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ObjectId: 201711329349307231 - Submission: 2017-05-12
TIN: 73-0700090
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
15
Open to Public Inspection
Name of the organization
Saint Francis Hospital Inc
Employer identification number
73-0700090
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
SAINT FRANCIS OUTREACH SERVICES LLC
6600 S YALE AVE STE 400
Tulsa
,
OK
74136
14-1841340
Health SVCS
OK
18,672,967
1,601,690
SFH
(2)
CARE COMMUNICATIONS LLC
6600 S YALE AVE STE 400
Tulsa
,
OK
74136
26-0015989
Comm SVCS
OK
3,672,683
5,799,584
SFH
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
SAINT FRANCIS HEALTH SYSTEM INC
6600 S YALE AVE STE 400
Tulsa
,
OK
74136
73-1501972
health svcs
OK
501(C)(3)
11b TYPE II
NA
No
(2)
SAINT FRANCIS HOSPITAL SOUTH LLC
6600 S YALE AVE STE 400
tulsa
,
OK
74136
01-0603214
health svcs
OK
501(C)(3)
3
SFHS
Yes
(3)
LAUREATE PSYCHIATRIC CLINIC & HOSP INC
6600 S YALE AVE STE 400
tulsa
,
OK
74136
73-1308273
health svcs
OK
501(C)(3)
3
SFHS
Yes
(4)
WARREN CLINIC INC
6600 S YALE AVE STE 400
tulsa
,
OK
74136
73-1310891
health svcs
OK
501(C)(3)
3
SFHS
Yes
(5)
SAINT FRANCIS HOME HEALTH INC
6600 S YALE AVE STE 400
tulsa
,
OK
74136
73-1234331
health svcs
OK
501(C)(3)
11a TYPE I
SFH
Yes
(6)
WARREN CANCER RESEARCH FOUNDATION INC
6600 S YALE AVE STE 400
tulsa
,
OK
74136
73-1426265
medical rsrch
OK
501(C)(3)
4
SFH
Yes
(7)
The Children's Hosp Fdn at Saint Francis
6600 S YALE AVE STE 400
tulsa
,
OK
74136
20-2843418
health svcs
OK
501(C)(3)
11a TYPE I
SFHS
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Page 2
Schedule R (Form 990) 2015
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
SPRINGER CLINIC INC
6600 S YALE AVE STE 400
tulsa
,
OK
741363319
73-1414359
health svcs
OK
SFH
s corp
1,232,387
0
100.000 %
Yes
(2)
RELATED HEALTH SERVICES INC
6600 S YALE AVE STE 400
tulsa
,
OK
741363319
73-1288715
health svcs
OK
SFH
s corp
3,004,074
72,750,258
100.000 %
Yes
(3)
XAVIER INSURANCE COMPANY INC
76 ST PAUL ST STE 500
burlington
,
VT
054014477
03-0333599
captive insurance
VT
SFHS
c corp
0
0
Yes
(4)
SAINT FRANCIS PAYROLL SERVICES LLC
6600 S YALE AVE STE 400
Tulsa
,
OK
741363319
45-0470422
common pay agent
OK
SFHS
c corp
0
0
Yes
(5)
SFHS GENERALPROF LIABILITY FUND
PO BOX 3038
MILWAUKEE
,
WI
532013038
75-6583874
Self Insurance
WI
SFHS
TRUST
0
0
Yes
Schedule R (Form 990) 2015
Page 3
Schedule R (Form 990) 2015
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
Yes
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
SAINT FRANCIS HEALTH SYSTEM INC
m
716,271
TRANS REVIEW
(2)
SAINT FRANCIS HEALTH SYSTEM INC
p
61,271,490
TRANS REVIEW
(3)
SAINT FRANCIS HEALTH SYSTEM INC
L
58,869
TRANS REVIEW
(4)
SAINT FRANCIS HEALTH SYSTEM INC
q
55,986,333
TRANS REVIEW
(5)
SAINT FRANCIS HEALTH SYSTEM INC
b
9,072,384
TRANS REVIEW
(6)
SAINT FRANCIS HEALTH SYSTEM INC
c
36,224,548
TRANS REVIEW
(7)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
m
377,346
TRANS REVIEW
(8)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
l
2,126,474
TRANS REVIEW
(9)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
q
71,274,116
TRANS REVIEW
(10)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
p
39,856,472
TRANS REVIEW
(11)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
s
30,140,615
TRANS REVIEW
(12)
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
r
6,683,617
TRANS REVIEW
(13)
WARREN CLINIC INC
i
411,868
TRANS REVIEW
(14)
WARREN CLINIC INC
J
412,926
TRANS REVIEW
(15)
WARREN CLINIC INC
K
225,311
TRANS REVIEW
(16)
WARREN CLINIC INC
M
5,815,116
TRANS REVIEW
(17)
WARREN CLINIC INC
L
9,155,345
TRANS REVIEW
(18)
WARREN CLINIC INC
Q
429,636,433
TRANS REVIEW
(19)
WARREN CLINIC INC
P
256,126,736
TRANS REVIEW
(20)
WARREN CLINIC INC
S
144,698,180
TRANS REVIEW
(21)
WARREN CLINIC INC
R
3,663,625
TRANS REVIEW
(22)
RELATED HEALTH SERVICES INC
P
299,612
TRANS REVIEW
(23)
RELATED HEALTH SERVICES INC
L
345,669
TRANS REVIEW
(24)
RELATED HEALTH SERVICES INC
Q
4,188,499
TRANS REVIEW
(25)
RELATED HEALTH SERVICES INC
B
1,195,141
TRANS REVIEW
(26)
SAINT FRANCIS HOSPITAL SOUTH LLC
K
454,223
TRANS REVIEW
(27)
SAINT FRANCIS HOSPITAL SOUTH LLC
L
5,440,995
TRANS REVIEW
(28)
SAINT FRANCIS HOSPITAL SOUTH LLC
P
94,326,835
TRANS REVIEW
(29)
SAINT FRANCIS HOSPITAL SOUTH LLC
S
69,318,879
TRANS REVIEW
(30)
SAINT FRANCIS HOSPITAL SOUTH LLC
R
11,807,445
TRANS REVIEW
(31)
SAINT FRANCIS HOSPITAL SOUTH LLC
Q
146,270,338
TRANS REVIEW
(32)
SAINT FRANCIS HOME HEALTH INC
c
1,124,892
TRANS REVIEW
(33)
SAINT FRANCIS HOME HEALTH INC
P
1,820,334
TRANS REVIEW
(34)
SAINT FRANCIS HOME HEALTH INC
S
9,870,827
TRANS REVIEW
(35)
SAINT FRANCIS HOME HEALTH INC
R
5,374,170
TRANS REVIEW
(36)
SAINT FRANCIS HOME HEALTH INC
L
557,393
TRANS REVIEW
(37)
SAINT FRANCIS HOME HEALTH INC
Q
12,972,428
TRANS REVIEW
(38)
SPRINGER CLINIC INC
K
216,701
TRANS REVIEW
(39)
SPRINGER CLINIC INC
Q
240,026
TRANS REVIEW
(40)
SPRINGER CLINIC INC
C
9,815,251
TRANS REVIEW
(41)
CHILDREN'S HOSPITAL FOUNDATION AT SAINT FRANC
P
62,907
TRANS REVIEW
(42)
CHILDREN'S HOSPITAL FOUNDATION AT SAINT FRANC
C
3,645,020
TRANS REVIEW
(43)
CHILDREN'S HOSPITAL FOUNDATION AT SAINT FRANC
B
258,065
TRANS REVIEW
(44)
CHILDREN'S HOSPITAL FOUNDATION AT SAINT FRANC
Q
1,420,414
TRANS REVIEW
Schedule R (Form 990) 2015
Page 4
Schedule R (Form 990) 2015
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2015
Page 5
Schedule R (Form 990) 2015
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2015
Additional Data
Software ID:
Software Version: