLENDALE,WI53212
39-1836357 		HOLDING CO WI WFH-SE WI
  		C CORP         No
(3) WFMG - Sussex Inc (2)

400 WEST RIVER WOODS PARKWAY
GLENDALE,WI53212
39-1361100 		MED GROUP WI WF HOLDINGS INC
  		C CORP         No
(4) Wheaton Franciscan Prov Network Inc (2

400 WEST RIVER WOODS PARKWAY
GLENDALE,WI53212
39-1952140 		PROVIDER CONTRACT WI WFH-SE WI
  		C CORP         No
(5) FMOB Condo Assoc Inc (2)

400 WEST RIVER WOODS PARKWAY
GLENDALE,WI53212
34-1983857 		CONDO MGMT WI FMOB LLC
  		C CORP         No
(6) Wheaton Way Condo Owners Assoc Inc (2)

10101 SOUTH 27TH STREET
FRANKLIN,WI53132
30-0659830 		CONDO ASSCN WI WFH-FRKLN
  		C CORP         No
(7) Wheaton Franciscan Insurance Company (4)

PO BOX 69 GT
GEORGETOWN,GRAND CAYMAN  
CJ
98-0691609 		FINANCIAL UK WFSI
  		Other         No
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
 
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
SCHEDULE R SUPPLEMENTAL INFORMATION (1) Effective March 1, 2016, organizations in the Marianjoy region were transferred from Wheaton Franciscan Services, Inc. to Northwestern Memorial Healthcare, and as a result, ceased to be related as of this date. (2) Effective March 1, 2016, organizations in the Southeast Wisconsin region were transferred from Wheaton Franciscan Services, Inc. to Ascension Health, and as a result, new organizations became related as of this date. (3) Effective May 1, 2016, organizations in the Iowa region were transferred from Wheaton Franciscan Services, Inc. to Mercy Health Network, and as a result of the SE WI transfer to Ascension Health, ceased to be related as of March 1, 2016. (4) Effective March 1, 2016, organizations in the Wheaton Franciscan Services, Inc. and Wheaton Franciscan Sisters Foundation, Inc. region were transferred to Wheaton Franciscan Sisters Corporation and as a result, ceased to be related as of this date. (5) Effective March 1, 2016, organizations in the Wheaton Franciscan Services, Inc. and Wheaton Franciscan Sisters Foundation, Inc. region were transferred to Wheaton Franciscan Sisters Corporation and were considered unrelated as of this date. Simultaneously with this transfer, Wheaton Franciscan Sisters Foundation, Inc. was removed as the corporate sponsor of Franciscan Sisters of Colorado, Inc., and the organization continued independently. (6) Effective May 4, 2016, O.S.F. Services, Inc. changed its legal name to Wheaton Franciscan Sisters Foundation, Inc. (7) Effective June 9, 2016, Canticle Ministries, Inc. was dissolved, and as such, this will be it's final 990 and the final year it will be reported as a related organization through March 1, 2016. (8) UHS, Inc. is listed without a direct controlling entity because of the two organizations with an interest, KHMC Community Board and Wheaton Franciscan Sisters Foundation, Inc., neither can appoint a majority of the board, and since KHMC is not an entity (it is a community board), neither body "controls". (9) Effective March 1, 2016, organizations in the Wheaton Franciscan Services, Inc. and Wheaton Franciscan Sisters Foundation, Inc. region were transferred to Wheaton Franciscan Sisters Corporation and ceased to be considered related as of this date. Effective December 31, 2016 (after the close of the current reporting year), Wheaton Franciscan Sisters Foundation, Inc. was removed as the corporate sponsor of S.E.T Ministries, Inc., and future of the organization is unknown until a new corporate sponsor is determined. (10) Indianapolis Manor 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective November 5, 2015. (11) Kokomo Manor, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 4, 2016. (12) Indianapolis Manor 2, Inc. was incorporated on September 25, 2015 and was granted exempt status effective November 5, 2015. (13) Paducah Ministries 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 15, 2016. (14) Princeton Ministries 4, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 21, 2016. (15) Richardson Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective January 15, 2016. (16) Effingham Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective December 21, 2015. (17) Moline Ministries 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 6, 2016. (18) Moline Ministries 2, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 30, 2016. (19) Lake Wales Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective January 7, 2016. (20) Pendleton Ministries 2, Inc. was incorporated on September 29, 2015 and was granted exempt status effective May 12, 2016. (21) Tucson Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective February 3, 2016. (22) Phoenix Ministries 3, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 16, 2016. (23) Davenport Ministries, Inc. was incorporated on September 29, 2015 and was granted exempt status effective January 15, 2016. (24) Alexandria Manor, Inc. was incorporated on September 25, 2015 and was granted exempt status effective February 2, 2016. (25) Effective January 31, 2016, assets of Villa St. Clare, Inc. were sold to an unrelated party, and the entity will subsequently be dissolved. (26) Effective November 1, 2016 (after the close of the current reporting year), a 25% ownership percentage in UHS, Inc. was transferred from Wheaton Franciscan Sisters Foundation, Inc. to UHS, Inc. making them 100% owner of St Catherine's Hospital, Inc. and United Hospital System, Inc. With the transfer of the SE WI organizations to Ascension Heatlh, the organizations under UHS, Inc. ceased to be considered related as of March 1, 2016. (27) Effective December 22, 2016 (after the close of the current reporting year), Franciscan Ministries Community Foundation, Inc. was dissolved. With the transfer of the SE WI organizations to Ascension Health, this organization ceased to be considered related as of March 1, 2016.
Schedule R (Form 990) 2015

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