ASCENSION ST CLARES HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ASCENSION ST CLARES HOSPITAL INC (EIN 72-1531917)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-08
IRS object ID
201302209349300995
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-08T12:58:15-07:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN721531917EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST CLARES HOSPITAL OF WESTON INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTCLNameControl
Phone7153933000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13400 MINISTRY PARKWAYAddressLine1
CityWESTONCity
StateWIState
ZIP Code54476ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARY KRUEGERName
TitlePRESIDENT & COOTitle
Date Signed2013-08-08DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARY KRUEGERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13400 MINISTRY PARKWAYAddressLine1
CityWESTONCity
StateWIState
ZIP Code54476ZIPCode
FieldValueIRS element (for citing)
Gross Receipts105178108GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.MINISTRYHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionST CLARES MISSION AS A CATHOLIC HOSPITAL IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR. WE PROVIDE ACUTE HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF A PERSON'S ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees579TotalNbrEmployees
Total Nbr Volunteers176TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year32381ContributionsGrantsPriorYear
Contributions Grants Current Year65817ContributionsGrantsCurrentYear
Program Service Revenue Prior Year94941769ProgramServiceRevenuePriorYear
Program Service Revenue CY105494505ProgramServiceRevenueCY
Investment Income Prior Year8653InvestmentIncomePriorYear
Investment Income Current Year4864InvestmentIncomeCurrentYear
Other Revenue Prior Year-3190337OtherRevenuePriorYear
Other Revenue Current Year-405704OtherRevenueCurrentYear
Total Revenue Prior Year91792466TotalRevenuePriorYear
Total Revenue Current Year105159482TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year34796787SalariesEtcPriorYear
Salaries Etc Current Year37513269SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year58544424OtherExpensePriorYear
Other Expenses Current Year63653800OtherExpensesCurrentYear
Total Expenses Prior Year93341211TotalExpensesPriorYear
Total Expenses Current Year101167069TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1548745RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3992413RevenuesLessExpensesCY
Total Assets BOY133806222TotalAssetsBOY
Total Assets EOY124177623TotalAssetsEOY
Total Liabilities BOY185701402TotalLiabilitiesBOY
Total Liabilities EOY183714934TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-51895180NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-59537311NetAssetsOrFundBalancesEOY
Mission DescriptionST CLARES MISSION AS A CATHOLIC HOSPITAL IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR. WE PROVIDE ACUTE HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF A PERSON'S ABILITY TO PAY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense96064104Expense
Revenue104221081Revenue
DescriptionTHE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY ROOM AND ANCILLARY SERVICES REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY OR METHOD OF PAYMENT. THE HOSPITAL ALSO PROVIDES EDUCATIONAL PROGRAMS AND SERVICES ON HEALTH CARE ISSUES TO THE COMMUNITY IT SERVES. SEE SCHEDULE H FOR FURTHER DETAILS.Description
Total Program Service Expense96064104TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershiptrueActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109649NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees579NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJEFF BADGER VP CORP FIN TRSNamePerson
Telephone Number7153433163TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14941 KIRSCHLING CRTAddressLine1
CitySTEVENS PTCity
StateWIState
ZIP Code54481ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
TEE DALY
BOARD MEMBER0.25X000
SISTER MARIA VINTON
BOARD MEMBER0.25X000
JOANNE LEONARD
BOARD MEMBER0.25X000
MIKE KRYDA
SECR/TREASURER0.25X045375516573X
MARY JO JOHNSON
BOARD MEMBER0.25X000
KEVIN NOEL
BOARD MEMBER0.25X000
KRISTINE GILMORE
CHAIRPERSN0.25X000X
TIM BODETTE
VICE CHAIRPERSN0.25X000X
JIM FRINGS
BOARD MEMBER0.25X000
THOMAS FELCH
BOARD MEMBER0.25X000
LARRY HEGLAND
CHIEF MED OFFCR10.00X038458937079X
MARY KRUEGER
PRESIDENT & COO40.00X038186740444X
JEFF MARTIN
REGIONAL CEO6.00X080421145600X
KRISTINE MCGARIGLE
VP-CLINCL OPER0.25019450532211X
RACHEL YARON
VP-QLTY & SFTY20.00019991913168X
COLLEEN HOERNEMAN
VP-PATIENT CARE40.00020255022263X
WILLIAM HINNER
VP-FIN ANALYSIS0.25033870347433X
MAHER SALEM
CLINCL PHARMACIST40.00122258018900X
RAYMOND BAKER
CLINCL PHARMACIST40.00120686021883X
SUSAN DRAEGER
CLINICL PHARMACIST40.0012094108837X
MARIA HEGLAND
CLINICL PHARMACIST40.0012421203182X
ROBERT MIDDLETON
PHARMACY DIRECTOR40.00138197024425X
FieldValueIRS element (for citing)
Total Reportable Comp From Org626294TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2960099TotalReportableCompFrmRltdOrgs
Total Other Compensation331998TotalOtherCompensation
Number Individuals GT100 K18NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDDATA
PO BOX 2065SEATTLEWA981112065BILLING SERVICES383344
MARSHFIELD CLINIC
1000 NORTH OAK AVEMARSHFIELDWI544495779MEDICAL SERVCS/STFF918791
JUDGES CLEANERS INC
2150 MAPLE DRIVEPLOVERWI54467LAUNDRY SERVICES391176
JOHNSON CONTROLS
PO BOX 905240CHARLOTTENC282905240EQUIP INSTL & MAINT462950
ADVANCE ICU CARE
PO BOX 790379ST LOUISMO63179MEDICAL SERVICES450000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
Related Organizations48828RelatedOrganizations
Government Grants16989GovernmentGrants
Total Contributions65817TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RENT INCOMES532000920567920567
PROGRAM SERVICE REVENUES9000999628412596284125
DTC INCOME62150070905087090508
CAPITAL LEASE INTEREST90009911993051199305
FieldValueIRS element (for citing)
Total Program Service Revenue105494505TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column22438TotalRevenueColumn
Exclusion$22,438ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real35438Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real35438Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column35438TotalRevenueColumn
Exclusion$35,438ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1052Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other18626Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-17574Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-17574TotalRevenueColumn
Exclusion-$17,574ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
STIMULUS DOLLARS90009924538722453872
MINISTRY HOSPICE621610284002284002
CAFETERIA722210697713$697,713

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column-3876729TotalRevenueColumn
Related Or Exempt Function Income-4011298RelatedOrExemptFunctionIncome
Exclusion$134,569ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue-441142TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column105159482TotalRevenueColumn
Related Or Exempt Function Income104221081RelatedOrExemptFunctionIncome
Exclusion$872,584ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total29723376Total
Program Services28041352ProgramServices
Management And General1682024ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1447409Total
Program Services1438107ProgramServices
Management And General9302ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4637043Total
Program Services4174521ProgramServices
Management And General462522ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1705441Total
Program Services1670627ProgramServices
Management And General34814ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total186007Total
Program Services5750ProgramServices
Management And General180257ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total2000Total
Program Services2000ProgramServices

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2334120Total
Program Services2225921ProgramServices
Management And General108199ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total173374Total
Management And General173374ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13540066Total
Program Services13350853ProgramServices
Management And General189213ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2258361Total
Program Services2256742ProgramServices
Management And General1619ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1454573Total
Program Services1455506ProgramServices
Management And General-933ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total52088Total
Program Services41217ProgramServices
Management And General10871ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total189185Total
Program Services126583ProgramServices
Management And General62602ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total10798642Total
Program Services10798642ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6773318Total
Program Services6637273ProgramServices
Management And General136045ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total156857Total
Program Services152442ProgramServices
Management And General4415ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Pharmaceuticals26339232633923
BAD DEBT44003054400305
UNDERARRANGEMENTS73036547303654
PURCHASED SERVICES78367146996666840048

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3560613Total
Program Services2352020ProgramServices
Management And General1208593ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total101167069Total
Program Services96064104ProgramServices
Management And General5102965ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1400BOY
EOY1700EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4904210BOY
EOY6468575EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9346220BOY
EOY11090899EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2219091BOY
EOY1971086EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY287536BOY
EOY306793EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis126591189LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec52833509LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY76378331BOY
EOY73757680EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY40669434BOY
EOY30580890EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY133806222BOY
EOY124177623EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY30692526BOY
EOY31134008EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY479455BOY
EOY455047EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY154529421BOY
EOY152125879EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY185701402BOY
EOY183714934EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-51895180BOY
EOY-59537311EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-51895180BOY
EOY-59537311EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY133806222BOY
EOY124177623EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3992413ReconcilationRevenueExpenses
Reconcilation Other Changes-11634544ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$7,780OtherActivitiesAmount
Total Lobbying Expenditures IIB7780TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationST CLARE'S HOSPITAL OF WESTON INC BELONGS TO A NUMBER OF TRADE ASSOCIATIONS (WHA,CHA,AHA,RWHC,MGMA). THESE ASSOCIATIONS ARE PAID ANNUAL DUES AND A PERCENTAGE OF THE DUES ARE RELATED TO LOBBYING DONE BY THE TRADE ASSOCIATION. LOBBY PERCENTAGES RANGE BETWEEN 5%-24% OF THE ANNUAL AMOUNTS. THE AMOUNT REPORTED ON SCHEDULE C, PT II-B, LINE 1(i) REPRESENTS THE SUM OF ALL TRADE ASSOCIATION DUES RELATED TO LOBBY EXPENSE.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1558074OtherCostOrOtherBasis
Book Value1558074BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis90359671OtherCostOrOtherBasis
Depreciation26177297Depreciation
Book Value64182374BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1179942OtherCostOrOtherBasis
Depreciation876480Depreciation
Book Value303462BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis33493502OtherCostOrOtherBasis
Depreciation25779732Depreciation
Book Value7713770BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings73757680TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
OTHER ACCOUNTS RECEIVABLE2687002
INVESTMENT IN DTC4955336
CAPITAL LEASE22938552
FieldValueIRS element (for citing)
Total Book Value Other Assets30580890TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
NOTE PAYABLE TO MHC (RELATED PARTY)$152,139,637
EST DUE TO THIRD PARTY PAYOR-$13,758
FieldValueIRS element (for citing)
Total Of Amounts152125879TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XI, Line 8Identifier
Return ReferencePart XI, Line 8: Other Changes in Net Assets or Fund BalancesReturnReference
ExplanationCASH TRANSFER TO ST CLARES FOUNDATION $ -7682 SJH OUTREACH ALLOCATION $ -2199997 HOSPICE/HOME HEALTH $ -121870 EHR FUNDING $ -154505 DTC INVESTMENT TRNSFR $ -9150490Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1038620TotalCommunityBenefitExpense
Net Community Benefit Expense1038620NetCommunityBenefitExpense
Percent Of Total Expense0.01030PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense11338837TotalCommunityBenefitExpense
Direct Offsetting Revenue9218837DirectOffsettingRevenue
Net Community Benefit Expense2120000NetCommunityBenefitExpense
Percent Of Total Expense0.02100PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense12377457TotalCommunityBenefitExpense
Direct Offsetting Revenue9218837DirectOffsettingRevenue
Net Community Benefit Expense3158620NetCommunityBenefitExpense
Percent Of Total Expense0.03130PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served80PersonsServed
Total Community Benefit Expense60214TotalCommunityBenefitExpense
Net Community Benefit Expense60214NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served29PersonsServed
Total Community Benefit Expense122891TotalCommunityBenefitExpense
Direct Offsetting Revenue3000DirectOffsettingRevenue
Net Community Benefit Expense119891NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Total Community Benefit Expense82391TotalCommunityBenefitExpense
Net Community Benefit Expense82391NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs24NumberOfActivitiesOrPrograms
Persons Served109PersonsServed
Total Community Benefit Expense265496TotalCommunityBenefitExpense
Direct Offsetting Revenue3000DirectOffsettingRevenue
Net Community Benefit Expense262496NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs24NumberOfActivitiesOrPrograms
Persons Served109PersonsServed
Total Community Benefit Expense12642953TotalCommunityBenefitExpense
Direct Offsetting Revenue9221837DirectOffsettingRevenue
Net Community Benefit Expense3421116NetCommunityBenefitExpense
Percent Of Total Expense0.03390PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense40660TotalCommunityBuildingExpense
Net Community Building Expense40660NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense4290TotalCommunityBuildingExpense
Net Community Building Expense4290NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense44950TotalCommunityBuildingExpense
Net Community Building Expense44950NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$4,401,362BadDebtExpenseAmount
Amount Reimbursed By Medicare40442921AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare51208198CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10765277MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1THE DIAGNOSTIC & TRMNT CNTRBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityOUTPATIENT/DIAGNOSTIC SERVSDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST CLARES HOSPITAL OF WESTONBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13400 MINISTRY PARKWAYAddressLine1
CityWESTONCity
StateWIState
ZIP Code54476ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST CLARES HOSPITAL OF WESTONBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Other ActionsXPermitOtherActions
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE DIAGNOSTIC & TREATMENT CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13401 CRANBERRY BLVDAddressLine1
CityWESTONCity
StateWIState
ZIP Code54476ZIPCode
FieldValueIRS element (for citing)
Facility TypeOUTPATIENT/DIAGNOSTIC SERVICESFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - States Where Community Benefit Report FiledWI
Part VI - Affilated Health Care System Roles and PromotionThe organization is part of an affiliated health care system called Ministry Health Care, Inc. The mission of Ministry as a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well being of all people, especially the poor, in the communities served. Ministry supports such non-hospital facilities as the Agape Community Center. As a community center, it has the unique advantage of welcoming youth, adults, families and seniors into the facility through a broad range of educational, social, recreational, cultural, health and life-long learning opportunities in an impoverished portion of Milwaukee. Our Catholic Identity expects leaders to initiate and support efforts to reach out to the poor and vulnerable people, especially where no one else wants to go. Health care can become very bureaucratic and burdened with oversight of finances, regulatory requirements and strategic planning. Our focus on these issues may cause us to lose touch with those for whom we have a primary responsibility-those who are poor and vulnerable. Tithing of time allows us to look into the face of the poor, hear the voice of the poor, and help us better understand the daily challenges and barriers they face. As an affiliated health system, all leaders with direct reports are required to provide service to the poor. This also includes physician leaders and hourly supervisory staff. The organization has a foundation which is not included within the operations of the organization. The foundation provides programs and cash donations which help support the mission of the organization and the affiliated health care system.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeThe organization strives to further its exempt purposes by the following: (1) The organization's governing board consists primarily of persons who reside within the primary service area. They are not employees of the organization. (2) As mentioned, the organization provides several services which are not otherwise available being in an urban setting. (3) Based on the organization's mission, emergency rooms are made available to all patients regardless of the ability to pay. (4) The organization also participates in the education and training of healthcare professionals through internship programs.St. Clare's Hospital is also involved in the following efforts to further its tax exempt status. Examples Include: The hospital participates in government-sponsored health programs (Medicare, Medicaid, CHAMPUS, Tricare)The role of the emergency department in serving all persons regardless of ability to pay.Financial assistance available based on individual circumstances and subject to sliding scale discounts.St. Clare's Hospital offers a volunteer services program where community members utilize the hospital as a vehicle to connect with and contribute to individuals and the overall community through volunteering.
Part VI - Community Building ActivitiesCommunity-building activities include 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 problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include cash, in-kind donations, and expenditures for the development of a variety of community health programs and partnerships.St. Clare's Hospital in collaboration with the community, help to identify various health problems affecting the surrounding area, causes leading to these health problems, and actions taken to communicate these issues. These are being done with various health fairs and education related to those at-risk population. The organization in conjunction with its foundation have a fund set up for patients who may need assistance with food, medication, clothing, transportation or basic needs when they leave the hospital.
Part VI - Community InformationWhile there is growing agreement in the United States about what constitutes a non-profit hospital's 'community benefit', this is a work in progress. The organization provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. Our hospital, like most hospitals, was created and is maintained in order to provide care locally-care that without our hospital, would not be available locally.Certain specialized services available include: emergency services, surgical services, inpatient medical services, & obstetrics.St. Clare's Hospital serves Weston, WI and the surrounding areas including Schofield, Rothschild, Rib Mountain, & Wausau.As of the 2010 Census, Weston had a population of 14,868. An increase of 23.1% compared to the 2000 census data. There were 5,796 households based on 2007-2011 data, with an average person per household being 2.49. The median household income was $55,636 and there were 6.1% of the population below the poverty level.In the village the population was spread out with 29.6% age 19 & under, 26.7% from 20 to 39, 32.1% from 40 to 64, 19.7% from 45 to 64, and 11.6% who were 65 years of age or older.
Part VI - Patient Education of Eligibility for AssistanceThe organization has financial counselors located at every hospital. If a patient indicates they are unable to pay their bill at any point during pre-service, admission, discharge or billing process, the financial counselors will assist the patient in either securing a funding source (grants, COBRA coverage, Disability benefits, Medicaid, VA, etc) if eligible or assist them in completing a financial assistance application.
Part VI - Needs AssessmentThe organization performs community needs assessments as needed. Planning workgroups consisting of community partners are formed to define the community and its needs through review of Health People Initiatives, census documents, and local government health and welfare agencies. Considering other community resources/assets, data collection methods are used to identify particular problems or subgroups and areas known to have high poverty rates and to be underserved. The data is analyzed and priorities are set based on trending information which may target a specific need. When a need is identified, the hospital develops a plan to implement a program either through community collaboration or individually. Outcomes from the programs are measured and considered in subsequent community needs assessments. Community benefit plans are presented to senior leadership and board members to ensure the findings are incorporated into the organization's strategy and policy development. For example, senior leaders are required to provide direct service to the poor hours as part of their performance goals.
Part V, Line 15e - Other Collection Actions Against a PatientMinistry makes every effort to determine patient's eligibility for assistance prior to billing. If patient is uncooperative or unresponsive, the patient account may be referred to a collection agency for further billing effort. If patient does indicate inability to pay, we will stop collection efforts and work with patient to complete a financial assistance application. We do not file liens, lawsuits, or report to credit agency, until all determination efforts have been exhausted.Number of Hospital Faciltiy - 0
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsThe organization has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts.
Part I, Line 7, Column F - Explanation of Bad Debt ExpenseBad Debt expense of $4,400,305 is excluded from total operating expenses of $101,167,069 when calculating percentage of total expense in Part I, Line 7, Col F.
Part I, Line 7 - Explanation of Costing MethodologyAmounts calculated in Part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other Benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with Worksheet 2, Ratio of Patient Care Cost to Charges.
Part I, Line 6a - Related Organization Community Benefit ReportAs part of Ministry Health Care, Inc., the organization files an annual community benefit report for all owned entities on its webpage. The report can be viewed by visiting www.ministryhealth.org/MinistryHealth/Community.nws. Each facility is included within the report.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
WILLIAM HINNER
23858856804433113053116902386136
ROBERT MIDDLETON
1333284869285821567162622
RACHEL YARON
127933393263266012419749213087
MIKE KRYDA
2005256501018822081608413470328
MARY KRUEGER
21240488601808622471615728422311
LARRY HEGLAND
24025362426819101908017999421668
KRISTINE MCGARIGLE
13698437730197911445017761226716
JEFF MARTIN
4225182080461736472955616044849811
COLLEEN HOERNEMAN
1333513657032629207971466224813

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 1aIdentifier
Return ReferencePart I, Line 1a: Relevant information in regards to selections on 1a.ReturnReference
ExplanationSOCIAL CLUB DUES PROVIDED ON BEHALF OF:MARY KRUEGER $5,097LARRY HEGLAND $5,097Explanation

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F99012734NoncashContribsRptdF990

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99014899NoncashContribsRptdF990
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990 PART IX LINE 24 - OTHER EXPSEXECUTIVES ARE EMPLOYED BY MINISTRY HEALTH CARE INC (39-1490371) AND THEIR SALARIES AND BENEFITS ARE ALLOCATED TO INDIVIDUAL FACILITIES BASED ON HOURS DEDICATED. ST CLARES REIMBURSES THE CORPORATE OFFICE FOR ITS SHARE AND THESE EXPENSES ARE INCLUDED ON FORM 990, PART IX, LINE 24 UNDER MINISTRY EXECUTIVE SERVICES. PLEASE SEE FORM 990 PART VII SECTION A AND SCHEDULE J FOR ADDITIONAL DISCLOSURES REGARDING EXECUTIVE COMPENSATION.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableTHE MINISTRY WEB PAGE IS AVAILABLE TO THE PUBLIC FOR INSPECTION WITH A GOOD DEAL OF INFORMATION REGARDING WHOM MINISTRY HEALTH CARE IS AND THE ENTITIES INCLUDED ALONG WITH OUR MISSION. THE ARTICLES OF INCORPORATION, BYLAWS, CONFLICTS POLICY, AND FINANCIAL STATEMENTS ARE NOT INCLUDED ON ANY WEB PAGE. HOWEVER IF AN INQUIRY IS MADE FOR ANY DOCUMENTS THEY ARE SHARED AS APPROPRIATE.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesTHE MINISTRY BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT IS ASSISTED BY AN INDEPENDENT OUTSIDE CONSULTING FIRM; SULLIVAN COTTER. SULLIVAN COTTER, IN PARTNERSHIP WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, REVIEWS MARKET DATA FOR COMPENSATION AND BENEFITS AND COMPARABILITY DATA ON EVERY MINISTRY HEALTH CARE EXECUTIVE.Form 990, Part VI, Line 15b
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsTHE BOARD MEMBERS COMPLETE EACH YEAR A "BOARD OF DIRECTORS CONFLICT OF INTEREST & INSIDER TRANSACTION POLICY QUESTIONNAIRE". A STANDARD ANNUAL REFRESHER IS COMPLETED EACH YEAR IN THE FALL. ANY SIGNIFICANT REPORTED ITEMS ARE CORRECTED PROMPTLY THROUGH THE MINISTRY CORPORATE COMPLIANCE OFFICER AND LOCAL ADMINISTRATOR.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessFORM 990 IS COMPLETED THROUGH JOINT EFFORTS OF SHARED FINANCE FUNCTION WITH REVIEW AND GUIDANCE OF LEGAL COUNCIL AND CORPORATE OVERSIGHT. FORM 990 WAS NOT PRESENTED TO THE HOSPITAL'S GOVERNING BODY BEFORE THE FILING DEADLINE DUE TO TIME CONSTRAINTS. THE PRESIDENT & FINANCE DIRECTOR WILL PRESENT AND BRIEFLY EXPLAIN THE FORM AND ITS PURPOSE AT THE NEXT BOARD MEETING IN AUGUST 2013.Form 990, Part VI, Line 11
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersMINISTRY HEALTH CARE INC HAS CERTAIN RESERVES AND INFLUENTIAL POWERS OVER ALL OF ITS WHOLLY OWNED HEALTHCARE FACILITIES. ST CLARE'S HOSPITAL IS ONE OF MINISTRY HEALTH CARE'S OWNED FACILITIES.Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyMINISTRY HEALTH CARE INC HAS CERTAIN RESERVES AND INFLUENTIAL POWERS OVER ALL OF ITS WHOLLY OWNED HEALTHCARE FACILITIES. ST CLARE'S HOSPITAL IS ONE OF MINISTRY HEALTH CARE'S OWNED FACILITIES.Form 990, Part VI, Line 7a
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderMINISTRY HEALTH CARE INC HAS CERTAIN RESERVES AND INFLUENTIAL POWERS OVER ALL OF ITS WHOLLY OWNED HEALTHCARE FACILITIES. ST CLARE'S HOSPITAL IS ONE OF MINISTRY HEALTH CARE'S OWNED FACILITIES.Form 990, Part VI, Line 6

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
FOUNDATION OF ST CLARES HOSPITAL
3400 MINISTRY PARKWAYWESTONWI54476753193633FOUNDATIONWI501(c)(3)11-1N/Atrue
MINISTRY HEALTH CARE
11925 W LAKE PARK DRMILWAUKEEWI53224391490371MANAGEMENT COMPANYWI501(c)(3)11-ON/Afalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
FOUNDATION OF ST CLARES HOSPITAL
q7681GL DETAIL
FOUNDATION OF ST CLARES HOSPITAL
n-131PAYROLL JRNL
FOUNDATION OF ST CLARES HOSPITAL
c36095DISTR JRNL
MINISTRY HEALTH CARE
o16512086COST
MINISTRY HEALTH CARE
n5338829PAY RECORDS
MINISTRY HEALTH CARE
i10572SQ FTG FMV
MINISTRY HEALTH CARE
e152139638PRINCIPLE PYMNT

Form990 Schedule R Part VI Form990ScheduleRPartVI

Name Of Business NameOfBusiness

FieldValueIRS element (for citing)
Business Name Line1THE DIAGNOSTIC & TREATMENT CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13401 CRANBERRY BLVDAddressLine1
CityWESTONCity
StateWIState
ZIP Code54476ZIPCode
FieldValueIRS element (for citing)
EIN200691634EIN
Primary ActivityOUTPATIENT SERVICESPrimaryActivity
Legal Domicile StateWILegalDomicileState
All Partners C3 StrueAllPartnersC3S
Share Of EOY Assets4965987ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner

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