SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
Saint Francis Hospital Inc
 
Employer identification number

73-0700090
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
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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
Yes
 
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) . . . 		    31,878,682   31,878,682 3.620 %
b Medicaid (from Worksheet 3, column a) . . . . .     147,946,735 120,241,835 27,704,900 3.150 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     179,825,417 120,241,835 59,583,582 6.770 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,291,864   1,291,864 0.150 %
f Health professions education (from Worksheet 5) . . .     5,643,729   5,643,729 0.640 %
g Subsidized health services (from Worksheet 6) . . . .     220,224,495 162,159,974 58,064,521 6.590 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     227,160,088 162,159,974 65,000,114 7.380 %
k Total. Add lines 7d and 7j .     406,985,505 282,401,809 124,583,696 14.150 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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     1,670,047   1,670,047 0.190 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy     1,717,837   1,717,837 0.200 %
8 Workforce development            
9 Other            
10 Total     3,387,884   3,387,884 0.390 %
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
93,650,395
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
15,462,055
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
230,347,293
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
223,957,079
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
6,390,214
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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Saint Francis Hospital Inc
6600 S Yale Ave Suite 400
Tulsa,OK741363319
WWW.SAINTFRANCIS.COM
2362 		X X X       X      
Schedule H (Form 990) 2017
Page 4
Schedule H (Form 990) 2017
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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)
Saint Francis Hospital Inc
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Schedule H, Part V, Section C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Saint Francis Hospital Inc
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
See Schedule H, Part V, Section C
b
See Schedule H, Part V, Section C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
Saint Francis Hospital Inc
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Saint Francis Hospital Inc
Name of hospital facility or letter of facility reporting group  
Yes No
22 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
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
Page 8
Schedule H (Form 990) 2017
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Part V, Section B, Line 5 The Community Health Needs Assessment (CHNA) report uses quantitative data derived from primary research and secondary data (American Community Survey data, Census Bureau data) obtained from the Tulsa County Health Department. The survey instrument used for this study was created by the Tulsa City-County Health Department, Health Data and Evaluation Division, with input from community partners. Community input focus group sessions were conducted in each of the eight Tulsa Health Department defined regions.
Part V, Section B, Line 6a Saint Francis Hospital, Inc. conducted the CHNA with Saint Francis Hospital South, LLC and Laureate Psychiatric Clinic and Hospital, Inc.
Part V, Section B, Line 6b Saint Francis Hospital Inc.s CHNA was conducted by the Tulsa County Health Department.
Part V, Section B, Line 7a https://www.saintfrancis.com/about-us/commitment-to-community
Part V, Section B, Line 10a https://www.saintfrancis.com/about-us/commitment-to-community
Part V, Section B, Line 11 The Community Health Needs Assessment (CHNA) identified the top ten needs (in order of highest priority) of the Tulsa community as poor diet/inactivity; chronic diseases; alcohol/drug abuse; access to healthcare; tobacco use; lack of education; aging problems; safety/crime; poverty/unemployment; and mental health. Saint Francis Hospital, Inc. does not intend to address the health needs due to lack of education; aging problems; safety/crime; and poverty/unemployment due to lack of expertise in these areas. It is an unfortunate matter that certain socioeconomic burdens to the health of our community cannot be fully or effectively addressed by individual private institutions. The hospitals comprising Saint Francis Health System, Inc. provide millions of dollars each year in uncompensated care to the poor in the form of free or discounted care to the uninsured, the underinsured, and the Medicaid beneficiaries. Saint Francis Hospital, Inc., as well as Saint Francis Hospital South, LLC, Laureate Psychiatric Clinic and Hospital, Inc., Saint Francis Hospital Vinita, Inc., Saint Francis Hospital Muskogee, Inc. and the senior leadership and Board of Directors of the Saint Francis Health System, Inc. will continue to work with community and state-level policy and political leaders, safety net providers, and community advocates to build sustainable partnerships to better address these broader community needs. Saint Francis Health System, Inc. and all of its entities, including those not covered by the CHNA implementation strategy, will continue to be an advocate for the poor, the vulnerable and the underserved. Saint Francis Hospital, Inc. and the other Saint Francis Health System, Inc. entities are addressing the community needs of access to healthcare; alcohol/drug abuse; chronic diseases; poor diet/inactivity; tobacco use; and mental health through various programs designed to improve access to healthcare, advance knowledge, identify root causes, and improve health status and quality of life. Access to healthcare Access to comprehensive, quality health services is necessary for health equity and a healthy quality of life for individuals in our community. Access to healthcare can impact physical, social and mental health, disease and disability prevention, and life expectancy, among other things. Not having healthcare coverage obstructs the ability to access medical care; reduces utilization of preventive services; and contributes greatly to the costs of healthcare. Uninsured people are also less likely to receive medical care, more likely to die early, and more likely to have poor health status as they tend to delay treatment; experience diagnoses at later stages of disease progression; and may receive less medical care than patients with health insurance. Current policy efforts focus on the provision of insurance coverage as the principal means of ensuring access to healthcare amount the general population. Almost two-thirds of Tulsa County adults surveyed ages 18 - 64 reported they had employer provided or private insurance (63.1 percent). An additional 14.3 percent reported insurance through a government sponsored program (Medicaid, Medicare, military benefits, or tribal/Indian health benefits). This age group was defined in order to exclude the Medicare population age 65 and older. However, 13.4 percent of Tulsa County adults ages 18-64 reported having no health coverage. This was lower than both Oklahoma (17.2 percent) and the US (20.0 percent). None of these regions met the Healthy People 2020 goal of universal coverage (no one without insurance). Saint Francis Health System, Inc. and Saint Francis Hospital, Inc. in its mission to extend the presence and healing ministry of Christ in all we do, addresses these community health needs by providing charity care to those families meeting the 225% Federal Poverty Guidelines criteria. Additionally, the Xavier Medical Clinic, an entity fully owned and operated by Saint Francis Health System, Inc. offers the resources of 50 volunteer physicians, pharmacists, nurses and other health professionals to women, children and men who are uninsured or underserved. The clinic has two components, Xavier Medical Clinic and Xavier Pregnancy Program. Xavier Medical Clinic seeks to provide free, limited outpatient primary health care services, facilitate referrals to volunteer specialists, educate in good health practices and increase access to traditional healthcare. The Xavier Pregnancy Program provides pregnancy screening services and prenatal servers to expectant mothers, many of whom lack the financial means necessary to purchase insurance. They follow the mother and baby throughout the pregnancy and during the postpartum time, assisting when needed as any identifiable need surfaces. Patients are referred to Saint Francis Hospital, Inc. for inpatient care including childbirth, as well as surgery and ancillary services. In fiscal year 2018, Xavier Medical Clinic received 8,900 patient visits, aided over 140 patients to receive referrals outside of the clinic, provided over 180 prescriptions with an equivalent cost of over $201,197 dispensed over 11,479 prescriptions and the Xavier Pregnancy Program assisted 472 women, resulting in 410 births at Saint Francis Hospital, Inc. Because of its dedicated and caring staff, Xavier Clinic is able to reach a group that might otherwise avoid or have difficulties accessing basic healthcare services. Saint Francis Health System, Inc. also holds several health fairs over the course of a year to disseminate health information and/or to provide health screenings to the community at large. Saint Francis Hospital, Inc., Saint Francis Hospital South, LLC, Laureate Psychiatric Clinic and Hospital, Inc., Saint Francis Hospital Vinita, Inc., and Saint Francis Hospital Muskogee, Inc. will serve as acute care hubs for the patients that utilize the health system's primary, urgent, and specialty care at outlying locations. These are a few of the many ways Saint Francis Health System, Inc. is addressing the need for improving access to healthcare. Alcohol and drug use Substance abuse has a major impact on individuals, families, and communities, and contributes to poor public health outcomes. These costly social, physical, mental, and public health problems include teenage pregnancies, HIV/AIDS and other STDs, domestic violence, child abuse, motor vehicle accidents, physical fights, crime, homicide, and suicide. Estimates of individuals who have a substance abuse disorder are high, indicating the importance of prevention efforts and improved access to treatment for substance abuse. Overall, 2.3 percent of Tulsa County adults reported that they had been told by a healthcare or support service provider that they had an alcohol dependency, and a total of 2.3 percent of Tulsa Country adults reported they had been told by a healthcare or support service provider that they had a drug dependency. These self-reported rates appear to be lower than much literature would suggest, lending support to the theory that mental health needs in general are a major area of need for both the service area and the nation as a whole. Saint Francis Hospital, Inc. is not addressing this issue; however, Laureate Psychiatric Clinic and Hospital, Inc., an entity of Saint Francis Health System, Inc. offers substance abuse counseling for adults on an inpatient basis, and adults and adolescents on an outpatient basis to address alcohol and drug abuse. Other entities in the community addressing this issue include Parkside Psychiatric Hospital, Brookhaven Hospital, Indian Healthcare Resource Center of Tulsa, Oxford House, St. John Health System, Hillcrest Health System, Alcoholics Anonymous, Shadow Mountain Behavioral Health System, Tulsa Center for Behavioral Health and Family and Children's Services. Chronic disease In the US, chronic diseases are the main causes of poor health, disability, and death, and account for most of healthcare expenditures. Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic diseases accounts for 86 percent of our nation's healthcare costs per the Centers for Disease Control and Prevention (CDC). Around half of adults in the US have at least one chronic condition and 26 percent have two or more conditions. The chronic disease burden in the US largely results from a short list of risk factors - including socioeconomic status, tobacco use, poor diet and physical inactivity (both strongly associated with obesity) - that can be effectively addressed for individuals and populations. To effectively and equitably address the chronic disease burden, public health and healthcare systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population - wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including
Part V, Section B, Line 13b Patients who have been evaluated and identified to be financial assistance plan eligible and meet the criteria established by Saint Francis Hospital, Inc. according to relevant circumstances regarding income, assets, or other resources available to the patient or patients family, are considered charity and therefore, by hospital policy, are not billed for any services.
Part V, Section B, Lines 16a, b and c https://www.saintfrancis.com/patients-and-guests/for-patients/billing-and- insurance/
Part V, Section B, Line 16j The billing statement includes information regarding financial assistance availability. Additionally, MyChart, a secure online tool that allows patients to connect with their personal health information 24/7, provides a link which takes the patient to the financial assistance letter and application form.
Part V, Section B, Line 20e Proactive phone calls and statements are sent before collection actions are taken.
Part V, Section B, Line 22d Amounts generally billed (AGB) are determined under the prospective method using Medicaid reimbursement rates. Additionally, a self-pay discount of 20 percent is provided on all charges for uninsured patients.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
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 3c Income based criteria is used as the basis in determining eligibility for free health services.
Part I, Line 6a Saint Francis Health System, Inc. 73-1501972, the parent organization of Saint Francis Hospital, Inc. produces a consolidated community benefit report included in the spring issue of the Saint Francis Health System magazine "Presence" that is made available to the public through the organization's website at https://www.saintfrancis.com/about-us/commitment-to-community
Part I, Line 7 Costing Methodology: A ratio of patient care cost to charges, as determined in Worksheet 2, was used to report the amounts in Part I, Lines 7a 7c. For amounts reported on lines 7e 7i, actual expenses for each community benefit activity are tracked and reported using the organizations accounting general ledger and are not based on a cost to charge ratio. The number reflected on line 7, column (f) excludes bad debt expense. The supplemental hospital offset payment program (SHOPP) was created and implemented in calendar year 2011 for the purpose of assuring access to quality care for Oklahoma Medicaid members. The program is designed to assess Oklahoma hospitals, unless exempt, a supplemental hospital offset payment program fee. The collected fees are placed in pools and then allocated to hospitals based on Medicaid revenues as directed by legislation. The Oklahoma Health Care Authority (OHCA) does not guarantee that allocation will equal or exceed the amount of the supplemental hospital offset payment program fees that were paid by Saint Francis Hospital, Inc.
Part II: Community Building Activities Community building activities improve the communitys health and safety by addressing the root cause of health problems. These activities strengthen the communitys capacity to promote the health and well-being of its residents by offering the expertise and resources of the healthcare organization. Costs for these activities include cash donations and expenses for the development of a variety of community-building programs and partnerships. See Schedule O for additional information regarding Saint Francis Health System, Inc.s and Saint Francis Hospital, Inc.s community building activities aimed at promoting the health of the community.
Part III, Section A, Line 2 Saint Francis Hospital, Inc. has an established process to determine the adequacy of the allowance for uncollectable receivables that relies on a number of analytical tools and benchmarks to arrive at a reasonable allowance. No single statistic or measurement determines the adequacy of the allowance for uncollectable receivables. Some of the analytical tools that Saint Francis Hospital, Inc. utilizes include, but are not limited to, historical cash collection experience, revenue trends by payer classification, and revenue days in accounts receivable. Accounts receivable are written off after collection efforts have been followed in accordance with Saint Francis Hospital, Inc.s policies.
Part III, Section A, Line 3 The bad debt expense attributable to patients eligible under the organizations financial assistance policy is calculated from a sample review of all bad debt accounts and subsequent information.
Part III, Section A, Line 4 Saint Francis Hospital, Inc.s audited financial statements provide a separate footnote addressing the organizations accounts receivable and allowance for doubtful accounts on pages 6, 7 and 8. Saint Francis Hospital, Inc. reports bad debt in accordance with Generally Accepted Accounting Principles (GAAP). Healthcare Financial Management Associate Statement 15 is followed to the extent that the provision for bad debt at cost is determined using the same cost to charge ratio that is used to calculate charity care and Medicaid shortfalls. Discounts and allowances are accounted for separately from the provision for bad debt. Accounts receivable are valued at net realizable value. Saint Francis Hospital, Inc. estimates the allowances for uncollectable receivables based on historic write-offs and the aging of the accounts.
Part III, Section B, Line 8 Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio and the Medicare filed cost report.
Part III, Section C, Line 9b Saint Francis Hospital, Inc.s debt collection policy is to pursue collections of patient balances from patients who have the ability to pay for the services. Saint Francis Hospital, Inc. applies its collections efforts consistently and fairly to all patients regardless of insurance. Saint Francis Hospital, Inc. works with those individuals who do not have the financial resources to pay outstanding balances to qualify for Saint Francis Hospital, Inc.s financial assistance policy. Charges to patients qualifying for charity care under the Saint Francis Hospital, Inc. financial assistance policy are written off 100 percent.
Part VI, Line 2 Needs assessment One of Saint Francis Hospital, Inc.s fundamental operational goals is to identify and address the needs of the defined community that it serves. Justice is one of the core values of Saint Francis Hospital, Inc. and Saint Francis Health System, Inc. It calls for the organization to advocate for systems and structures that are attuned to the needs of the vulnerable and disadvantaged and to promote a sense of community among all persons. To effectively do this requires that Saint Francis Health System, Inc.: 1.Gathers and obtains information identifying those needs; and 2.Develops programs and services that address and provides access to those in greatest need of healthcare services. Historically, Saint Francis Health System, Inc. and its entities focus have been caring for those who are sick or vulnerable. In order to make informed decisions on how to care for the sick, at-risk and minority populations, Saint Francis Health System, Inc. must first identify priority health needs. During the fiscal year 2016, Saint Francis Health System, Inc. conducted a Community Health Needs Assessment (CHNA) to address the healthcare needs of the community for each of its licensed hospital facilities and developed an implementation strategy to address the needs identified in the CHNA. The assessment is a compilation of national survey results, health information databases, government data, and analytical feedback from state and local partners. This data is used to identify potential courses of action based on existing healthcare facilities, available resources within the community, and capabilities of the community in terms of both socioeconomic and education status. Providing access to comprehensive, quality health services; providing effective treatments and services in the community for substance abuse disorders and mental health disorders; promoting the prevention of disease; reducing obesity and promoting healthy eating; cessation of tobacco use; and promoting the health of low-income and at-risk communities are among the public health issues that the assessment seeks to prioritize. The CHNA and implementation strategies are available to the public on Saint Francis Health System, Inc.s website at https://www.saintfrancis.com/Documents/CHNA.pdf
Part VI, Line 3 Patient education of eligibility for assistance Saint Francis Health System, Inc. and its entities are committed to promoting health in the community including providing or finding financial assistance programs to assist patients. Saint Francis Health System, Inc. uses a multi-faceted approach to educate our patients on the availability of charity, as well as state and federal financial assistance. This includes several ways including, but not limited to, the following: - A brochure titled "Patient Financial Policy" on financial rights and responsibility is provided to every patient at the time of their registration and is available on the Saint Francis Health System, Inc. and Saint Francis Hospital, Inc. websites. The brochure provides financial assistance program details. - The financial assistance policy, plain language summary, and application are posted on the Saint Francis Health System, Inc. and Saint Francis Hospital, Inc. websites in English and the Limited English Proficiency languages of the Primary Service Area (PSA). - Saint Francis Health System, Inc. prints a phone number where patients can obtain information about financial assistance on the back of the billing invoices. - Self-pay patients are visited by a financial counselor upon admission to verify their self-pay status. The financial counselor works with the self-pay patients to determine if the patient may qualify for assistance under a government sponsored plan. If the patient does not qualify for a government sponsored plan then the financial counselor works with the patient to determine if they qualify for charity based on the Saint Francis Health System, Inc.s financial assistance policy. - Saint Francis Health System, Inc. offers the financial assistance policy, as well as payment options as part of the patient responsibility during the follow up collection calls.
Part VI, Line 4 Community Information The Primary Service Area (PSA) of Saint Francis Health System, Inc. and Saint Francis Hospital, Inc. consists of Tulsa County, where a significant majority of inpatient admissions originate. The tertiary service area is encompassed by the whole of eastern Oklahoma. The most recent needs assessment of fiscal year 2016 identified approximately 630,000 people in the PSA. Over one-quarter of Tulsa County residents are under the age of 18, and 13 percent of the population is over the age of 65. Both of these figures indicate that the PSA has a slightly younger population than both the State of Oklahoma and the nation as a whole. The PSA is comprised of the following representation: - 64% Caucasian - 12% Hispanic or Latino - 11% African-American - 7% Native-American - 6% Two or more races In 2018, the median household income in Tulsa County was $52,959, (about 9 percent below the US median) and the 2017 mean household income was $74,062 (about 10 percent below the US average). The per capita income is slightly below the national median, but higher than the average for Oklahoma. Approximately 16 percent of the PSA's population lives in poverty, with the number climbing to almost 23 percent for those under 18. Nearly 13 percent of households in the county received food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits within 2017. The uninsured rate in Tulsa County is approximately 15 percent. Of those in the PSA that do have insurance, 79 percent of hold private insurance policies. Distressingly, when narrowing focus to the PSA civilian population age 19 to 64 that participates in the labor force, the uninsured rate rises to nearly 18 percent. During Oklahoma's 2018 fiscal year, there were 1,020,726 unduplicated Medicaid enrollees; meaning over 25 percent of the state's population was enrolled in the Medicaid program at some point in time. Tulsa County was home to 165,085 of those unduplicated enrollees or approximately 26 percent of the PSA's population.
Part VI, Line 5 Promotion of community health Saint Francis Hospital, Inc. is part of an integrated healthcare delivery system with the mission of extending the presence and healing ministry of Christ in all we do. Saint Francis Health System, Inc., as a Catholic organization, seeks to reflect the presence of Christ in every personal and corporate encounter. Saint Francis Hospital, Inc. is dedicated to giving back to the community in which its employees live and work. This can be seen through Saint Francis Hospital, Inc.s promotion of community health through community events such as sponsored on-site educational seminars and classes on health issues. Saint Francis Health System, Inc. and Saint Francis Hospital, Inc.s governing body is comprised of community representatives on the Board of Directors that provide leadership and governance for the organization. The Board of Directors has the overall responsibility for the charitable and the mission of Saint Francis Hospital, Inc. and the other entities that are part of Saint Francis Health System, Inc. The members of the Board of Directors are selected based on their areas of expertise and experience including such areas as education, research, business and government. The members of the governing body contribute their wisdom, insights, and expertise to ensure the organization is fulfilling its mission and charitable purpose while providing efficient administrative support services and direction for Saint Francis Health System, Inc. The goal of Saint Francis Health System, Inc. is to sustain and grow its technology, to attract talented healthcare professionals from across the country and to provide high quality patient care to all the residents of northeastern Oklahoma and the neighboring states we serve. This can be seen in numerous construction projects that have been undertaken over the past several years. Most notable is the decision by our Board of Directors to construct a childrens hospital when there was only one other childrens facility in the state. Saint Francis Hospital, Inc. also undertook the financial strain that comes from running a childrens hospital in a state where 60 plus percent of all the children are insured under the state Medicaid program. The construction of the building notable, however, so is the infrastructure needed to make the hospital successful, including the ongoing recruitment of numerous pediatric sub-specialists, which helps to ensure the highest quality of care is given to this most valuable patient population. Another notable decision by our Board of Directors was to construct a level II trauma emergency center which was completed in September 2014 to meet the healthcare needs of eastern Oklahoma and provide more access to needed emergency services. The trauma center provides comprehensive critical care to those facing complex, life-threatening emergencies. The trauma center specialists adhere to the highest standards of critical care medicine and the services are greatly enhanced by the many sub-specialty services available within the hospital. The trauma center accommodates more than 112,000 patient visits annually (average of 300 per day). Adjacent to the trauma center is eastern Oklahomas only Pediatric Emergency Center, which can accommodate over 34,800 pediatric patients each year. The trauma center also has the ability to adapt to offer high volume triage and receive mass casualties during a disaster if necessary. Saint Francis Hospital, Inc. provides financial assistance in the form of charity care to patients who are indigent and satisfy certain requirements. Additionally, Saint Francis Hospital, Inc. is committed to treating patients who are eligible for means tested government programs such as Medicaid and other government sponsored programs including Medicare, which is provided regardless of the reimbursement shortfall, and thereby relieves the state and federal government of the burden of paying the full cost of care for those patients. Often, patients are unaware of the federal, state and local programs open to them for financial assistance, or they are unable to access them due to the cumbersome enrollment process required to receive these benefits. Saint Francis Health System, Inc. offers assistance in enrollment to these government programs or extends financial assistance in the form of charity care through the organizations Financial Assistance Policy. Saint Francis Hospital, Inc. reinvests its net operating income back into the facility to improve patient care, to benefit society and to allow Saint Francis Hospital, Inc. to carry out its vision to be the regional leader in the delivery of quality Catholic healthcare services.
Part VI, Line 6 Affiliated healthcare system Saint Francis Hospital, Inc., the largest entity within Saint Francis Health System, Inc., has one of the busiest emergency rooms in the State of Oklahoma. Over 112,000 patients were seen in the hospitals emergency room. Additionally, Saint Francis Hospital, Inc. admitted approximately 45,500 patients; provided ancillary and diagnostic services on an outpatient basis to an additional 328,600 patients; and handled approximately 4,200 births. See Schedule O for additional information regarding Saint Francis Hospital, Inc.s role within Saint Francis Health System, Inc
Part VI, Line 7 State filing of community benefit report Saint Francis Health System, Inc., which includes Saint Francis Hospital, Inc., publishes a community benefit report in Oklahoma. A written report that is included in the spring issue of the Saint Francis Health System, Inc. magazine "Presence" which is distributed to 40,000 households across eastern Oklahoma and to all Saint Francis Health System, Inc. locations for display and pick up to help educate the community on the benefits that Saint Francis Hospital, Inc. and Saint Francis Health System, Inc. provide to the communities we serve in return for our not-for-profit status. The report is also made available to the public on the health system's website.
Schedule H (Form 990) 2017
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