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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
right arrow Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
right arrow Attach to Form 990.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
St Charles Health System Inc
 
Employer identification number
93-0602940
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A HOSPITAL FACILITY AUTHORI
  		93-0991182 000000000 05-17-2022 75,260,000 SEE PART VI   X   X   X
B HOSPITAL FACILITY AUTHORI
  		93-0991182 250336DY7 10-12-2016 114,801,653 SEE PART VI   X   X   X
C HOSPITAL FACILITY AUTHORI
  		93-0991182 250336EY6 10-22-2020 51,302,850 SEE PART VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired ..................   7,055,000    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 75,260,000 115,768,627 51,343,229  
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............   2,334    
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 260,000 1,200,176    
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   68,596,617    
11 Other spent proceeds ............. 75,000,000 45,969,500    
12 Other unspent proceeds .............     51,343,229  
13 Year of substantial completion ............. 2020
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X     X   X    
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X X     X    
16 Has the final allocation of proceeds been made? .......... X   X     X    
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2022
Page 2

Schedule K (Form 990) 2022
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X   X     X    
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X X     X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?     X          
c Are there any research agreements that may result in private business use of bond-financed property? ............. X   X     X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....right arrow 0.700 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... right arrow        
6 Total of lines 4 and 5 ............. 0.700 %      
7 Does the bond issue meet the private security or payment test? ... X   X   X      
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X      
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X    
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? ....... X     X X      
b Exception to rebate? ........ X     X   X    
c No rebate due? .........   X X     X    
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....                
Schedule K (Form 990) 2022
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Schedule K (Form 990) 2022
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X X     X    
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X      
Part Ⅴ
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Part VI Column A: Part I (f) - The Bonds were issued for the purpose of making a loan to the Borrower. The proceeds were used to (i) refinance the Authority's Series 2014 Bonds originally issued on 4/1/2014, and (ii) to pay costs of issuance.Column A: Part III, line 7 - As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private security or payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The organization has not undertaken an analysis of the private security or payment test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code.Column A: Part IV, Line 2(b) - The current refunding portion of the bonds met the 6-month exception to rebate.Column B: Part I(f) - The Series 2016A Bonds were issued to finance capital projects, advance refunded the Borrower's 2005B Bonds which were issued on December 21, 2005 and to pay costs of issuance relating to the Column B: Part II, Line 3 - The total proceeds shown in Part II, Line 3 differs from the Issue Price shown in Part I, (e) due to interest earnings on invested proceeds.Column B: Part III, line 7 - As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private security or payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The organization has not undertaken an analysis of the private security or payment test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code.Column B: Part IV, Line 2C - The rebate computation for Series 2016A dated November 28, 2021 was completed by BLX Group LLC and states no rebate due.Column C: Part I (f) - The Bonds were issued to pay costs of capital improvements to the Borrower's health care system.Column C: Part II, Line 3 - The total proceeds shown in Part II, Line 3 differs from the Issue Price shown in Part I, (e) due to interest earnings on invested proceeds.Column C: Part III, line 7 - As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private security or payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The organization has not undertaken an analysis of the private security or payment test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code.
Schedule K (Form 990) 2022

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