Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a | Statement of Accomplishments Saint Francis Hospital South, LLC is a member of Saint Francis Health System, Inc. The Saint Francis Health System, Inc. Is a Catholic, not-for profit health system whose mission is to extend the presence and healing ministry of Christ in all we do. Saint Francis Hospital South, LLC's accomplishments includes operating an acute care hospital where admitting physicians, who are primarily practitioners in the local area, provide inpatient/outpatient and emergency care services to residents of Broken Arrow and Tulsa, Oklahoma and surrounding areas and operating a healthplex in Glenpool, Oklahoma that provides a variety of outpatient services as well as a full-service emergency room. In fiscal year 2023, Saint Francis Hospital South, LLC provided approximately $2,876,570 of charity care (measured at established rates) and $278,670 in unreimbursed Medicaid services (measured at established rates). Recognition : In the following, you will see many ways Saint Francis Health System, Inc. and Saint Francis Hospital South, LLC distinguish themselves through recognition by national associations and publications. Saint Francis Hospital South, LLC is committed to continual improvement in both patient service and clinical quality in order to better serve our community. Quality commendations received in the fiscal year include: Saint Francis Hospital South, LLC was recognized as an award winner by the national healthcare research firm Professional Research Consultants, Inc (PRC) based on performance in FY 2023. These competitive national awards recognize organizations who achieve excellence throughout the year by improving patient experiences based on surveys of their patients. Saint Francis Hospital South, LLC received a Five Star Award for achieving a top decile ranking for its free-standing emergency department in Glenpool. It also achieved a Four Star Award for inpatient services with an overall quality of care score in the top quartile of the country. Healthgrades, a website devoted to providing independent ratings and assessments of healthcare providers, recognized Saint Francis Hospital South, LLC with five-star ratings on its website for the conditions and procedures: Sepsis, Pneumonia, and Respiratory Failure. US News and World Report recognized Saint Francis Hospital South, LLC in its 2023-2024 Best Hospitals rankings. Saint Francis Hospital South, LLC was recognized as high performing for treatment of Kidney Failure. The Lown Institute recognized Saint Francis South with an A grade for clinical outcomes. This designation as based on Saint Francis Hospital South's best in the state results for mortality and readmissions. |
| Form 990, Part V, Line 2b | Saint Francis Payroll Services, LLC, EIN 45-0470422, has been authorized to act as a common pay agent under Section 3504 of the Internal Revenue Code for Saint Francis Health System, Inc. effective July 1, 2002, in accordance with revenue procedure 70-6, 1970-1 C.B. 420. Saint Francis Payroll Services, LLC assumed reporting obligations for federal income tax, social security, Medicare withholding tax purposes as well as advance payment of earned income credit for Saint Francis Health System, Inc. and year-end reporting effective July 1, 2002. |
| Form 990, Part V, Line 15 | Common Law Employees: Individuals listed as officers of the organization that are paid full time by a related organization are common law employees of Saint Francis Health System, Inc., a separate legal entity. It is the intention of Saint Francis Health System, Inc. and the filing organization to make information accessible and transparent, reporting those Saint Francis Health System, Inc. employees who have officer and key employee responsibilities to the filing organization. |
| Form 990, Part VI, Section A, Line 2 | Description of Relationships Many of the persons listed on Part VII have a "business relationship" with each other by virtue of serving on related Saint Francis Health System, Inc. entity boards and other corporation boards. There are also "family relationships" requiring disclosure. The organization has determined these associations do not present a conflict of interest. Cliff A. Robertson M.D, an officer and director, served on a board outside of Saint Francis Health System, Inc. with another director, William R. Lissau. William K. Warren, Jr., a trustee, is the father of John Kelly C. Warren, a director and chairman of the board, and has a family relationship. William R. Lissau, a director, has business relationships with William K. Warren Jr., a trustee, and John Kelly C. Warren, a director and chairman of the board. Bishop David Konderla, a trustee, serves on other boards outside of Saint Francis Health System, Inc. with William R. Lissau, a director. William R. Lissau, a director, is the father of Michael Lissau, an officer, have a family relationship. |
| Form 990, Part VI, Section A, Line 3 | The director functions are delegated to the Saint Francis Health System, Inc. board of directors. |
| Form 990, Part VI, Section A, Line 6 | Saint Francis Health System, Inc., is the sole member of Saint Francis Hospital South, LLC. |
| Form 990, Part VI, Section A, Line 7a | Saint Francis Health System, Inc., the sole member of Saint Francis Hospital South, LLC appoints the managers. |
| Form 990, Part VI, Section A, Line 7b | As the sole member of Saint Francis Hospital South, LLC, Saint Francis Health System, Inc., has authority to follow its bylaws which dictates the following: Either the board of directors and a majority of the trustees or unanimous trustee approval is required for the sale of corporate assets valued at $10,000,000 or more. Additionally, the trustees have sole authority to: - amend the certificate of incorporation - approve mergers or consolidations - approve the sale, lease or transfer of all, or substantially all, of the assets of the corporation - amend the bylaws - appoint board members - approve dissolution or revocation of dissolution of the corporation |
| Form 990, Part VI, Section B, Line 11b | The finance committee, a sub-committee of the board of directors of Saint Francis Health System, Inc., has access to the password-protected form 990 online prior to filing with the IRS. |
| Form 990, Part VI, Section B, Line 12c | The organization uses the conflict of interest, whistleblower and record- retention policies of Saint Francis Health System, Inc. A request for information on potential conflicts is solicited annually from directors, trustees and all employees at manager level and above to monitor proposed or ongoing transactions for conflicts of interest and dealing with potential or actual conflicts. Three directors, two officer/directors and two officers reported potential conflicts that were addressed by the governing body. Conflicts are regularly disclosed and addressed. |
| Form 990, Part VI, Section B, Line 15a and 15b | Compensation of officers and senior level management is reviewed annually and approved by the compensation committee with guidance from independent consultants and the use of comparative data. |
| Form 990, Part VI, Section C, Line 19 | These requests are determined on a case-by-case basis. |
| Form 990, Part VII, Section A | The hours per week reported on Form 990, Part VII for officers and directors are the hours spent on the filing entity only. The remaining portion of the 40 hours per week of the officers and directors with related compensation is allocated among the entities reported on Schedule R. |
| Form 990, Part XI, Line 9 | The change in fund balance of $34,458,274 was a net equity transfer. |
| Software ID: | |
| Software Version: |