SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
St Clare's Hospital of Weston Inc
 
Employer identification number

72-1531917
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    328,258 0 328,258 0.31 %
b Medicaid (from Worksheet 3, column a) . . . . .     12,216,317 12,955,701 -739,384 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 12,544,575 12,955,701 -411,126 0.31 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 18 404 413,810 13,087 400,723 0.38 %
f Health professions education (from Worksheet 5) . . . 5 0 183,736 0 183,736 0.17 %
g Subsidized health services (from Worksheet 6) . . . . 2   23,540 2,974 20,566 0.02 %
h Research (from Worksheet 7) .     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 11   232,660 7,598 225,062 0.21 %
j Total. Other Benefits . . 36 404 853,746 23,659 830,087 0.78 %
k Total. Add lines 7d and 7j . 36 404 13,398,321 12,979,360 418,961 1.10 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support 4   28,387   28,387 0.03 %
4 Environmental improvements         0 0 %
5 Leadership development and training for community members 1   1,500   1,500 0 %
6 Coalition building 3   64,190   64,190 0.06 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 8 0 94,077 0 94,077 0.09 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,134,452
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
46,161,378
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
53,374,319
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-7,212,941
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Saint Clare's Hospital of Weston Inc
3400 Ministry Parkway
Weston,WI54476
www.ministryhealth.org
310 		X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Saint Clare's Hospital of Weston Inc
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://ministryhealth.org/SaintClaresHospital0/MSCH_Implementation_Plan_2013_12_3_2014REV.pdf
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Saint Clare's Hospital of Weston Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Saint Clare's Hospital of Weston Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Saint Clare's Hospital of Weston, Inc.. In the past decade, representatives from health care, business and other community resources have been actively engaged in the Marathon County LIFE report and Healthy Marathon County Board structures in an effort to positively impact the quality of life in this county. These committees regularly analyze and publicly report progress made on the key priorities that were identified through the assessment process. They also review updated data and reprioritize the key issues impacting health and quality of life, in an effort to continually realign resources to take action on those priorities. Ministry Saint Clare's leadership participates on The Marathon County LIFE Report Steering Committee. United Way of Marathon County serves as the lead agent for this committee of community partners who collaboratively seeks to maximize opportunities to analyze, strategize and ultimately implement plans to address community health care needs. The four major health care systems of the region are active leaders on this committee and include Ministry Health Care, Aspirus, Marshfield Clinic and Marathon County Public Health. Participants also include governmental and business representatives, as well as other community organizations and volunteer community representatives. The Healthy Marathon County Board of Directors is comprised of diverse organizations working together to make a healthier community. Healthy Marathon County serves as the oversight board for Marathon County's Community Health Improvement Plan to ensure the success of the Action Teams tasked with addressing identified health priorities. Ministry Saint Clare's Hospital leadership also serves on this Board. Detailed analysis of health issues was conducted by the Health and Wellness Sub-Committee, a collaborative team comprised of membership from the LIFE steering committee, the Healthy Marathon County Board, and representation from the community. Six representatives of Ministry Saint Clare's Hospital were liaisons to the subcommittee. Appendix 3 includes the names of the individuals, and their corresponding organizations, whom are representing the organizations described above. - Joan Theuer, Health Officer, Marathon County Public Health, RN, MSN. Ms. Theuer has served for nearly four years as the health officer for Marathon County. Prior to this role, she worked as public health nurse consultant for the State of Wisconsin - Division of Public Health for 12 years of which the majority was in the Northern Region. Ms. Theurer cites many successes that include combining the Community Health Needs Assessment with the Life Report; the development of new health coalitions including the Early Age Initiative and the AODA Coalition; and an increased awareness and strengthening of Healthy Marathon County. Ms. Theuer's proudest accomplishment to date is an approved 2012 resolution to make Marathon County the healthiest one in the state. - Roger Lucas LIFE Project Chair, Aspirus Wausau Hospital, Inc. - Rita Straub LIFE Project Vice Chair Retired, Professor Emeriti-UW - Rachel Yaron Ministry Saint Clare's Hospital - Joan Theurer, RN, MSN, Marathon County Health Officer - Ann Lucas, Marshfield Clinic - Dr. Tom Peterson, Retired Physician - Andy Napgezek, Aspirus Wausau Hospital, Inc. - Paula Brabec Aspirus Wausau Hospital, Inc. - Ken, Day American Society for Laser Medicine & Surgery, Inc/Marathon County Board - Sandi Cihlar, Rural Health Care Advocate - Rick Nevers, Aspirus Wausau Hospital, Inc. - Deb Hager, Marathon County Administration - Julie Burmesch Wausau School District - Michael Beck, Wausau Daily Herald - JoAnn Janikowski, United Way of Marathon County - Karen Katz EO Johnson Office Technologies - James McCluskey University of Wisconsin-Marathon County - Hugh Jones, M&I Bank & Wealth Management - Jeff Sargent, North Central Community Action Program - Diane Wessel, Marathon County-Conservation, Planning and Zoning - Jeff Zriny, Wausau Region Chamber of Commerce - Jeff Hardel, Wausau Police Department - Joel VerDuin, Wausau School District - Joanne Kelly, United Way of Marathon County - Mary Radke, LIFE Project Manager - Zachary Heit, LIFE Project Associate
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Clare's. Using the CHNA completed in Fiscal Year 2013 (Tax Year 2012), the hospital developed, adopted, and worked on executing a 2012 Implementation Strategy to address priority community health needs. In 2014, the hospital implemented the following plan to address the priority needs: 1. Access to Health Care: Increase access to, and affordability of, healthcare in Marathon County. Support Rural Health Initiative (RHI) outreach to farm families. Provide funding to RHI. Provide staff to the RHI Steering Committee. 2. Domestic Violence: Decrease domestic violence. Increase public awareness through health fairs, public forums and news articles. Develop and maintain strong community partnerships. Sit on the Board of The Women's Community (TWC). Provide funding to TWC. Provide SANE nurse program. Cover costs of annual training and certifications; support cost of supplies; cover cost of conference's; pay for instate training sessions for SANE's attending training at Saint Clare's. 3. Early Childhood: Improve health, behavior, and learning of young children through early interventions including reducing food insecurity in school aged children, increasing breastfeeding of newborns, decreasing elective deliveries. Provide Blessings in a Backpack program. Provide annual funding; provide staff to steering committee; provide staff to pack backpacks. Provide Lactation program including breastfeeding classes, lactation consulting, providing breast pumps. Support Start Right program. Needs that are not being addressed: alcohol and drug misuse, oral health care, tobacco use, chronic illness. Reasons why: Ministry Saint Clare's Hospital has a number of internal programs which help to support the care and treatment of People with Chronic Illness. These include a Palliative Care Program which helps to ensure that patients living with chronic disease have the highest quality of life possible. Additionally, it proactively engages patients and their families in making life decisions which will support their physical, emotional and spiritual well-being. Saint Clare's Hospital works with their pharmacists to verify the accuracy of patients' current medication lists upon admission. Select patients, such as those with chronic illnesses, receive detailed discharge counseling to improve understanding and management of their medications with the goal of improving compliance with their treatment plans. Saint Clare's Hospital also provides necessary medications to those patients whom are unable to afford them while working to get them enrolled in sustainable medication programs. Saint Clare's Hospital actively works to prevent readmission due to chronic conditions by calling patients after discharge to ensure that they understand their follow-up directives, including future appointments, pain management, and medication instructions. At this time, however, Ministry Saint Clare's Hospital staff does not have the resources to extend this care to the general public, although information regarding ways to access healthcare for chronic conditions is diligently provided to all whom inquire.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address Type of Facility (describe)
1 The Diagnostic & Treatment Center
3401 Cranberry Blvd
Weston,WI54476 		Outpatient/Diagnostic Services
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 6a Community benefit report prepared by related organization Saint Clare's Hospital of Weston, Inc. is included in the annual community benefit report which is published by Ministry Health Care (EIN: 39-1490371) and available to the public on its website, www.ministryhealth.org. This report includes all of the related entities within the Ministry Health Care network of hospitals, clinics and other health-related organizations.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Amounts 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. Bad Debt expense of $3,134,452 is excluded from total operating expenses when calculating percentage of total expense in Part I, line 7, Column F.
Schedule H, Part II Community Building Activities Community building activities include 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. Saint Clare's Hospital of Weston, Inc. 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.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Accounts are written off to bad debt after all internal collection efforts have been exhausted. Attempts to resolve these outstanding balances can include, but are not limited to statements being sent, phone calls and letters being sent. Account follow up protocol is based on personal pay balance size owed.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology Saint Clare's Hospital of Weston, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the consolidated audited financial statements of Ministry Health Care, Inc. (which includes the activity of Saint Clare's Hospital of Weston, Inc.): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies. The methodology for determining the allowance for doubtful accounts and related write offs on uninsured patient accounts has remained consistent with the prior year.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The 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.
Schedule H, Part V, Section B, Line 16a FAP website - Saint Clare's Hospital of Weston, Inc.: Line 16a URL: http://ministryhealth.org/Ministry_Health_Care/Financial_Assistance_Program_RC08.pdf;
Schedule H, Part V, Section B, Line 16b FAP Application website - Saint Clare's Hospital of Weston, Inc.: Line 16b URL: http://ministryhealth.org/Ministry_Health_Care/MHC_FinancialAid_Application_REV4.pdf;
Schedule H, Part VI, Line 2 Needs assessment The 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 health 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 required to provide direct service to the poor in their communities, and hours are included as part of their performance goals.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The 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.
Schedule H, Part VI, Line 4 Community information While there is growing agreement in the United States about what constitutes a non-profit hospitals 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 rural hospitals, was created and is maintained in order to provide care locally - care that without our hospital, may not be available locally. Certain specialized services available include: emergency services, surgical services, inpatient medical services & obstetrics. Saint Clare's Hospital of Weston, WI and the surrounding areas include Schofield, Rothschild, Rib Mountain & Wausau. The 2014 estimated population for Weston, WI is 14,988. Based on the 2010 census, the racial make-up was 87.7% white, 0.8% African American, 0.4% Native American, 8.7% Asian, 2.0% Hispanic, and 0.4% of other races. 11.5% of the population were over 65 year old and 27.4% under 18. The median household income for the last five years was $50,657 and 14.9% of the population was below the poverty line.
Schedule H, Part VI, Line 5 Promotion of community health The 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 who 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 professional through internship programs. Saint Clare's Hospital of Weston, Inc. 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 and urgent care units in serving all persons regardless of ability to pay. - Availability of financial assistance and sliding scale discounts and changes to financial assistance or collection policies that would be viewed as constructive. - The hospital offers volunteer service program where community members utilize the hospital as a vehicle to connect with and contribute to individuals and the overall community through volunteering.
Schedule H, Part VI, Line 6 Affiliated health care system Ministry Health Care, Inc. (Ministry or the Health Ministry) is a member of Ascension Health. In December 2011, Ascension Health Alliance, doing business as Ascension, became the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 23 states and the District of Columbia. In addition to serving as the sole corporate member of Ascension Health, Ascension serves as the member or shareholder of various other subsidiaries. Ascension, its subsidiaries, and the Health Ministries are referred to collectively from time to time hereafter as the System. Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province, the Congregation of St. Joseph, the Congregation of the Sisters of St. Joseph of Carondelet, the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province, and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi-US/Caribbean Province. The Health Ministry is a Wisconsin non-stock, tax-exempt corporation that manages, promotes, and supports health care and related ministries in Wisconsin and Minnesota. The Health Ministry provides inpatient, outpatient, and emergency care services for the residents of Wisconsin and Minnesota. Admitting physicians are primarily practitioners in the local area. The Health Ministry is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of the Health Ministry are related to providing health care services. Effective November 1, 2014, the Health Ministry sold 50% of its ownership in Network Health, Inc. to an unrelated health system (see Note 3). On February 1, 2015, the Health Ministry transferred its ownership in Ministry Home Care, Inc. to Ascension Health. The consolidated financial statements include the following affiliates located primarily in Wisconsin, in which Ministry has a controlling interest and/or is the sole sponsor. Affinity Health System, Inc. (Affinity): Calumet Medical Center, Inc. (CMC): Affinity Medical Group (AMG) Twin Med, LLC Mercy Medical Center, Inc. Mercy Health Foundation St. Elizabeth Hospital Catalpa Health: St. Elizabeth Foundation Agape Community Center of Milwaukee, Inc. Door County Memorial Hospital (Door County) Good Samaritan Health Center of Merrill Good Samaritan Health Center Foundation Howard Young Health Care, Inc. (Howard Young): Dr. Kate Newcomb Convalescent Center Howard Young Medical Center, Inc. Dr. Howard Young Foundation Eagle River Memorial Hospital, Inc. Ministry Medical Group, Inc. Ministry Holdings, Inc. (through November 1, 2014): Network Health (NH) (through November 1, 2014) Network Health Insurance Corporation (NHIC) (thru November 1, 2014) Our Lady of Victory Hospital Sacred Heart Hospital-St. Mary's Hospital, Inc. St. Clare's Hospital of Weston, Inc. Foundation of St. Clare's Hospital of Weston, Inc. St. Elizabeth's Hospital of Wabasha, Inc. St. Joseph's Hospital of Marshfield, Inc. Foundation of St. Joseph's Hospital of Marshfield, Inc. St. Michael's Hospital of Stevens Point, Inc. St. Michael's Foundation of Stevens Point, Inc. The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care that sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and to other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and for community benefit programs: 1. Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured. 2. Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and for other vulnerable persons. 3. Cost of other programs for persons living in poverty and for other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and the other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome. 4. Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care to persons living in poverty or in the cost of other community benefit programs. The cost of providing care to persons living in poverty and of other community benefit programs is estimated using internal cost data and is estimated by reducing charges forgone by a factor derived from the ratio of total operating expenses to billed charges for patient care. The amount of traditional charity care provided, determined on the basis of cost, was approximately $12,600 and $18,400 for the years ended June 30, 2015 and 2014, respectively. The amount of unpaid cost of public programs, cost of other programs for persons living in poverty and for other vulnerable persons, and cost of community benefit programs are reported in the accompanying supplementary information.
Schedule H, Part VI, Line 7 State filing of community benefit report WI
Schedule H (Form 990) 2014
Additional Data


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