SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) 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
Return Reference Explanation
Form 990, Part III, Line 4d: Other Program Services Description OTHER PROGRAM SERVICES 4: Sage View mental health, Community Education and rents from affiliates. OTHER PROGRAM SERVICES 5: Pioneer Memorial Hospital OTHER PROGRAM SERVICES 6: St. Charles Medical Group (SCMG)SCMG is a group of medical clinics owned and operated by St. Charles Health System. These clinics are located throughout the region and provide outpatient services such as primary care, cancer care, OB/GYN, pulmonary care, sleep disorder resources, and primary care. SCMG provided 58,499 visits in Bend clinics, 49,235 visits in Redmond clinics, 5,495 visits in Sisters clinics and 24,915 visits in Prineville clinics in 2013. SCMG also operates an immediate care clinic to provide low-cost urgent care services to the community; the immediate care clinic provided services for 12,936 patient visits in 2013. OTHER PROGRAM SERVICES 7: Home Health/Hospice
Form 990, Part VI, Line 11b: Form 990 Review Process The 990 was prepared internally and reviewed by an external consultant. It was reviewed by the organization's Director of Finance and the Exec VP of Finance/CFO, both CPAs. It was also sent to each Board member and an acknowledgment of receipt and review is required by each member. It was presented to the Audit Committee on behalf of the Board of Directors for final review and approval before filing.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts The policy covers any SCHS director, principal officer, or member of a committee with powers delegated by the SCHS Board of Directors (the Board) who has a direct or indirect financial interest in SCHS or any entity within SCHS. Each interested person shall annually complete the Conflict of Interest Questionnaire. This completed form is automatically submitted to the SCHS Compliance Officer and/or Senior Internal Auditor who will evaluate the completed forms and present a report to the Governance Committee . In addition, should a subsequent conflict arise after the submission of the previously completed Conflict of Interest Questionnaire each interested person shall orally disclose, prior to the Boards or the relevant committees consideration of a proposed transaction or arrangement, the existence of any financial interest that he or she may have with respect to the transaction or arrangement. The board will then review the transaction or arrangement to determine if it is in SCHS's best interest, for its own benefit, and whether it is fair and reasonable. In conformity with the above determination, it shall make its decision as to whether to enter into the transaction or arrangement.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management SCHS utilizes an independent outside consultant to provide comparability data regarding compensation for the CEO and top management officials. The analysis covers all elements of total compensation. The CEO compensation is reviewed and approved by the Board of Directors following an annual performance evaluation and compensation review. The evaluation and review process is prescribed in an internal policy and the process is documented. The most recent study for the CEO and top management officials was performed in November of 2013.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Governing documents are available upon request. The Conflict of Interest policy is available to employees through a shared document management system. Financial reports are shared with employees monthly. Audited financial statements are available to the public upon request and on the internet at www.DACBond.com.
Other Changes In Net Assets Or Fund Balances - Other Decreases DISTRIBUTIONS = -$3651658
Other Changes In Net Assets Or Fund Balances - Other Decreases ROUNDING = -$0
Other Changes In Net Assets Or Fund Balances - Other Decreases UNRESTRICTED NET ASSETS NON CONTROLLING = -$0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID: 13000170
Software Version: 2013v3.1