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 See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
St Charles Health System Inc
 
Employer identification number

93-0602940
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 income based criteria 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
 
No
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) . . . 		  17,148 18,038,978   18,038,978 3.200 %
b Medicaid (from Worksheet 3, column a) . . . . .   88,582 136,693,655 66,187,301 70,506,354 12.510 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .   105,730 154,732,633 66,187,301 88,545,332 15.710 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   9,828 1,243,494 4,500 1,238,994 0.220 %
f Health professions education (from Worksheet 5) . . .   3,807 1,075,998 381,174 694,824 0.120 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .   15,304 859,997 1,301 858,696 0.150 %
j Total. Other Benefits . .   28,939 3,179,489 386,975 2,792,514 0.490 %
k Total. Add lines 7d and 7j .   134,669 157,912,122 66,574,276 91,337,846 16.200 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development   328 178,563   178,563 0.030 %
9 Other            
10 Total   328 178,563   178,563 0.030 %
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
Yes
 
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
27,778,636
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
 
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
128,096,282
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
161,682,332
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-33,586,050
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 %
1Cascade Medical Imaging LLC
  		CT, Mammography and Other 70.000 %   30.000 %
2Central Oregon Magnetic Res
  		Magnetic Resonance Imaging 33.300 %   66.700 %
3Heart Center of the Cascade
  		Owns & manages a medical bu 50.000 %   50.000 %
4Cascade SurgiCenter LLC
  		Outpatient surgery 50.000 % 2.780 % 45.650 %
5Institute of the Cascades L
  		Administration & Marketing 50.000 %   50.000 %
6Cascade Medical Buildings L
  		Owns & manages a medical bu 50.000 % 3.270 % 50.000 %
7Cascade Property Holdings L
  		Owns bare land for investme 50.000 % 2.703 % 50.000 %
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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?4
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 St Charles Bend
2500 NE Neff Road
Bend,OR97701 		X X         X      
2 St Charles Redmond
1253 NW Canal Blvd
Redmond,OR97756 		X X         X      
3 Pioneer Memorial Hospital
1201 NE Elm St
Prineville,OR97754 		X X     X   X      
4 St Charles Madras
470 NE A
Madras,OR97741 		X X     X   X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
St Charles Bend
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 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 Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a 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)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b   No
c If "Yes" to line 8b, 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.0000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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 actions the hospital facility may take upon non-payment?........ 15 Yes  
16 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
17 Did the hospital facility or an 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?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
21 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? ............................... 21   No
If "Yes," explain in Part VI.
22 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?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
St Charles Redmond
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		2
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 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 Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a 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)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b   No
c If "Yes" to line 8b, 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.0000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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 actions the hospital facility may take upon non-payment?........ 15 Yes  
16 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
17 Did the hospital facility or an 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?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
21 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? ............................... 21   No
If "Yes," explain in Part VI.
22 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?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
Pioneer Memorial Hospital
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		3
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 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 Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a 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)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b   No
c If "Yes" to line 8b, 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.0000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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 actions the hospital facility may take upon non-payment?........ 15 Yes  
16 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
17 Did the hospital facility or an 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?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
21 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? ............................... 21   No
If "Yes," explain in Part VI.
22 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?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
St Charles Madras
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		4
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 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 Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a 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)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b   No
c If "Yes" to line 8b, 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.0000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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 actions the hospital facility may take upon non-payment?........ 15 Yes  
16 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
17 Did the hospital facility or an 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?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
21 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? ............................... 21   No
If "Yes," explain in Part VI.
22 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?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
Part V, Line 3 - Account Input from Person Who Represent the Community Methodologyprimary researchThe CHNA was conducted using many forms of data collection and analysis including the following primary research:Surveys: DHM Research conducted telephone interviews of approximately 800 residents throughout the four communities (Bend, Redmond, Prineville and Madras) served by a St. Charles facility to determine the health-related priorities of the population residing in Central Oregon. The survey was designed to establish a baseline of importance, priorities and needs around health and wellness, including access, quality and cost. Community stakeholder interviews: The St. Charles Health System Community Benefit department conducted meetings and interviews with over 52 organizations and key stakeholders throughout the health systems service area, with representation from Bend, Redmond, Prineville, Sisters, Madras and La Pine. The interviewees included persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations throughout the Central Oregon region, including the St. Charles Bend defined community. The majority of these took place at the interviewees location. The recommendations from these organizations were compiled and considered while selecting the significant health needs for the local communities. Participants included:Abilitree, Advantage Dental, Advantage Smiles for Kids, ALS Association of Oregon and SW Washington, American Legion, American Red Cross, Assistance League of Bend, Bakestarr, Barbara's Place, Bend Parks and Rec, Bend Senior Center, Bend Area Habitat for Humanity, Bend City Care, Bend Community Center, Bend Community of Christ Church, Bend-La Pine School District Health Services, Bend-La Pine School District Nutrition Services, Bend Learning Center, Bend Metro Park and Recreation, Best Care Treatment, Bethlehem Inn, Big Brothers Big Sisters of Central Oregon, Birthing and Beyond, Boys and Girls Clubs of Central Oregon, Cascade Child Treatment Center, Inc., Central Oregon AA Intergroup Inc., Central Oregon Disability Support Network, Central Oregon Down Syndrome Network, CASA of Central Oregon, Cascade Youth and Family, Cascades East Transit, Central Oregon Chapter of Compassionate Friends, Central Oregon Council on Aging, Central Oregon Food Policy Council, Central Oregon Intergovernmental Council, Central Oregon City Care Clinic, Clare Bridge of Bend, CO Autism Spectrum Resource & Family Support Group, Central Oregon Community College, Commute Options, Critical Care Dental Clinic, Deschutes County Health, Department of Human Services, Family Access Network, Family Kitchen, Family Resource Center, Full Access Brokerage, Full Circle Outreach Center, Goodwill Industries, Grandma's House of Central Oregon, Hanger Prosthetics and Orthotics, Healing Reins, Healthy Beginnings, Healthy Families of the High Desert, Healthy Kids, Hearing Loss Association of Central Oregon, Heart of Oregon Corps, High Desert Education Services District, Hospice House, House of Hope, Housing Works, Hunger Prevention Coalition of Central Oregon, J Bar J Youth Services, KIDS Center, Kids in the Game, Kidtalk, Oregon Scottish Rite Clinics, Latino Community, Meals on Wheels, Methamphetamine Action Coalition, Mosaic Medical, Mountain Star Family Relief Nursery, Mt. Bachelor Sports Education Foundation, NeighborImpact/Head Start, New Priorities Family Services, Opportunity Foundation of Central Oregon, Partners in Care, Partnership to End Poverty, Pregnancy Resource Centers of Central Oregon, Ronald McDonald House, Saving Grace, Serenity Lane, Shepherd's House, Sparrow Clubs, The Center Foundation, The Giving Plate, The Salvation Army Bend Corps Church, United Way, Veterans of Foreign Wars, Volunteer Connect, Project Connect, Volunteers in Action, Volunteers in Medicine, Vocational Rehabilitation Services, Willing to Help, Women's Resource Center of Central Oregon
Part V, Line 3 - Account Input from Person Who Represent the Community Methodologyprimary researchThe CHNA was conducted using many forms of data collection and analysis including the following primary research:Surveys: DHM Research conducted telephone interviews of approximately 800 residents throughout the four communities (Bend, Redmond, Prineville and Madras) served by a St. Charles facility to determine the health-related priorities of the population residing in Central Oregon. The survey was designed to establish a baseline of importance, priorities and needs around health and wellness, including access, quality and cost. Community stakeholder interviews: The St. Charles Health System Community Benefit department conducted meetings and interviews with over 52 organizations and key stakeholders throughout the health systems service area, with representation from Bend, Redmond, Prineville, Sisters, Madras and La Pine. The interviewees included persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations throughout the Central Oregon region, including the St. Charles Redmond defined community. The majority of these took place at the interviewees location. The recommendations from these organizations were compiled and considered while selecting the significant health needs for the local communities.Participants included:Abilitree, Advantage Dental, Advantage Smiles for Kids, ALS Association of Oregon and SW Washington, American Legion, American Red Cross, Bakestarr, Barbara's Place, Bend Area Habitat for Humanity, Best Care Treatment, Bethlehem Inn, Big Brothers Big Sisters of Central Oregon, Birthing and Beyond, Boys and Girls Clubs of Central Oregon, CASA of Central Oregon, Cascades East Transit, CO Autism Spectrum Resource & Family Support Group, Central Oregon Chapter of Compassionate Friends, Central Oregon Community College, Central Oregon Council on Aging, Cascade Child Treatment Center, Inc., Central Oregon AA Intergroup Inc., Central Oregon Disability Support Network, Central Oregon Down Syndrome Network, Central Oregon Veteran Outreach, Central Oregon Food Policy Council, City Care Clinic, Department of Human Services, Deschutes Children's Foundation, Deschutes County Health Department, Family Access Network, Family Resource Center, FISH, Full Access Brokerage, Full Circle Outreach Center, Goodwill Industries, Grandma's House of Central Oregon, Hanger Prosthetics and Orthotics, Healing Reins, Healthy Beginnings, Healthy Families of the High Desert, Healthy Kids, Hearing Loss Association of Central Oregon, Heart of Oregon Corps, High Desert Education Services District, Hospice of Redmond, House of Hope, Housing Works, Hunger Prevention Coalition of Central Oregon, J Bar J Youth Services, Jericho Road, KIDS Center, Kids in the Game, Kidtalk, Oregon Scottish Rite Clinics, Latino Community Association, Meals on Wheels, Methamphetamine Action Coalition, Mosaic Medical, Mt. Bachelor Sports Education Foundation, Neighbor-Impact / Head Start, New Priorities Family Services, Opportunity Foundation of Central Oregon, Partnership to End Poverty, Pregnancy Resource Centers of Central Oregon, Ronald McDonald House, Redmond Alano Club, Redmond Parks and Recreation Department, Residential Housing, Inc., Saving Grace, Seventh Day Adventist, Sparrow Clubs, St. Vincent de Paul Redmond Conference, The Giving Plate, The Salvation Army Bend Corps Church, United Way, Veterans of Foreign Wars, Volunteer Connect, Project Connect, Volunteers in Action, Volunteers in Medicine, Willing to Help, Women's Resource Center of Central Oregon, Vocational Rehabilitation Services
Part V, Line 3 - Account Input from Person Who Represent the Community Methodologyprimary researchThe CHNA was conducted using many forms of data collection and analysis including the following primary research:Surveys: DHM Research conducted telephone interviews of approximately 800 residents throughout the four communities (Bend, Redmond, Prineville and Madras) served by a St. Charles facility to determine the health-related priorities of the population residing in Central Oregon. The survey was designed to establish a baseline of importance, priorities and needs around health and wellness, including access, quality and cost. Community stakeholder interviews: The St. Charles Health System Community Benefit department conducted meetings and interviews with over 52 organizations and key stakeholders throughout the health systems service area, with representation from Bend, Redmond, Prineville, Sisters, Madras and La Pine. The interviewees included persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations throughout the Central Oregon region, including the Pioneer Memorial Hospital defined community. The majority of these took place at the interviewees location. The recommendations from these organizations were compiled and considered while selecting the significant health needs for the local communities. Participants included:Abilitree, Advantage Smiles for Kids, ALS Association of Oregon and SW Washington, American Legion, American Red Cross, Bakestarr, Bend Area Habitat for Humanity, Best Care Treatment, Bethlehem Inn, Big Brother Big Sisters of Central Oregon, Birthing and Beyond, Boys and Girls Clubs of Central Oregon, CASA of Central Oregon, Cascades East Transit, CO Autism Spectrum Resource & Family Support Group, Central Oregon Chapter of Compassionate Friends, Central Oregon Community College, Central Oregon Council on Aging, Cascade Child Treatment Center, Inc., Central Oregon AA Intergroup Inc., Central Oregon Disability Support Network, Central Oregon Down Syndrome Network, Central Oregon Food Policy Council, Central Oregon Intergovernmental Council, Central Oregon Veteran Outreach, Crook County Commission on Children and Families, Crook County Community Coalition, Crook County Habitat for Humanity, Crook County Health Department, Crook County School District Nutrition Services, Department of Human Services, Family Resource Center, Full Access Brokerage, Goodwill Industries, Hanger Prosthetics and Orthotics, Healing Reins, Healthy Beginnings, Healthy Families of the High Desert, Healthy Kids, Hearing Loss Association of Central Oregon, Heart of Oregon Corps, Heart n Home Hospice Palliative Care, High Desert Education Services District, Housing Works, Hunger Prevention Coalition of Central Oregon, J Bar J Youth Services, KIDS Center, Kids in the Game, Kidtalk, Oregon Scottish Rite Clinics, Latino Community Association, Lutheran Family Services of Crook County, Meals on Wheels, Mosaic Medical, NeighborImpact, Oasis Food Kitchen, Opportunity Foundation of Central Oregon, Partnership to End Poverty, Pioneer Memorial Hospice, Pregnancy Resource Centers of Central Oregon, Rimrock Trails Adolescent Treatment Services, Ronald McDonald House, Saving Grace, Sparrow Clubs, The Salvation Army Bend Corps Church, Veterans of Foreign Wars, Volunteer Connect, Project Connect, Women's Resource Center of Central Oregon, Vocational Rehabilitation Services
Part V, Line 3 - Account Input from Person Who Represent the Community Methodologyprimary researchThe CHNA was conducted using many forms of data collection and analysis including the following primary research:Surveys: DHM Research conducted telephone interviews of approximately 800 residents throughout the four communities (Bend, Redmond, Prineville and Madras) served by a St. Charles facility to determine the health-related priorities of the population residing in Central Oregon. The survey was designed to establish a baseline of importance, priorities and needs around health and wellness, including access, quality and cost. Community stakeholder interviews: The St. Charles Health System Community Benefit department conducted meetings and interviews with over 52 organizations and key stakeholders throughout the health systems service area, with representation from Bend, Redmond, Prineville, Sisters, Madras and La Pine. The interviewees included persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations throughout the Central Oregon region, including the St. Charles Bend defined community. The majority of these took place at the interviewees location. The recommendations from these organizations were compiled and considered while selecting the significant health needs for the local communities. Participants included:Abilitree, Advantage Smiles for Kids, ALS Association of Oregon and SW Washington, American Legion, American Red Cross, Bakestarr, Best Care Treatment, Bethlehem Inn, Big Brother Big Sisters of Central Oregon, Birthing and Beyond, Boys and Girls Clubs of Central Oregon, CASA of Central Oregon, Cascades East Transit, Children's Learning Center, CO Autism Spectrum Resource & Family Support Group, Central Oregon Chapter of Compassionate Friends, Central Oregon Community College, Central Oregon Council on Aging, Cascade Child Treatment Center, Inc., Central Oregon AA Intergroup Inc., Central Oregon Disability Support Network, Central Oregon Down Syndrome Network, Central Oregon Food Policy Council, Central Oregon Veteran Outreach, Department of Human Services, Family Resource Center, Full Access Brokerage, Goodwill Industries, Hanger Prosthetics and Orthotics, Healing Reins, Healthy Beginnings, Healthy Families of the High Desert, Healthy Kids, Hearing Loss Association of Central Oregon, Heart of Oregon Corps, High Desert Education Services District, Housing Works, Hunger Prevention Coalition of Central Oregon, J Bar J Youth Services, Jefferson County Commission on Children & Families, Jefferson County Health Department, Jefferson County Education Service District, Joint Health Commission, Indian Health Services, Juniper Junction Relief Nursery, KIDS Center, Kids Club of Jefferson County, Kids in the Game, Kidtalk, Oregon Scottish Rite Clinics, Latino Community Association, Let's Talk Diversity Coalition, LINC Gap Ministries, Madras Aquatic Center, Madras Gospel Mission, Meals on Wheels, Mosaic Medical, Mountain View Hospice, Opportunity Foundation of Central Oregon, Oregon Child Development Coalition Jefferson County, Partnership to End Poverty, Pregnancy Resource Centers of Central Oregon, Ronald McDonald House, Saving Grace, Senior Citizens of Jefferson County, Sparrow Clubs, Volunteer Connect, Project Connect, Women's Resource Center of Central Oregon, Vocational Rehabilitation Services
Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment St. Charles Redmond, St Charles Madras, Pioneer Memorial Hospital
Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment St. Charles Bend, St Charles Madras, Pioneer Memorial Hospital
Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment St. Charles Bend, St Charles Redmond, St Charles Madras
Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment St. Charles Bend, St Charles Redmond, Pioneer Memorial Hospital
Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why The following are significant health needs identified in the St. Charles Bend CHNA that will not be addressed in this implementation plan:Jobs/job securityPovertyChronic disease preventionBehavioral healthincluding substance abuseTobacco useThe main reason these health needs were not prioritized this cycle is that they ranked lower in priority relative to the two selected health needs. Additionally, as with most health care facilities, St. Charles Bend has limited resources. However, the driving factor was the desire to make the biggest community impact possible by combining the efforts of all four St. Charles Health System facilities toward two high priority health needs.
Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why The following are significant health needs identified in the St. Charles Redmond CHNA that will not be addressed in this health implementation plan:Jobs/job securityPovertyChronic disease preventionBehavioral healthincluding substance abuseTobacco useThe main reason these health needs were not prioritized this cycle is that they ranked lower in priority relative to the two selected health needs. Additionally, as with most health care facilities, St. Charles Redmond has limited resources. However, the driving factor was the desire to make the biggest community impact possible by combining the efforts of all four St. Charles Health System facilities toward two high priority health needs.
Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why The following are significant health needs identified in the Pioneer Memorial Hospital CHNA that will not be addressed in this implementation plan:Jobs/job securityPovertyBehavioral healthincluding substance abuseTobacco useChronic disease preventionDental issuesThe main reason these health needs were not prioritized this cycle is that they ranked lower in priority relative to the two selected health needs. Additionally, as with most health care facilities, Pioneer Memorial Hospital has limited resources. However, the driving factor was the desire to make the biggest community impact possible by combining the efforts of all four St. Charles Health System facilities toward two high priority health needs.
Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why The following are significant health needs identified in the St. Charles Madras CHNA that will not be addressed in this CHNA implementation plan:Jobs/job securityPovertyBehavioral healthincluding substance abuseChronic disease preventionTobacco usePregnancy related issuesThe main reason these health needs were not prioritized this cycle is that they ranked lower in priority relative to the two selected health needs. Additionally, as with most health care facilities, St. Charles Madras has limited resources. However, the driving factor was the desire to make the biggest community impact possible by combining the efforts of all four St. Charles Health System facilities toward two high priority health needs.
Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A REFERENCE TO THE FINANCIAL ASSISTANCE POLICY WAS INCLUDED ON BILLING STATEMENTS.
Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A REFERENCE TO THE FINANCIAL ASSISTANCE POLICY WAS INCLUDED ON BILLING STATEMENTS.
Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A REFERENCE TO THE FINANCIAL ASSISTANCE POLICY WAS INCLUDED ON BILLING STATEMENTS.
Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A REFERENCE TO THE FINANCIAL ASSISTANCE POLICY WAS INCLUDED ON BILLING STATEMENTS.
Part V, Line 20d - Other Billing Determination of Individuals Without Insurance SCHS utilizes a single charge master, regardless of payer. SCHS utilizes one year of historical gross charges to calculate the estimated charges for the requested services. FAP eligible patient account balances will be reduced by the discount level determined in the financial assistance application process.
Part V, Line 20d - Other Billing Determination of Individuals Without Insurance SCHS utilizes a single charge master, regardless of payer. SCHS utilizes one year of historical gross charges to calculate the estimated charges for the requested services. FAP eligible patient account balances will be reduced by the discount level determined in the financial assistance application process.
Part V, Line 20d - Other Billing Determination of Individuals Without Insurance SCHS utilizes a single charge master, regardless of payer. SCHS utilizes one year of historical gross charges to calculate the estimated charges for the requested services. FAP eligible patient account balances will be reduced by the discount level determined in the financial assistance application process.
Part V, Line 20d - Other Billing Determination of Individuals Without Insurance SCHS utilizes a single charge master, regardless of payer. SCHS utilizes one year of historical gross charges to calculate the estimated charges for the requested services. FAP eligible patient account balances will be reduced by the discount level determined in the financial assistance application process.
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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?24
Name and address Type of Facility (describe)
1 St Charles Cancer Center
2100 NE Wyatt Ct
Bend,OR97701 		Outpatient Cancer Center
2 Cascade Medical Imaging
1460 NE Medical Center Dr
Bend,OR97701 		Diagnostic Imaging Clinic
3 Sage View Psychiatric Center
1885 NE Purcell Blvd
Bend,OR97701 		Mental Health Services
4 St Charles Cardiothoracic Surgery
2500 NE Neff Rd
Bend,OR97701 		Cardiothoracic Surgery
5 Cascade SurgiCenter
2200 NE Neff Rd 100
Bend,OR97701 		Surgery Center
6 Central Oregon Magnetic Resonance Imaging
1460 NE Medical Center Dr
Bend,OR97701 		MRI Center
7 St Charles Family Care - Redmond
211 NW Larch Ave
Redmond,OR97756 		Primary Care Clinic
8 St Charles Family Care Prineville
1103 NE Elm St
Prineville,OR97754 		Rural Health Clinic
9 St Charles Sleep Center - Bend
2042 Williamson Ct
Bend,OR97701 		Sleep Lab
10 St Charles Hospice - Prineville
1201 NE Elm St
Prineville,OR97754 		Hospice Care
11 St Charles Family Care - Bend
2965 NE Conners Ave Ste 127
Bend,OR97701 		Primary Care Clinic
12 St Charles OBGYN Redmond
213 NW Larch Ste A
Redmond,OR97756 		OB/GYN Clinic
13 St Charles Pulmonary Clinic
2275 NE Doctors Dr
Bend,OR97701 		Lung Clinic
14 St Charles Immediate Care
2600 NE Neff Rd
Bend,OR97701 		Immediate Care Clinic
15 Behavioral Health - Bend
2542 Courtney Dr
Bend,OR97701 		Behavioral Health Clinic
16 St Charles Family Care - Sisters
615 Arrowleaf Trail
Sisters,OR97759 		Primary Care Clinic
17 St Charles Sleep Center - Redmond
655 NW Jackpine Ave
Redmond,OR97756 		Sleep Lab
18 St Charles Paliative Care
2500 NE Neff Rd
Bend,OR97701 		Paliative Care Clinic
19 St Charles Anticoagulation Clinic
2100 NE Wyatt Ct
Bend,OR97701 		Anticoag Clinic
20 St Charles Preoperative Medicine
2500 NE Neff Rd
Bend,OR97701 		Comprehensive Care for Surgery Patients
21 St Charles Medical Supply
2042 NE Williamson Ct
Bend,OR97701 		Sleep Medical Equip Sales
22 St Charles Infectious Disease
2965 NE Conners Ave Suite 127
Bend,OR97701 		Infectious Disease Clinic
23 St Charles Pulmonary Clinic - Redmond
655 NW Jackpine Ave
Redmond,OR97756 		Lung Clinic
24 MSA Madras
480 NE A St
Madras,OR97741 		Primary Care Clinic
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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
Part I, Line 7 - Explanation of Costing Methodology The costing methodology used was derived from SCHS's financial and cost accounting systems, which address all hospital-based patient segments and other services provided. A cost-to-charge ratio from these financial systems was used to calculate the cost of Financial Assistance in line 7a. Numbers reported in column (b) in lines 7a and 7b refer to the number of patient encounters.
Part I, Line 7, Column F - Explanation of Bad Debt Expense 27,778,636
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense When SCHS provides care to patients, it does not require collateral; however, it maintains an estimated allowance for doubtful accounts. The primary collection risks relate to uninsured patient accounts and patient accounts for which the primary insurance payor has paid, but patient responsibility amounts (generally deductibles and copayments) remain outstanding. The allowance for doubtful accounts is estimated based primarily upon SCHS historical collection experience, the age of the patients account, managements estimate of the patients economic ability to pay, and the effectiveness of collection efforts. Patient accounts receivable balances are routinely reviewed in conjunction with historical collection rates and other economic conditions that might ultimately affect the collectibility of patient accounts when considering the adequacy of the amounts recorded in the allowance for doubtful accounts. Actual write offs have historically been within managements expectations.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit SCHS currently has no reasonable way to track or estimate the amount of bad debt expense attributable to charity care, and accordingly this line has been left blank.
Part III, Line 4 - Bad Debt Expense See page 10, footnote 1 (g) "Patient Accounts Receivable, Allowance for Doubtful Accounts, and Other Receivables", in the attached Audited Financial Statements.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit As a response to efforts to improve the health and quality of life of people living in the community, SCHS provided $33,586,050 in unreimbursed services to patients enrolled in Medicare programs. SCHS believes that the Medicare shortfall should be treated as a community benefit since it has a clear mission to serving and improving the health status of the elderly. If SCHS should cease to exist, this shortfall would have to be absorbed by another health care provider. Costs are from the financial and cost accounting system using cost-to-charge ratios, but none of these costs are being claimed as a community benefit in Part I, line 7.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it, the account is referred back for a financial assistance review.
Part VI - Needs Assessment St. Charles Health System (SCHS) assesses the needs of each of our communities in many different ways other than the facility community health needs assessments. SCHS partners with Healthy Communities Institute (HCI) to purchase a dashboard of each community and populations risk profiling data that is continuously updated, accessible to the community, easy to understand and directly embeddable in our existing website. This information helps SCHS to keep a finger on the pulse of each populations many health indicators, helping us to continually assess each communitys needs, positive changes and/or opportunities for improvement. This information can be found at http://www.stcharleshealthcare.org/Healthy-Communities/CHNA. We also have partnered with the three local health departments and PacificSource Health Plan to fund Healthier Central Oregon, a Healthy Communities Network dashboard (another HCI product) similar to the SCHS purchased dashboard, with enhancements such as local news, BMI calculator, a walk score and website survey. To view this information, please go to http://www.healthiercentraloregon.org/. Each year St. Charles also produces the St. Charles Health System Annual Report. This report is comprised of a summary of each of the following: Community BenefitTotalsFinancial OverviewDays cash on handOperating marginExcess marginFull time employee countEach health system facility (St. Charles Bend, St. Charles Redmond, Pioneer Memorial Hospital and St. Charles Madras) BirthsDischargesIn-patient casesOut-patient casesEmergency visitsSt. Charles Medical GroupPatient visits for each clinicsSt. Charles FoundationDistributions (amount and to which service line)The 2013 Annual Report will be posted online on the St. Charles Health System website at https://www.stcharleshealthcare.org/About-Us/Reports. This report and the primary data collected for its creation let us know what the trends are for different hospital stays, conditions and out-patient visits, helping to decide what services we offer and where the needs are. St. Charles also plays a big role in local, regional and State groups in order to stay abreast of the newest information, trends, health data and best practices. SCHS has representation on the Central Oregon Health Council, the governance entity over the regions Coordinated Care Organization, PacificSource Community Solutions, alongside representatives from the three counties, PacificSource Health Plan, county commissioners, local medical clinics and regional dental clinic. By participating on this council, St. Charles is able to hear from the experts in each of the three counties to hear firsthand how each community is doing and what their health needs are. St. Charles also sits on different committees for the Oregon Association for Hospitals and Health Systems (OAHHS), local non-profits and is a strategic partner with the Institute for Healthcare Improvement (IHI). Being part of these groups helps St. Charles to better understand the needs of our communities while also learning how to better collect, track, report and improve upon collected information.
Part VI - Patient Education of Eligibility for Assistance Financial assistance policy is posted on the SCHS websiteFinancial counselors and registration staff in our facilities & primary care clinics offer FAP to patients, both upon request and by design when patients are uninsured or underinsuredChamberlin-Edmonds (CE) - Chamberlin-Edmonds has a contractual arrangement with SCHS to identify patients who may qualify for coverage through the following government programs (uninsured patients seen in our Emergency departments & those admitted to all of our facilities are automatically referred to CE by report): Cobra (these are referred to Financial Counselors)Crime Victims AssistanceEmergency Medicaid for Aliens Medicaid for pregnant women and children Medicaid, Medicare Supplemental Security Income (SSI)Temporary Aid for Needy Families (TANF) VeteransChamberlin-Edmonds will work with these individuals through the process of qualifying for coverage until SCHS receives reimbursement from any of the above referenced programs for the services we have rendered to patients. Patients working with Chamberlin-Edmonds have their accounts put on hold from collections activities during these actvities. Only Chamberlin-Edmonds will work with these patients. Patients that Chamberlin-Edmonds cannot help will be referred to Patient Access Services Financial Counseling for follow-up.
Part VI - Community Information DESCHUTES COUNTY: (St. Charles Bend and St. Charles Redmond) from HCI unless otherwise noted:UrbanPopulation: 160,140 (Oregon Employment Department, 2012 http://www.olmis.org/pubs/pop/population12.pdf )Median Household Income: $51,468 (2008-2012)Percentage living below FPL: Families: 9.7 percent (2008-2012) People: 13.1 percent (2008-2012)Children: 18.3 percent (2008-2012)Adults with health insurance: 78 percent (2012) Children with health insurance: 91.1 percent (2013)Median Age: 39.7 (The Central Oregon Regional Health Assessment, www.cohealthcouncil.org)Population by Race (United States Census Bureau http://quickfacts.census.gove/gfd/states/41/41017.html ):White alone, not Hispanic: 88.2 percentHispanic or Latino: 7.6 percentTwo or more races: 2.4 percentAmerican Indian and Alaska Native: 1.1 percentAsian: 1 percentBlack or African American: .4 percentNative Hawaiian or other Pacific Islander: .1 percentCommunity Partners/Assets in Deschutes County (outside St. Charles Bend and Redmond):Mosaic Medical Clinic, Bend and Redmond (FQHC)Lynch Community Clinic (partnership between Mosaic Medical, Redmond School District and Deschutes County)Ensworth Community School-Based Health Center (partnership between Mosaic Medical, Bend LaPine School District and Deschutes County)Bend Memorial Clinic, Bend, Redmond and SistersCROOK COUNTY: (Pioneer Memorial Hospital-Prineville) from HCI unless otherwise noted:RuralMedically underserved area (MUA)Population: 20,650 (Oregon Employment Department, 2012 http://www.olmis.org/pubs/pop/population12.pdf)Median Household Income: $40,263 (2008-2012)Percentage living below FPL:Families: 13.3 percent (2008-2012)People: 17.4 percent (2008-2012)Children: 26.1 percent (2008-2012)Adults with health insurance: 78 percent (2012)Children with health insurance: N/AMedian Age: 43.6 (The Central Oregon Regional Health Assessment, www.cohealthcouncil.org)Population by Race (United States Census Bureau http://quickfacts.census.gove/gfd/states/41/41013.html ):White alone, not Hispanic: 88.9 percentHispanic or Latino: 7.5 percentTwo or more races: 2.0 percentAmerican Indian and Alaska Native: 1.4 percentAsian: .6 percentBlack or African American: .2 percentNative Hawaiian or other Pacific Islander: .1 percentCommunity Partners/Assets in Deschutes County (outside Pioneer Memorial Hospital):Mosaic Medical (FQHC) Crook Kids Clinic (partnership between Mosaic Medical and Crook County School District)JEFFERSON COUNTY: (St. Charles Madras) from HCI unless otherwise noted:RuralMedically underserved area (MUA)Population: 21,940 (Oregon Employment Department, 2012 http://www.olmis.org/pubs/pop/population12.pdf)Median Household Income: $43,330 (2008-2012)Percentage living below FPL:Families: 13.5 percent (2008-2012)People: 19.2 percent (2008-2012)Children: 30 percent (2008-2012)Adults with health insurance: 69.8 percent (2012)Children with health insurance: (N/A)Median Age: 39.1 (The Central Oregon Regional Health Assessment, www.cohealthcouncil.org)Population by Race (United States Census Bureau http://quickfacts.census.gove/gfd/states/41/41031.html ):White alone, not Hispanic: 60.8 percentHispanic or Latino: 19.8 percentAmerican Indian and Alaska Native: 18.4 percentTwo or more races: 3.2 percentBlack or African American: 1 percentAsian: .5 percentNative Hawaiian or other Pacific Islander: .2 percentCommunity Partners/Assets in Deschutes County (outside St. Charles Madras):Mosaic Medical (FQHC) Confederated Tribes of Warm Springs
Part VI - Community Building Activities Our community building activities focused on workforce development activities which support the community by offering the expertise and resources of our hospital systems caregivers for the betterment of the community. Specifically these programs address community-wide workforce issues, potentially providing health care workers for promoting the health of the community.
Part VI - Explanation Of How Organization Furthers Its Exempt Purpose SCHS provides services without charge, or at amounts less than its established rates, to patients who meet the criteria of its charity care policy. SCHS criteria for the determination of charity care include the patients or other responsible partys annual household income, number of people in the home and claimed on taxes, assets, credit history, existing medical debt obligations, and other indicators of the patients ability to pay. Generally, those individuals with an annual household income at or less than 100% of the Federal Poverty Guidelines (the Guidelines) qualify for charity care under SCHS policy. In addition, SCHS provides discounts on a sliding scale to those individuals with an annual household income of between 100% and 300% of the Guidelines. Since SCHS does not pursue collection of amounts determined to qualify as charity care, those amounts are not reported as net patient service revenue.Because both Madras and Prineville are located in medically underserved areas (MUAs), the resources used for provider recruitment in those communities are counted as community benefit. St. Charles also allows nursing students, high school students and other providers to partake in job-shadowing with our paid caregivers to help them complete their course work and/or earn credits, without restrictions related to future employment.
Part VI - States Where Community Benefit Report Filed OR
Schedule H (Form 990) 2013
Additional Data


Software ID: 13000170
Software Version: 2013v3.1