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ObjectId: 201901359349304960 - Submission: 2019-05-15
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.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
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
21,079,292
1,879,930
SFH
(2)
Care Communications LLC
6600 S Yale Ave Ste 400
Tulsa
,
OK
74136
26-0015989
Comm Svcs
OK
4,201,453
5,943,510
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)
12b 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)
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)
12a Type I
SFHS
Yes
(5)
Saint Francis Hospital Vinita Inc
6600 Yale Ave Ste 400
Tulsa
,
OK
74136
81-3747248
Health Svcs
OK
501(c)(3)
3
SFHS
Yes
(6)
Saint Francis Hospital Muskogee Inc
6600 S Yale Ave Ste 400
Tulsa
,
OK
74136
81-4322087
Health Svcs
OK
501(c)(3)
3
SFHS
Yes
(7)
Saint Francis Home Health Inc
6600 S Yale Ave Ste 400
Tulsa
,
OK
74136
73-1234331
Health Svcs
OK
501(c)(3)
12a Type I
SFH
Yes
(8)
Warren Clinic Inc
6600 S Yale Ave Ste 400
Tulsa
,
OK
74136
73-1310891
Health Svcs
OK
501(c)(3)
3
SFHS
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2017
Page 2
Schedule R (Form 990) 2017
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
74136
73-1414359
Health Svcs
OK
SFH
S Corp
0
0
100.000 %
Yes
(2)
Related Health Services Inc
6600 S Yale Ave Ste 400
Tulsa
,
OK
74136
73-1288715
Health Svcs
OK
SFH
S Corp
-1,980,378
65,399,155
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
74136
45-0470422
common pay agent
OK
SFHS
C Corp
0
0
Yes
(5)
Saint Francis Hlth Sys Gen-Prof Lia
PO Box 3038
Milwaukee
,
WI
532013038
75-6583874
Self Insurance
WI
SFHS
Trust
0
0
Yes
(6)
Saint Francis Pharmacy Services Inc
6600 S Yale Ave Ste 400
tulsa
,
OK
74136
81-3127970
Pharmacy
OK
SFH
S Corp
1,576,117
4,756,053
100.000 %
Yes
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
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)
Laureate Psychiatric Clinic & Hospital Inc
L
2,224,139
Trans Review
(2)
Laureate Psychiatric Clinic & Hospital Inc
Q
56,280,198
Trans Review
(3)
Laureate Psychiatric Clinic & Hospital Inc
P
41,747,492
Trans Review
(4)
Laureate Psychiatric Clinic & Hospital Inc
S
13,230,613
Trans Review
(5)
Laureate Psychiatric Clinic & Hospital Inc
M
112,789
Trans Review
(6)
Laureate Psychiatric Clinic & Hospital Inc
R
8,092,648
Trans Review
(7)
Warren Clinic Inc
K
442,396
Trans Review
(8)
Warren Clinic Inc
J
975,232
Trans Review
(9)
Warren Clinic Inc
M
6,082,522
Trans Review
(10)
Warren Clinic Inc
L
7,123,136
Trans Review
(11)
Warren Clinic Inc
Q
412,264,770
Trans Review
(12)
Warren Clinic Inc
P
288,294,904
Trans Review
(13)
Warren Clinic Inc
S
74,677,891
Trans Review
(14)
Warren Clinic Inc
R
3,324,443
Trans Review
(15)
Related Health Services Inc
L
369,060
Trans Review
(16)
Related Health Services Inc
P
5,517,871
Trans Review
(17)
Related Health Services Inc
Q
4,788,076
Trans Review
(18)
Related Health Services Inc
C
3,518,087
Trans Review
(19)
Saint Francis Hospital South LLC
I
10,215,808
Trans Review
(20)
Saint Francis Hospital South LLC
K
215,840
Trans Review
(21)
Saint Francis Hospital South LLC
L
4,249,411
Trans Review
(22)
Saint Francis Hospital South LLC
Q
124,699,423
Trans Review
(23)
Saint Francis Hospital South LLC
P
104,227,751
Trans Review
(24)
Saint Francis Hospital South LLC
S
40,841,888
Trans Review
(25)
Saint Francis Hospital South LLC
R
15,574,699
Trans Review
(26)
Saint Francis Home Health Inc
L
900,109
Trans Review
(27)
Saint Francis Home Health Inc
Q
20,719,619
Trans Review
(28)
Saint Francis Home Health Inc
P
10,911,552
Trans Review
(29)
Saint Francis Home Health Inc
S
6,954,953
Trans Review
(30)
Saint Francis Home Health Inc
R
4,667,675
Trans Review
(31)
Saint Francis Home Health Inc
C
619,164
Trans Review
(32)
The Children's Hospital Fdn at Saint Francis
Q
1,374,671
Trans Review
(33)
The Children's Hospital Fdn at Saint Francis
P
76,126
Trans Review
(34)
The Children's Hospital Fdn at Saint Francis
C
7,154,134
Trans Review
(35)
Saint Francis Pharmacy Services Inc
L
81,468
Trans Review
(36)
Saint Francis Pharmacy Services Inc
Q
31,885,659
Trans Review
(37)
Saint Francis Pharmacy Services Inc
P
10,838,227
Trans Review
(38)
Saint Francis Pharmacy Services Inc
C
1,853,388
Trans Review
(39)
Saint Francis Hospital Vinita Inc
R
366,956
Trans Review
(40)
Saint Francis Hospital Vinita Inc
L
645,023
Trans Review
(41)
Saint Francis Hospital Vinita Inc
Q
18,477,510
Trans Review
(42)
Saint Francis Hospital Vinita Inc
P
15,719,473
Trans Review
(43)
Saint Francis Hospital Vinita Inc
S
73,126
Trans Review
(44)
Saint Francis Hospital Muskogee Inc
L
309,594
Trans Review
(45)
Saint Francis Hospital Muskogee Inc
Q
122,643,912
Trans Review
(46)
Saint Francis Hospital Muskogee Inc
P
8,653,312
Trans Review
(47)
Saint Francis Hospital Muskogee Inc
R
123,867
Trans Review
(48)
The Children's Hospital Fdn at Saint Francis
B
300,000
Trans Review
Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
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) 2017
Page 5
Schedule R (Form 990) 2017
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) 2017
Additional Data
Software ID:
Software Version: