2013-05-15T10:09:21-05:00 2012-06-30 990 2011-07-01 421264647 Covenant Medical Center Inc % TIMOTHY HUBER COVE 3192728000 3421 West Ninth Street Waterloo IA 507025499 MICHELE M PANICUCCI 3192727300 2013-05-15 2011 2016-02-24 21:20:13Z Jack Dusenbery 3421 West Ninth Street Waterloo IA 507025499 378339162 false 0928 X www.wheatoniowa.org X 1985 IA To provide inpatient and outpatient healthcare services. 17 10 2491 429 1172000 211829 1926005 1985123 233841802 248615969 2799404 3386155 6838095 15557643 245405306 269544890 367176 437739 0 0 130061762 135658885 0 0 0 105517372 118276478 235946310 254373102 9458996 15171788 183332174 203081146 41073512 38206419 142258662 164874727 X AS A MEMBER OF WHEATON FRANCISCAN HEALTHCARE, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION 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. false false 224155383 437739 252434338 WHEATON FRANCISCAN SERVICES, INC. (WFSI) is a Catholic, not-for-profit health care and housing organization serving at sites in Wisconsin, Iowa, Illinois, and Colorado. The System includes 15 hospital sites*, three transitional and extended-care facilities, two home health agencies, more than 3,000 physicians, more than 70 clinic sites with 610 employed physicians, and approximately 2,620 units of assisted living and other housing, and the corporate services offices in Wheaton, Illinois, and Glendale, Wisconsin. Started more than 125 years ago and formally incorporated in 1983, WFSI is committed to living out the Mission and Values of its Sponsors, the Wheaton Franciscan Sisters, by providing excellent and compassionate health care and housing services to all, regardless of their ability to pay. WFSI was incorporated in 1983 to preserve and strengthen Judeo-Christian values, provide a framework for lay expertise and involvement, respond to an increasingly complex environment, ensure continuity of Franciscan sponsorship, and assure viability and excellence throughout the organization. As a not-for-profit organization, WFSI reinvests all net income into the communities it serves. Its multiple entities are dedicated to delivering quality health care to patients and residents through highly-trained staff, advanced technology, and superior and compassionate service; caring for each person's body, mind, and spirit with respect and dignity; working to improve the health of the communities; and ensuring health care access for everyone. WFSI is organized into market-based regional holding companies organized in the Southeast, Wisconsin region, as well as other regional holding companies conducting services in Illinois, Iowa, and Colorado. The System's housing and spiritual development services are organized under the holding company name of Franciscan Ministries, Inc. Since 2006, the "doing business as" name for WFSI's health care ministry has been Wheaton Franciscan Healthcare (WFH). 2012 marked the 11th consecutive year Wheaton Franciscan Healthcare in Southeast Wisconsin has been named one of the top 100 most efficient, best performing health care networks in the nation, according to IMS (formerly SDI), the nation's premier integrated health network (IHN) evaluation system. Wheaton Franciscan Healthcare is ranked 32nd and is the top system in Southeast Wisconsin. The top 100 ranking is based on integration in areas such as managed care, information systems, and physician affiliations. Wheaton Franciscan Healthcare scored above the nation's top 100 integrated health networks' average score in the areas of hospital utilization, physician participation, services and access, outpatient utilization, integration, and integrated technology. Other national recognitions include being named one of the best performing 50 systems in Thompson Reuters' 100 Top Hospitals: Health Systems Quality/Efficiency Study in 2009. Wheaton Franciscan Healthcare is a recent recipient of the ECRI Institute's Healthcare Supply Chain Achievement Award. The award honors organizations that demonstrate excellence in overall cost management and in adopting best practice solutions in supply chain processes. Wheaton is one of five health care organizations nationwide to be honored. Wheaton Franciscan Healthcare also received a 2009 VIP Award from McKesson Technology Solutions for its success in using information technology to enhance patient safety across nine hospital sites and more than 100 physician offices. The VIP Awards are presented annually to organizations that demonstrate vision, innovation and performance in the use of healthcare IT. Wheaton Franciscan Healthcare was one of five health care organizations selected by a panel of experts in the field of health care IT use to receive the award. *The interest in Affinity Health System was sold to Ministry Healthcare in February 2012 and as such statistics related to that system have not been included in this filing. Please see our full 2012 Annual Report online at: www.WheatonAnnualReport.org CORPORATE STRUCTURE: Parent Company: Wheaton Franciscan Services, Inc. DBA Wheaton Franciscan Healthcare Health care ministry: Wheaton Franciscan Healthcare Housing ministry: Franciscan Ministries, Inc. Health Care Mission: Wheaton Franciscan Healthcare is committed to living out the healing ministry of Jesus by providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve. Health Care Vision: Our health ministries will be recognized in each community we serve for superior and compassionate patient service, clinical excellence, as the health care employer of choice, and the preferred partner of physicians. Housing Mission: Franciscan Ministries is committed to providing quality and affordable housing in a compassionate environment that promotes wholeness of life within ourselves and the communities we serve. Housing Vision: Our housing ministries will be recognized for excellence in property management and a well-integrated network of support services that provide hope, growth, and opportunity. Values: Our common Values, which flow from our Mission and Catholic tradition, must have meaning for every one of us. Through them we put the healing ministry of Jesus into practice throughout the Wheaton Franciscan System. Respect: We value each person as sacred, created in the image and likeness of God, which gives worth and meaning to each person's life. Integrity: We value honesty and words and actions that build trust. Development: We value personal and professional growth that combines the physical, emotional, spiritual and relational aspects of life and work. Excellence: We value superior performance in our work and service. Stewardship: We value our responsibility to use human, financial, and natural resources entrusted to us for the common good, with special concern for those who are poor. WHEATON FRANCISCAN HEALTHCARE Wheaton Franciscan Services, Inc.'s health care division, doing business as Wheaton Franciscan Healthcare (WFH), consists of facilities in Illinois, Iowa, and Wisconsin. SYSTEM STATISTICS Hospital Sites: 15 Staffed Hospital beds: 1,794 Long-term Care Facilities: 3 Home Health Agencies: 2 Units of Housing: 2,620 Associates: 17,143 Affiliated Physicians: 2,424 Employed Physicians: 610 Emergency Room Visits: 345,145 Newborns: 8,677 Hospital Admissions: 72,335 Hospital Patient Days: 348,751 Skilled Nursing Unit Patient Days: 24,057 Long-term Care Facility Patient Days: 83,512 Hospital Outpatient Visits: 1,696,550 Hospice Days: 22,324 Home Health Visits: 117,452 Medical Group Physician Visits: 1,540,488 WFH ORGANIZATIONS Iowa Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. Covenant Regional Services, Inc. Illinois Marianjoy Rehabilitation Hospital and Clinics Marianjoy Medical Group Marianjoy Foundation RUSH OAK PARK HOSPITAL, Inc. OSF Services Canticle Ministries Clara Pfaender Fund Upendo Village Wisconsin Wheaton Franciscan - Elmbrook Memorial, St. Joseph, and The Wisconsin Heart Hospital Campuses All Saints St. Francis Franklin Franciscan Woods The Terrace at St. Francis Wheaton Franciscan Home Health Wheaton Franciscan Hospice Wheaton Franciscan Laboratories Wheaton Franciscan Medical Group All Saints Foundation Volunteers in Partnership with Wheaton Franciscan Healthcare-All Saints St. Joseph Foundation Elmbrook Memorial Foundation Circle of Life Foundation The Foundation for St. Francis and Franklin AFFILIATIONS INCLUDE: Midwest Orthopedic Specialty Hospital - Franklin, WI United Hospital System - Kenosha, Wisconsin St. Catherine's Medical Center and Kenosha Medical Center Campuses WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT FOR SYSTEM / 2012 Charity Care: $37,795,590. 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: $91,349,958. 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: $3,900,044. 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: $2,687,567. 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 purpose 224155383 true true false true false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true X 116 0 true 2491 true true true false false false false false false false false false X 17 10 true false false false true true true true true false true true true true true true true true true true false X TIMOTHY HUBER 3192727607 3421 WEST NINTH STREET WATERLOO IA 507025499 X Neil McMahon MD 40.0 X 368315 39122 James Peterson MD 40.0 X 294677 37141 Brian Sims DO 40.0 X 543746 47619 Michael Slavin DO 40.0 X 523824 42172 Jack Dusenbery 40.0 X X 598977 74086 John Oliverio 40.0 X X 2520506 161546 Sandie Graf 1.0 X Jerry Harris 1.0 X Camille Hogan 1.0 X X Eric Locke 1.0 X X Michael Mallaro 1.0 X Becky Mudd 1.0 X X Robert W Peterson 1.0 X Gregory Schmitz 1.0 X Frank Seng 1.0 X Douglas Stanford MD 1.0 X Ron Van Veldhuizen 1.0 X Nancy Schaefer 40.0 X 51020 9215 Michele Panicucci 40.0 X 442415 72111 Paul Franke MD 40.0 X 401467 34366 Rose Fowler 40.0 X 227616 41600 Jeffrey Halverson 40.0 X 299699 60214 Christopher Hyers 40.0 X 258881 46561 Nancy Weber 40.0 X 338163 252487 Gary Knudson 40.0 X 1528738 44266 Ahsan Maqsood 40.0 X 911728 37193 Victor Mujica 40.0 X 990081 42803 Richard Naylor 40.0 X 2030138 37475 Richard Valente 40.0 X 901930 44595 Peter Hohnstein MD 40.0 X 438874 46429 Jon Wachs 40.0 X 461202 11838 8984538 5147459 1182839 131 true true false Iowa Emergency Physicians LLP PO Box 793 TRAVERSE CITY MI 496850793 Physician Services 1121427 GE Medical Systems PO Box 96483 CHICAGO IL 60693 Medical Testing 768142 Quest Diagnostics PO Box 740709 ATLANTA GA 303740709 Medical Testing 572026 Larson Construction Company PO Box 112 INDEPENDENCE IA 50644 Construction 567986 Peters Construction Corp PO Box 2940 WATERLOO IA 50704 Construction 380976 25 1925705 20246 39172 1985123 NET PROGRAM SERVICE REVENUE 900099 119044834 119044834 MEDICARE/MEDICAID PAYMENTS 900099 121274054 121274054 REFERRAL LAB 621500 6000 6000 TECHS - PHYSICIAN 621110 27830 27830 PHARMACY OPERATIONS 446110 1138170 1138170 7125081 7125081 248615969 2060717 2060717 0 0 806610 293826 512784 512784 512784 109761911 63973 108499871 575 1262040 63398 1325438 1325438 0 0 0 CAFETERIA 722210 1208375 1208375 ELECTONIC HEALTH RECORD 900099 1002840 1002840 PHARMACY REVENUE 446110 9422557 9422557 3411087 1690053 1721034 15044859 269544890 252434338 1172000 13953429 437739 437739 0 0 0 2392684 1896616 496068 485302 485302 109722826 109194554 528272 5495185 5468728 26457 10822584 10770478 52106 6740304 6714661 25643 0 0 0 0 0 213328 213328 2626284 2573556 52728 12833 12833 7112416 7087372 25044 0 0 7413972 7413972 277194 269063 8131 0 76799 75321 1478 632685 632685 379888 379888 8227451 8227275 176 674714 674714 MEDICAL SUPPLIES 40127203 40127159 44 CORPORATE SERVICES ALLOCATION 21689618 2061141 19628477 BAD DEBT EXPENSE 10375073 10375073 PARENT COMPANY ALLOCATION 9321610 1094204 8227406 9115410 8815734 299676 254373102 224155383 30217719 0 3727 3727 62036084 84116216 0 0 27759139 30530632 0 0 0 0 0 0 3912603 3883834 58280 61577 247589256 165057712 84831300 82531544 0 0 0 0 0 0 0 0 4731041 1953616 183332174 203081146 18589554 17535584 0 0 0 0 0 0 0 0 0 0 16575043 14800742 0 0 5908915 5870093 41073512 38206419 X 142105635 164664536 153027 210191 0 0 142258662 164874727 183332174 203081146 X 15171788 7444277 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 24944 false false true 0 24944 false Schedule C Disclosures Part II-B Line 1i Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of healthcare and housing organizations that are related through a common parent organization. Certain entities within this controlled group engage in limited lobbying activities that benefit each organization collectively. Wheaton Franciscan Healthcare employs one full time Vice President of Strategic Planning and Government Relations whose duties include a portion of lobbying activities. These lobbying activities approximate 20% of total annual salary. A benefits factor of 25% is added, and the total is allocated amongst the organizations receiving the benefit of these services. The lobbying activities include such things as preservation of Medicare and Medicaid funding; monitoring federal legislation that may impact the organization; participating in and coordinating visits with elected officials; coordinating advocacy activities in conjunction with relevant trade associations; and providing awareness on specific state related legislative issues when the need arises (e.g.: state hospital assessment legislation in Wisconsin). 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 added or estimated, as appropriate. Lobbying expenses incurred by each organization directly, are reflected on their respective IRS Form 990, and can be summarized as follows: Wheaton Franciscan Services, Inc. #36-3262111 $69,998 Wheaton Franciscan Healthcare - Southeast Wisconsin, Inc. #39-1566865 $38,576 Wheaton Franciscan, Inc. #39-0816857 $17,457 Wheaton Franciscan Healthcare - St. Francis, Inc. #39-0907740 $9,611 Wheaton Franciscan Healthcare - All Saints, Inc. #39-1264986 $10,004 Wheaton Franciscan Healthcare - Franklin, Inc. #56-2592868 $1,838 Wheaton Franciscan Home Health and Hospice, Inc. #39-1559428 $1,407 Marianjoy, Inc. #36-3483589 $4,242 Marianjoy Rehabilitation Hospitals and Clinics, Inc. #36-2680776 $12,138 Wheaton Franciscan Healthcare - Iowa, Inc. #42-1177001 $4,243 Covenant Medical Center, Inc. #42-1264647 $24,944 Sartori Hospital, Inc. #42-0758901 $4,516 Mercy Hospital, Inc. #42-1178403 $2,008 TOTAL LOBBYING EXPENSES: $200,982 4033723 4033723 88365162 43832073 44533089 4246079 3916676 329403 94010563 77905136 16105427 56933729 39403827 17529902 82531544 0 DUE TO THIRD PARTY PAYOR 5870093 5870093 true true true X true X false true true false true true 3920906 3920906 0.01610 28457445 24385104 4072341 0.01670 32378351 24385104 7993247 0.03280 1383555 5191 1378364 0.00560 2624604 1150784 1473820 0.00600 6629828 4307853 2321975 0.00950 758627 758627 0.00310 11396614 5463828 5932786 0.02420 43774965 29848932 13926033 0.05700 180194 890 179304 0.00070 180194 890 179304 0.00070 true 10375073 50681804 41481480 9200324 X true true 1 1 Covenant Medical Center Inc

3421 West Ninth Street Waterloo IA 50702

X X X X Covenant Medical Center Inc 1 true true 200. true 400. true X X X X X X true true X X X true false X true X false false 39 CMC's Horizons Substance Abuse

2101 KIMBALL AVENUE WATERLOO IA 50702

OUTPATIENT SUBSTANCE ABUSE SERVICES Covenant Wellness Center

2101 KIMBALL AVENUE WATERLOO IA 50702

WELLNESS CENTER Covenant Cancer Treatment Center

200 EAST RIDGEWAY AVENUE SUITE CTC WATERLOO IA 50702

OUTPATIENT CANCER TREATMENT Covenant Clinic Hematology Oncology

200 EAST RIDGEWAY AVENUE SUITE 400 WATERLOO IA 50702

OUTPATIENT HEMATOLOGY AND ONCOLOGY SERVICES Covenant Medical Center's Sleep Lab

2710 ST FRANCIS DRIVE SUITE 409 WATERLOO IA 50702

OUTPATIENT SLEEP DISORDER DIAGNOSTICS Iowa Spine and Brain Institute

2710 ST FRANCIS DRIVE SUITE 110 WATERLOO IA 50702

OP NEURO SURGERY OP PAIN MANAGEMENT OP X-RAY SERVICES Covenant Clinic Neurology

2710 ST FRANCIS DRIVE SUITE 104 WATERLOO IA 50702

OUTPATIENT CLINIC- NEUROLOGY SERVICES Covenant Clinic Convenient Care

2710 ST FRANCIS DRIVE SUITE 111 WATERLOO IA 50702

OUTPATIENT CLINIC Covenant Clinic Family Practice

2710 ST FRANCIS DRIVE SUITE 210 WATERLOO IA 50702

OP FAMILY PRACTICE, GYNECOLOGY, PODIATRY, LABORATORY SERVICES Covenant Clinic Orthopedics

2710 ST FRANCIS DRIVE SUITE 319 WATERLOO IA 50702

OUTPATIENT CLINIC- ORTHOPEDIC SERVICES Covenant Clinic Cardiology

2710 ST FRANCIS DRIVE SUITE 320 WATERLOO IA 50702

OUTPATIENT CLINIC- CARDIOLOGY SERVICES Covenant Clinic Pulmonology

2710 ST FRANCIS DRIVE SUITE 402 WATERLOO IA 50702

OUTPATIENT CLINIC- PULMONOLOGY SERVICES Covenant Clinic Surgery

2710 ST FRANCIS DRIVE SUITE 410 WATERLOO IA 50702

OP GENERAL SURGERY, WOUND CARE, VASCULAR SURGERY SERVICES Covenant Clinic Ent Allergies

2710 ST FRANCIS DRIVE SUITE 411 WATERLOO IA 50702

OUTPATIENT CLINIC - EAR, NOSE & THROAT AND ALLERGY SERVICES Cov Clinic Nephrology Podiatry Pediatr

2710 ST FRANCIS DRIVE SUITE 510 WATERLOO IA 50702

OP NEPHROLOGY, PODIATRY, AND PEDIATRIC SERVICES Mammography Screening Center

432 KING DRIVE WATERLOO IA 50702

OUTPATIENT MAMMOGRAPHY IMAGING SERVICES Covenant Clinic - Psychiatry

2750 ST FRANCIS DRIVE WATERLOO IA 50702

OUTPATIENT CLINIC - PSYCHIATRY SERVICES Covenant Clinic - Psychiatry

2802 ORCHARD DRIVE CEDAR FALLS IA 50613

OUTPATIENT CLINIC- PSYCHIATRY SERVICES Covenant Clinic - Arrowhead

226 BLUEBELL ROAD SUITE CC CEDAR FALLS IA 50613

OP FAMILY PRACTICE, PSYCHIATRY, PODIATRY, GYNECOLOGY SERVICES Arrowhead Medical Center

226 BLUEBELL ROAD SUITE OPT CEDAR FALLS IA 50613

OP PHYSICAL THERAPY, OCCUPATIONAL HEALTH, RADIOLOGY SERVICES Covenant Clinic- Rehabilitation Medicine

3421 WEST NINTH STREET SUITE 100 WATERLOO IA 50702

OUTPATIENT CLINIC- PHYSIATRY SERVICES Covenant Clinic

2055 KIMBALL SUITE 400 WATERLOO IA 50702

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Family Practice

516 SOUTH DIVISION STREET SUITE 11 CEDAR FALLS IA 50613

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic Bariatrics

516 SOUTH DIVISION STREET SUITE 10 CEDAR FALLS IA 50613

OUTPATIENT PHYSICIAN CLINIC - BARIATRICS SERVICES Covenant Clinic Family Practice

516 SOUTH DIVISION STREET SUITE 10 CEDAR FALLS IA 50613

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic Orthopedics

516 SOUTH DIVISION STREET SUITE 12 CEDAR FALLS IA 50613

OUTPATIENT CLINIC - ORTHOPEDIC SERVICES Covenant Clinic Specialist

516 SOUTH DIVISION STREET SUITE 14 CEDAR FALLS IA 50613

OP CLINIC - ENT, ALLERGY, CARDIOLOGY, PAIN MANAGEMENT SERVICES Covenant Clinic - Dysart

501 CLARK STREET DYSART IA 52224

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Evansdale

3562 LAFAYETTE ROAD EVANSDALE IA 50707

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Fairbank

105 SOUTH WALNUT STREET FAIRBANK IA 50629

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Gladbrook

309 SECOND STREET GLADBROOK IA 50635

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Jesup

1094 220TH STREET JESUP IA 50648

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - LaPorte City

601 HIGHWAY 218 NORTH LAPORTE CITY IA 50651

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Oelwein

129 EIGHT AVENUE SE OELWEIN IA 50662

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Reinbeck

501 MAIN STREET REINBECK IA 50669

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Shell Rock

309 SOUTH CHERRY STREET SHELL ROCK IA 50670

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Traer

200 WALNUT STREET TRAER IA 50673

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Tripoli

602 SEVENTH AVENUE SW TRIPOLI IA 50676

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Covenant Clinic - Waverly

217 20TH STREET NW WAVERLY IA 50677

OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES Schedule H Supplemental Information Various - see the following references Schedule H Part 1 Line 4 Wheaton Franciscan Healthcare's generous Payment for Services Policy specifies that for uninsured patients whose income is at or below 400% of the Federal Poverty Income Guidelines, the maximum out-of-pocket liability that Wheaton Franciscan Healthcare will charge for medically necessary services shall not exceed 15% of gross household income. This also applies to patients who are underinsured whose income is at or below 300% of the Federal Poverty Income Guidelines. Free or discounted care is available to those who meet requirements including income level, family size, and assets. Schedule H Part 1 Line 6a The Annual Report that outlines the Hospital's community benefit information is contained in a report prepared by the system, Wheaton Franciscan Services, Inc. which is the ultimate parent organization of an integrated health care system operated in Wisconsin, Illinois, and Iowa. For more information, please see our annual report at www.mywheaton.org. It is available under "About Us" by clicking on "Community Impact," and scrolling down to "For more information." Schedule H Part 1 Line 7 Community Benefit amounts are reported using total actual costs per the hospital's managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information are published. Amounts are compiled using a software application recommended by the Catholic Health Association because it has the ability to provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the organization. After amounts are verified and approved, community benefit amounts become finalized. Wheaton Franciscan Healthcare complies with Illinois state law which requires reporting to the Attorney General's Office. Additionally, Wheaton Franciscan Healthcare voluntarily reports community benefit information in Wisconsin and Iowa by making the information readily available on certain websites. Finally, the information is compiled with the assistance of the software, for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. Schedule H Part 1 Line 7 Column f Wheaton Franciscan Healthcare organizations follow guidelines established by the Catholic Health Association, who recommends that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $10,375,073 has not been included in the calculation of the percentages reported on Schedule H Line 7 Column f. Schedule H Part 1 Line 7g In the Southeast Wisconsin and Marianjoy regions, physician clinics are operated by a separate legal entity and are therefore not included in Community Benefit amounts on hospital 990's. In the Iowa region, clinic operations are included as a department of the hospital, Covenant Medical Center, Inc. Clinic operations for the Iowa clinics are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, for all entities, including Covenant Medical Center, Inc., costs related to physician clinics are not included in subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-4 As part of an annual process, affiliates of Wheaton Franciscan Healthcare complete a consolidated audit each year, which for June 30, 2012, contained the following footnote disclosure related to bad debt reporting: "In July 2011, the FASB issued ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. ASU 2011-07 requires that entities that recognize significant amounts of patient service revenue at the time the services are rendered, even though they do not assess the patient's ability to pay, must present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their consolidated statements of operations. All other entities would continue to present the provision for bad debts as an operating expense. In addition, there are enhanced disclosures about the entities policies for recognizing revenue and assessing bad debts. The ASU also requires disclosures of patient service revenue as well as qualitative and quantitative information about changes in the allowance for doubtful accounts. The disclosure requirements are applicable for WFSI effective for fiscal years ending after December 15, 2012, with early adoption permitted. WFSI has elected to early adopt the provisions of this ASU. The provision for uncollectible accounts on the accompanying consolidated statements of operations for the years ended June 30, 2012 and June 30, 2011 have been presented on a separate line as a deduction from net patient service revenue (net of contractual allowances and discounts) to reflect the retrospective application of ASU 2011-07." It is the practice of Wheaton Franciscan Healthcare to record actual bad debt expense for each organization at the time the amount due is determined to be uncollectible, and thus written off. With the onset of presumptive care effective July 1, 2011, practices are now in place to retroactively determine a patient's eligibility under Wheaton's Charity Care Policy, and remove those amounts from bad debt expense in order to correctly show these patients as charity care. Wheaton Franciscan Healthcare's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, and corrective action is taken based on presumptive care. Bad debt expense is only determined after many months of collection efforts, and for this reason Part III Section A Line 3 is reported as none (ie at zero). Additionally, since the organization follows guidelines established by the Catholic Health Association and the related state counterpart in Wisconsin, Iowa, or Illinois as appropriate, Wheaton Franciscan Healthcare does not include any form of bad debt expense in its annual reporting of community benefit amounts. Schedule H Part III Section B Line 6-8 Schedule H Part III Section B Line 6 reports "allowable costs of care" as taken from the most recently filed Medicare cost report available at the time the Community Benefit Report is published. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid cost is determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Wisconsin, Iowa, or Illinois Hospital Association as applicable, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b Wheaton Franciscan Healthcare has a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Schedule H Part V Section A and Section C Affiliates of Wheaton Franciscan Healthcare have defined and reported "hospital facilities" to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Wisconsin, Iowa, or Illinois state laws, as applicable, required for hospital licensing. Although there are other facilities within our system built to hospital standards, performing hospital-based billing, and conforming to other "hospital" standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpa true Covenant Foundation Inc 3421 West 9th St Waterloo IA 507025499 421295784 501(c)(3) 85563 Book Provide support Schoitz Health Resources Inc 3421 West 9th St Waterloo IA 507025499 421232935 501(c)(3) 352176 Book Provide support Clara Pfaender Fund Inc PO Box 667 Wheaton IL 601870667 363353311 501(c)(3) 362388 Book Provide support 3 0 Schedule I Disclosures Schedule I, Part I, Line 2 Wheaton Franciscan Healthcare and Franciscan Ministries maintain files and records to manage the decision-making and award process for organizations that it provides community sponsorship dollars to. Decisions are made by a Community Sponsorship Committee with leaders who hold positions in Diversity, Strategic Planning, Mission Services, Marketing and Philanthropy. The Committee generally strives to sponsor organizations that have missions that align with the mission, vision and values of Wheaton Franciscan Healthcare and/or Franciscan Ministries. The committee also looks for certain other criteria when deciding which organizations will receive contributions, including but not limited to supporting healthcare or housing related activities within the Southeast Wisconsin, Iowa, and Illinois markets, supporting programming that work to further diversity and cultural competency, aligning with other WFH business relationships or service lines, supporting student academic achievement or workforce development initiatives, and finally, supporting environmental "green" initiatives. Leaders periodically meet with representatives of sponsored organizations to discuss objectives including how dollars will be spent. Currently, confirmation letters are sent to sponsored organizations when award dollars are given, that confirm the dollar amount awarded and the intended purpose, with a request that the recipient acknowledge receipt of the funds in written correspondence. Files are maintained in the Organizational Change and Leadership Performance Department to include copies of letters of request, award and denial letters along with acknowledgement receipts from sponsored organizations. true true true false false false false false false Neil McMahon MD 362774 750 4791 20999 18123 407437 James Peterson MD 283014 1500 10163 21012 16129 331818 Brian Sims DO 541681 750 1315 20857 26762 591365 Michael Slavin DO 504682 1500 17642 20965 21207 565996 Paul Franke MD 298208 102200 1059 13185 21181 435833 Peter Hohnstein MD 435972 450 2452 20964 25465 485303 Gary Knudson 1524757 2250 1731 21020 23246 1573004 Ahsan Maqsood 900372 300 11056 13214 23979 948921 Victor Mujica 976556 300 13225 20909 21894 1032884 Richard Naylor 2016731 2250 11157 17776 19699 2067613 Richard Valente 877399 17245 7286 13185 31410 946525 Jack Dusenbery 381642 206600 10735 46586 27500 673063 Rose Fowler 173685 53700 231 24246 17354 269216 Jeffrey Halverson 206887 77800 15012 35719 24495 359913 Christopher Hyers 176470 67800 14611 19223 27338 305442 John Oliverio 952774 662500 905232 99519 62027 2682052 Michele Panicucci 247640 129400 65375 49061 23050 514526 54030 Jon Wachs 309928 151274 11838 473040 Nancy Weber 200958 87600 49605 237991 14496 590650 42720 Schedule J Disclosures Various - See the following references Schedule J Part 1 Line 3 The compensation of the filing organization's CEO and/or the Executive Director is determined at the parent organization level, using the process described in Schedule O related to Part VI Section B Line 15. The parent organization, Wheaton Franciscan Services, Inc. (FEIN: 36-3262111) uses a compensation committee, independent compensation consultants, and compensation surveys and studies to determine appropriate levels of compensation that are reflective of fair market value. All compensation is approved by the board and/or compensation committee. Schedule J Part 1 Line 4a Reportable compensation of Jon Wachs includes $309,928 in severance payments made during calendar year 2011. Schedule J Part 1 Line 4b John Oliverio received a 2011 taxable payout of $887,366 related to a supplemental nonqualified retirement plan known as the Wheaton Franciscan Services Benefit Restoration Plan. Jon Wachs received a 2011 taxable payout of $146,835 related to a supplemental nonqualified retirement plan known as the Wheaton Franciscan Services Benefit Restoration Plan. Schedule J Part 1 Line 4c Nancy Weber received a 2011 taxable payout of $42,720 related to a grandfathered option-based compensation program. Michele Panicucci received a 2011 taxable payout of $54,030 related to a grandfathered option-based compensation program. Mary Halverson Spouse of Jeff Halverson 14313 Employment false Schedule O Disclosures Various - See the following references IRS Form 990 Part VI Section A Line 2 Greg Schmitz, Mike Mallaro, and Frank Seng have a business relationship; they are all employed by The VGM Group. IRS Form 990 Part I Line 6 Covenant Medical Center, Inc. received donated services through volunteers assisting in a variety of areas which include the information desk, escorts, medical runner, nursing units, ambulatory surgery, Cancer Treatment Center, rehabilitation therapies, and volunteer transportation services. Total estimated volunteer hours were 43,130. The total estimated value of these services was $712,699. Part V Line 1a and Part VII Section B Line 1-2 Effective for calendar year 2011 1099-MISC reporting, Wheaton Franciscan Healthcare streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC were reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but possibly no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Lines 6-7b Covenant Medical Center, Inc. has one member which holds several reserved powers over Covenant Medical Center, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Line 10 Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of health care and housing providers, controlled under a common parent organization Wheaton Franciscan Services, Inc. Some of these organizations are exempt through the Catholic Group Ruling and other organizations have a stand-alone exemption (IRS determination) letter. As such, these related affiliates have certain policies and procedures that were adopted at the parent level, but are applicable to the entire controlled group of organizations. All policy and procedure matters are handled in a manner to ensure that all activities are consistent with the organization's overall exempt purposes. Please see Schedule R for a full listing of all related affiliate organizations. IRS Form 990 Part VI Section B Line 11 Affiliates of Wheaton Franciscan Healthcare use a multiple-level review process on all Federal and State information and tax returns to ensure accurate and timely filing for all organizations. Under the direction of the Tax Manager, the Accounting Department prepares Forms 990, 990-T, and associated state filings. When complete, the return is first reviewed by the Controller, who focuses on the income statement and balance sheet items, and all schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Accounting, the return is provided to the Tax Department, where the Tax Manager and Vice President of Treasury and Risk Management focus their review on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule K, Schedule H, and Schedule J, may be selected for review by outside bond counsel, a community benefit associate, and/or the compensation committee respectfully and as needed. This decision will vary from year to year, again based on many factors. The Accounting Department, upon completion of all levels of review, will schedule an appointment with the Senior Vice President and CFO, who will perform a review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors. The parent organization, Wheaton Franciscan Services, Inc. has designated that the Audit Committee review the parent return in certain years, where the 990 is explained at a high level by management representatives, and any questions or concerns that the Committee has can be addressed. At a later date and prior to efiling, the full board is provided access to all 990's throughout the system via an online portal. A similar process exists at the regional holding company levels - a 990 is selected for review in certain years by the Finance and Operations Committee. Similarly, the 990 is explained at a high level, and Committee questions or concerns are addressed. Members of the full board are provided access to all 990's within that region prior to efiling via an online portal. IRS Form 990 Part VI Section B Line 12 As part of an annual process, conflict of interest questions are sent out to all Officers, Directors, and other individuals in key positions using software designed to capture this information. The responses are analyzed in order to determine information on potential conflicts, as well as information on business and family relationships for purposes of answering certain questions on IRS Form 990. Responses to these questions are reviewed by the Vice President of Compliance and the Manager of Tax Compliance, and follow up action, if any, are documented within the software. After an approximate 3 and again at 6 weeks, names of all non responders are compiled, and these individuals receive either an email or letter reminding them to complete the information. Responses to questions continue to be reviewed and documented throughout this time period. Approximately 1 month prior to the filing deadline of IRS Form 990, responses to date are compiled. Any response requiring disclosure is entered into the information return. The remaining non responder names are determined, and a letter, along with the actual Conflict of Interest Policy, is sent to the Chairperson of each board. The letter outlines the current non responders, as well as any Officer or Board member that has disclosed a financial interest that might pose a potential conflict of interest. Depending upon the nature of the financial interest and work done by the board, several actions may be considered - the board member with a financial interest would need to voluntarily excuse him or herself from the deliberations and/or voting on such a matter; or, if necessary, the board would determine that the subject's financial interest was an actual conflict of interest, in which case the board member would be informed by the board Chairperson that he or she would not be allowed to vote in any such matters due to this real or perceived conflict of interest. Minutes of the board meeting would document this decision process, and reflect whatever action(s) are ultimately taken. The board chairperson is also required to discuss with non responders the repercussions of not responding, and require the board member to complete the annual conflict of interest disclosure questions before being allowed to continue in any board matters. If the board member refuses, the Chairperson has the authority to determine the appropriate action, including, but not limited to prohibiting them from participating in deliberations, preventing them from voting, and/or removing them as a board member. Schedule O Disclosures (cont'd) Various - See the following references IRS Form 990 Part VI Section B Line 15 The compensation of the CEO of Wheaton Franciscan Services Inc. (WFSI) and other officers and key employees of the filing organization is reviewed and approved on an annual basis by the Executive Committee of the WFSI Board of Directors, an independent board, acting in a manner consistent with its conflicts of interest policy. The board's decision is informed by an opinion on market comparable compensation data provided to the board by an independent compensation expert. The organization maintains contemporaneous documentation of the substantiation of the deliberation and decision by the board. Compensation for the organization's President and other officers and key management employees, is reviewed and approved, as part of the Wheaton Franciscan Services, Inc. Executive Compensation Plan, on an annual basis by the Executive Committee of the Wheaton Franciscan Services, Inc. Board of Directors (the "Executive Committee of the WFSI Board"), an independent board, acting in a manner consistent with its conflicts of interest policy. The Executive Committee of the WFSI Board's decision is informed by an opinion on market comparable compensation data provided to the board committee by an independent compensation expert. The Executive Committee of the WFSI Board maintains contemporaneous documentation of the substantiation of the deliberation and decisions it makes. For those officers and key employees that are paid for their services other than pursuant to the WFSI Executive Compensation Plan, the compensation terms are approved by the President of Covenant Medical Center, Inc. and Wheaton Franciscan Services - Iowa, Inc. In such case, decisions are made in accordance with the organization's conflict of interest requirements. Also, in such case, the compensation paid pursuant to a contract is determined with reference to market comparable information. Organizational policy requires that contemporaneous documentation of the same be maintained. IRS Form 990 Part VI Section C Line 19 Affiliates of Wheaton Franciscan Healthcare and Franciscan Ministries provide upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. Requests for information are considered on a case-by-case basis, and this process is outlined in our Public Disclosure Policy. As part of the requirements for tax exempt bond financing, the consolidated financial statements of Wheaton Franciscan Services, Inc. (#36-3262111), the parent corporation of Wheaton Franciscan Healthcare and Franciscan Ministries affiliates are required to be provided each quarter to the Municipal Securities Rule Making Board (MSRB). The vehicle used to accomplish this is through an external website (http://emma.msrb.org/) referred to as "EMMA" (Electronic Municipal Market Access System). The financial statements are uploaded each quarter to the website, and along with other information provided at the bond's inception, are available for viewing by the general public. IRS Form 990 Part VII Column B Wheaton Franciscan Healthcare and Franciscan Ministries are a controlled group of related healthcare and housing organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part VIII Lines 2a and 2b MEDICARE MEDICAID OTHER REV 247,121,155 72,466,268 266,053,086 CONT ALLOW (149,724,907) (48,588,462) (134,734,307) CHARITY (11,101,945) UBI (1,172,000) TOTAL 97,396,248 23,877,806 119,044,834 IRS Form 990 Part XI Line 5 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances are settled through the equity account at the end of each fiscal year to bring the receivable/payable balances to zero. Disclosure Statement Related to Forms 5471 Information return of US persons with respect to certain Foreign corporations filed on behalf of the taxpayer Under the constructive ownership rules of Internal Revenue Code Sections 958(a) and (b), the taxpayer is required to file Forms 5471, Information Return of US persons with respect to certain foreign corporations, as a category 5 filer with respect to certain controlled foreign corporations (cfcs). These filing requirements are or will be satisfied through the filing of Forms 5471 for these cfcs by other US taxpayers identified below who have the same filing requirement. Taxpayer name: Wheaton Franciscan Services, Inc. Address: 26 w171 Roosevelt Road, Wheaton IL 60187 FEIN number of US Tax return with which form 5471 was filed: 36-3262111 IRS Service Center where US Tax return was or will be filed: e-filed WHEATON FRANCISCAN SERVICES INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 363262111 PARENT CORP IL 501(c)(3) 11 - III-FI NA false AFFINITY HEALTH SYSTEM (1) 1570 MIDWAY PLACE MENASHA WI 54942 391638765 HOLDING CO IL 501(c)(3) 11 - I WFSIMHC false AUXILIARY OF ST ELIZABETH HOSP INC (1) 1506 SOUTH ONEIDA STREET APPLETON WI 54915 396077331 AUXILIARY WI 501(c)(3) 11 - III-O ST ELIZ HOSP false CALUMET MEDICAL CENTER INC (1) 614 MEMORIAL DRIVE CHILTON WI 53014 390905385 HOSPITAL WI 501(c)(3) 3 AFF HLTH SYS false MERCY MEDICAL CENTER OF OSHKOSH INC (1) 500 SOUTH OAKWOOD ROAD OSHKOSH WI 54904 390806268 HOSPITAL WI 501(c)(3) 3 AFF HLTH SYS false NETWORK HEALTH SYSTEM INC (1) 1570 MIDWAY PLACE MENASHA WI 54942 391127163 MED GROUP WI 501(c)(3) 3 AFF HLTH SYS false ST ELIZABETH HOSPITAL COMM FNDN INC(1) 1506 SOUTH ONEIDA STREET APPLETON WI 54915 391256677 FOUNDATION WI 501(c)(3) 11 - I AFF HLTH SYS false ST ELIZABETH HOSPITAL INC (1) 1506 SOUTH ONEIDA STREET APPLETON WI 54915 390816818 HOSPITAL WI 501(c)(3) 3 AFF HLTH SYS false WFH - SOUTHEAST WISCONSIN INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391568865 HOLDING CO IL 501(c)(3) 11 - III-FI WFSI false WFH - ALL SAINTS INC 3801 SPRING STREET RACINE WI 53405 391264986 HOSPITAL WI 501(c)(3) 3 WFH-SE WI false WFH - ALL SAINTS FOUNDATION INC 3805B SPRING STREET RACINE WI 53405 391570877 FOUNDATION WI 501(c)(3) 11 - I WFH-AS INC false VOLUNTEERS IN PTNRSHIP WITH WFH-AS INC 3801 SPRING STREET RACINE WI 53405 930838390 FOUNDATION WI 501(c)(3) 11 - III-O WFH-AS INC false WFH - CIRCLE OF LIFE FOUNDATION INC 4300 WEST BROWN DEER RD STE250 BROWN DEER WI 53223 562426294 FOUNDATION WI 501(c)(3) 11 - I WFH-PE false WHEATON FRAN HOME HEALTH & HOSPICE INC 3070 NORTH 51ST STREET STE 406 MILWAUKEE WI 53210 391559428 HOME HLTH WI 501(c)(3) 3 WFH-SE WI false WHEATON FRANCISCAN MEDICAL GROUP INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391791586 MED GROUP WI 501(c)(3) 3 WFH-SE WI false WHEATON FRANCISCAN -ELMBROOK FNDN 19333 WEST NORTH AVENUE BROOKFIELD WI 53045 392028808 FOUNDATION WI 501(c)(3) 11 - I WF INC false WHEATON FRANCISCAN LABORATORIES INC 3237 SOUTH 16TH STREET MILWAUKEE WI 53215 391701402 LABORATORY WI 501(c)(3) 9 WFH-SE WI false WFH PHARMACY ENT AND FRAN WOODS INC 4300 WEST BROWN DEER RD 2ND FLR BROWN DEER WI 53223 391613624 PHARMACY WI 501(c)(3) 9 WFH-SE WI false WFH - ST FRANCIS INC 3237 SOUTH 16TH STREET MILWAUKEE WI 53215 390907740 HOSPITAL WI 501(c)(3) 3 WFH-SE WI false WF - ST JOSEPH FOUNDATION INC 5000 WEST CHAMBERS STREET MILWAUKEE WI 53210 391636804 FOUNDATION WI 501(c)(3) 11 - I WF INC false WHEATON FRANCISCAN INC 5000 WEST CHAMBERS STREET MILWAUKEE WI 53210 390816857 HOSPITAL WI 501(c)(3) 3 WFH-SE WI false WFH-FNDN FOR ST FRANCIS AND FRANKLIN INC 3237 SOUTH 16TH STREET MILWAUKEE WI 53215 320135258 FOUNDATION WI 501(c)(3) 11 - I WFH-SFH false WFH - TERRACE AT ST FRANCIS INC 3200 SOUTH 20TH STREET MILWAUKEE WI 53215 391486775 NURSING HOME WI 501(c)(3) 9 WFH-SE WI false WFH - FRANKLIN INC 10101 SOUTH 27TH STREET FRANKLIN WI 53132 562592868 HOSPITAL WI 501(c)(3) 3 WFH-SE WI false WHEATON WAY CONDO OWNERS ASSCN INC 10101 SOUTH 27TH STREET FRANKLIN WI 53132 300659830 CONDO ASSCN WI N/A N/A WFH-FRKLN false METRO PHYSICIANS INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 943436893 MED GROUP WI 501(c)(3) 3 WFMG false MARIANJOY INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 363483589 HOLDING CO IL 501(c)(3) 11 - III-FI WFSI false MARIANJOY FOUNDATION INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 352165613 FOUNDATION IL 501(c)(3) 7 MJ HOSP false MARIANJOY REHAB CENTER AUXILIARY INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 363896976 AUXILIARY IL 501(c)(3) 11 - I MJ HOSP false MARIANJOY REHAB HOSPITAL & CLINICS INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 362680776 REHAB HOSPITA IL 501(c)(3) 3 MARIANJOY false REHABILITATION MEDICINE CLINIC INC 26 W 171 ROOSEVELT RD WHEATON IL 60187 363236791 MEDICAL GRP IL 501(c)(3) 3 MARIANJOY false OSF SERVICES INC PO Box 667 WHEATON IL 601870667 391471463 HOLDING CO WI 501(c)(3) 11 - III-FI WFSI false CANTICLE MINISTRIES INC PO Box 667 WHEATON IL 601870667 364091836 HOUSING/ADVCY IL 501(c)(3) 7 OSF SVCS INC false CLARA PFAENDER FUND INC (2) PO Box 667 WHEATON IL 601870667 363353311 SPONSORSHIP IL 501(c)(3) 11 - III-O OSF SVCS INC false FRANCISCAN SISTERS CHARITABLE FUND OF CO 2626 OSCEOLA STREET DENVER CO 80212 840733072 AUXILIARY CO 501(c)(3) 7 OSF SVCS INC false RUSH OAK PARK HOSPITAL INC 520 SOUTH MAPLE AVENUE OAK PARK IL 60304 362183812 HOSPITAL IL 501(c)(3) 3 OSF SVCS INC false SET MINISTRY INC 2977 NORTH 50TH STREET MILWAUKEE WI 53210 391618277 SOCIAL WORK WI 501(c)(3) 9 OSF SVCS INC false ST CATHERINE'S HOSPITAL INC 9555 76TH STREET PLEASANT PRAIRIE WI 53158 390855075 HOSPITAL WI 501(c)(3) 3 OSF SVCS INC false SYNERGON HEALTH SYSTEM INC (6) 520 SOUTH MAPLE AVENUE OAK PARK IL 60304 363739067 HOSPITAL IL 501(c)(3) 3 NONE false UHS INC (7) 6308 EIGHTH AVENUE KENOSHA WI 53143 391956749 HOSPITAL WI 501(c)(3) 3 NONE false UPENDO VILLAGE NFP (3) PO Box 667 WHEATON IL 601870667 331007368 HIV SUPPORT IL 501(c)(3) 9 OSF SVCS INC false WFH - IOWA INC 3421 WEST NINTH STREET WATERLOO IA 50702 421177001 HOLDING CO IA 501(c)(3) 11 - III-FI WFSI false COVENANT FOUNDATION INC 3421 WEST NINTH STREET WATERLOO IA 50702 421295784 FOUNDATION IA 501(c)(3) 9 COV MED CTR true MERCY HOSPITAL OF FRANCISCAN SISTERS INC 3421 WEST NINTH STREET WATERLOO IA 50702 421178403 HOSPITAL IA 501(c)(3) 3 WFH-IOWA false NE IOWA REAL ESTATE INVESTMENTS LTD 3421 WEST NINTH STREET WATERLOO IA 50702 421207432 HOLDING CO IA 501(c)(2) N/A WFH-IOWA false SCHOITZ HEALTH RESOURCES INC (9) 3421 WEST NINTH STREET WATERLOO IA 50702 421232935 PROMOTE HLTH IA 501(c)(3) 11 - II NA false SCHOITZ MEDICAL CENTER INC (10) 3421 WEST NINTH STREET WATERLOO IA 50702 420718472 OP ROOM SVCS IA 501(c)(3) 3 SCHOITZ HR false SARTORI HEALTH CARE FOUNDATION INC 3421 WEST NINTH STREET WATERLOO IA 50702 421240996 FOUNDATION IA 501(c)(3) 11 - I SARTORI HOSP false SARTORI MEMORIAL HOSPITAL INC 515 COLLEGE STREET CEDAR FALLS IA 50613 420758901 HOSPITAL IA 501(c)(3) 3 WFH-IOWA false FRANCISCAN MINISTRIES INC 26W171 ROOSEVELT ROAD WHEATON IL 601870667 363259684 HOLDING CO IL 501(c)(3) 11 - III-FI WFSI false ASSISI HOMES - BATAVIA APARTMENTS INC 1259 EAST WILSON STREET BATAVIA IL 60510 363914084 HOUSING IL 501(c)(3) 9 FMI false ASSISI HOMES - COLONY PARK INC 550 EAST THORNHILL DRIVE CAROL STREAM IL 60188 364039278 HOUSING IL 501(c)(3) 9 FMI false ASSISI HOMES - CONSTITUTION HOUSE INC 401 NORTH CONSTITUTION DRIVE AURORA IL 60506 364049150 HOUSING IL 501(c)(3) 9 FMI false ASSISI HOMES - JEFFERSON COURT INC 415 EAST KNAPP STREET MILWAUKEE WI 53202 391771526 HOUSING WI 501(c)(3) 9 FMI false ASSISI HOMES - KENOSHA INC 1860 27TH AVENUE KENOSHA WI 53140 391814815 HOUSING WI 501(c)(3) 9 FMI false ASSISI HOMES - SAXONY INC 1876 22ND AVENUE KENOSHA WI 53140 391790498 HOUSING WI 501(c)(3) 9 FMI false ASSISI HOMES OF GURNEE INC 3495 WEST GRAND AVENUE GURNEE IL 60031 363942336 HOUSING IL 501(c)(3) 9 FMI false ASSISI HOMES OF ILLINOIS INC 2126 WEST ROOSEVELT ROAD WHEATON IL 60187 363803443 HOUSING IL 501(c)(3) 9 FMI false Assisi HOMES OF NEENAH INC 210 BYRD AVENUE NEENAH WI 54946 363767250 HOUSING WI 501(c)(3) 9 FMI false CANTICLE PLACE INC 26W171 ROOSEVELT ROAD WHEATON IL 601870667 363957850 HOUSING IL 501(c)(3) 9 FMI false CATHERINE MARIAN HOUSING INC 806 SOUTH WISCONSIN AVENUE RACINE WI 53403 391657098 HOUSING WI 501(c)(3) 9 FMI false CLARE GARDENS INC 2626 OSCEOLA STREET DENVER CO 80212 237200039 HOUSING CO 501(c)(3) 9 FMI false CLARE OF ASSISI HOMES-WESTMINSTER INC 2451 WEST 82ND PLACE WESTMINSTER CO 80031 742740978 HOUSING CO 501(c)(3) 9 FMI false DAYSPRING VILLA INC 3777 WEST 26TH AVENUE DENVER CO 80211 363933908 HOUSING CO 501(c)(3) 9 FMI false FRANCIS HEIGHTS INC 2626 OSCEOLA STREET DENVER CO 80212 840626174 HOUSING CO 501(c)(3) 9 FMI false FRANCISCAN MINISTRIES COMMUNITY FNDN INC 26W171 ROOSEVELT ROAD WHEATON IL 601870667 364456204 FOUNDATION IL 501(c)(3) 11 - II FMI false FRANCISCAN SENIORS KENOSHA INC (4) 1920 27TH AVENUE KENOSHA WI 53140 391821568 HOUSING WI 501(c)(3) 9 FMI false MARIAN HOUSING CENTER INC 4105 SPRING STREET RACINE WI 53405 391515867 HOUSING WI 501(c)(3) 9 FMI false MARIAN PARK INC 2126 WEST ROOSEVELT ROAD WHEATON IL 60187 362750105 HOUSING IL 501(c)(3) 9 FMI false RIDGEWAY PLACE INC 155 EAST RIDGEWAY AVENUE WATERLOO IA 50702 421416064 HOUSING IA 501(c)(3) 9 FMI false STARVED ROCK-LASALLE MANOR INC (5) 1135 10TH STREET LASALLE IL 61301 363796933 HOUSING IL 501(c)(3) 9 FMI false VILLA MARIA INC 2461 WEST 82ND PLACE WESTMINSTER CO 80031 841347868 HOUSING CO 501(c)(3) 9 FMI false VILLA ST CLARE INC 130 BYRD AVENUE NEENAH WI 54946 391769395 HOUSING WI 501(c)(3) 9 FMI false ASSISI HOMES LASALLE MANOR INC 26W171 ROOSEVELT ROAD WHEATON IL 601890795 800623447 HOUSING IL 501(c)(3) 9 FMI false KENOSHA SNR(4) PO BOX 667 WHEATON IL 60187 391801541 HOUSING WI FR SNRS 0 STARVED ROCK PO BOX 667 WHEATON IL 60187 363811835 HOUSING IL SRLM INC 0 NETWORK HEALTH INSURANCE CORPORATION 1570 MIDWAY PLACE MENASHA WI 54942 392020474 INSURANCE CO WI NETWK HLTH SY C CORP NETWORK HEALTH PLAN 1570 MIDWAY PLACE MENASHA WI 54942 391442058 HLTH MAINT ORG WI NETWK HLTH SY C CORP WHEATON FRANCISCAN ENTERPRISES INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391985204 HOLDING CO WI WF HOLDINGS INC C CORP WHEATON FRANCISCAN HOLDINGS INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391836357 HOLDING CO WI WFH-SE WI C CORP WHEATON FRANCISCAN MED GRP-SUSSEX INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391361100 MED GROUP WI WF HOLDINGS INC C CORP WHEATON FRANCISCAN PROVIDER NETWORK INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391952140 ADMIN SUPPORT WI WFH-SE WI C CORP COVENANT REGIONAL SERVICES INC (8) 3421 WEST NINTH STREET WATERLOO IA 50702 421189805 PHARMACY IA WFH-IOWA C CORP WHEATON FRANCISCAN INSURANCE COMPANY 980691609 FINANCIAL UK WFSI false true true true true false false true true true true true true true true true true true Covenant Foundation Inc C 1651745 Book Value Covenant Foundation Inc B 85563 Book Value Schedule R Disclosures Various - See the following references Part II (1) Wheaton Franciscan Healthcare's 50% interest in Affinity Healthcare was sold to Ministry Healthcare on February 8, 2012. As such, this is the last fiscal year these Affinity organizations will be reported as related organizations. (2) Effective June 30, 2012, Clara Pfaender Fund Inc. was merged with Wheaton Franciscan Services, Inc. (FEIN #36-3262111). (3) Upendo Village NFP joined the Wheaton Franciscan Healthcare system under O.S.F. Services, Inc. effective November 17, 2011. (4) Franciscan Seniors, Kenosha, Inc. sold its interest in Kenosha Seniors Limited Partnership effective August 31, 2011 and subsequently dissolved effective March 29, 2012. (5) Starved Rock - LaSalle Manor, Inc. was dissolved effective June 12, 2012. (6) Synergon Health System Inc is listed with no direct controlling entity because of the two organizations with an interest, Rush Presbyterian and OSF Services Inc, neither can appoint a majority of the board, therefore neither organization "controls". (7) UHS, Inc. is listed without a direct controlling entity because of the two organizations with an interest, KHMC Community Board and OSF Services 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) Related only to the following organizations: Schoitz Medical Center, Covenant Medical Center, Wheaton Franciscan Healthcare-Iowa, Covenant Regional Services, Mercy Hospital of Fransican Sisters, and NE Iowa Real Estate Investments. (10) Related only to the following organizations: Schoitz Health Resources, Covenant Medical Center, Wheaton Franciscan Healthcare-Iowa, Covenant Regional Services, Mercy Hospital of Franciscan Sisters, and NE Iowa Real Estate Investments. Part IV (8) Covenant Regional Services, Inc. was dissolved effective September 30, 2011.