Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (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
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization?
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013
Page 2

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Absalon Jeffrey MDChief Physician Officer (i)
(ii)		 326,715
  		58,138
  		31,120
  		50,387
  		30,044
  		496,404
  		 
 
2Blizzard John DPhysician (i)
(ii)		 920,154
  		 
  		18,386
  		15,300
  		24,325
  		978,165
  		 
 
3Boileau Michel MDEVP/CCO (i)
(ii)		 439,192
  		86,450
  		155,091
  		15,300
  		30,236
  		726,269
  		 
 
4Boone RobPhysician (i)
(ii)		 704,580
  		 
  		24,221
  		15,300
  		22,931
  		767,032
  		 
 
5Diegel James APresident/CEO (i)
(ii)		 578,918
  		117,691
  		273,154
  		105,452
  		32,502
  		1,107,717
  		 
 
6Eixenberger Tim DChief Nursing Officer - Bend (i)
(ii)		 217,938
  		 
  		38,126
  		15,300
  		13,923
  		285,287
  		 
 
7Gomes BobCEO SCMC-R & PMH (i)
(ii)		 284,111
  		47,199
  		62,201
  		41,454
  		28,271
  		463,236
  		 
 
8Henry JamesCEO SCMC-Bend (i)
(ii)		 289,173
  		55,016
  		74,456
  		46,825
  		29,972
  		495,442
  		 
 
9Kornfeld StevePhysician (i)
(ii)		 746,892
  		 
  		17,733
  		15,300
  		24,667
  		804,592
  		 
 
10Martin RichardVP Service Lines (i)
(ii)		 221,600
  		42,102
  		56,634
  		15,300
  		24,086
  		359,722
  		 
 
11Martin WilliamPhysician (i)
(ii)		 739,404
  		25
  		18,040
  		15,300
  		28,891
  		801,660
  		 
 
12Schueler KirkEVP/Chief Admin. Officer (i)
(ii)		 280,129
  		53,297
  		654
  		44,015
  		29,870
  		407,965
  		19,920
 
13Shepard Karen MExec VP Finance (i)
(ii)		 369,306
  		69,817
  		149,402
  		54,640
  		24,490
  		667,655
  		21,372
 
14Steinke PamelaVP Quality/Chief Nursing Exec. (i)
(ii)		 260,802
  		49,416
  		74,100
  		42,273
  		29,739
  		456,330
  		23,736
 
15Vlessis AngeloPhysician (i)
(ii)		 1,122,754
  		 
  		886
  		15,300
  		28,684
  		1,167,624
  		 
 
16Winnenberg WilliamCIO (i)
(ii)		 273,640
  		54,817
  		131,591
  		15,300
  		22,646
  		497,994
  		 
 
Schedule J (Form 990) 2013
Page 3

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Schedule J (Form 990) 2013

Additional Data


Software ID: 13000170
Software Version: 2013v3.1