This story is part of a collaborative project involving reporters Ziva Branstetter of the Tulsa World and Clifton Adcock of Oklahoma Watch.

At least 40 nonprofit or government-owned hospitals in Oklahoma spent less than 1 percent of their net patient revenues caring for those who couldn’t afford to pay their medical bills, records show.

The data, obtained by Oklahoma Watch and analyzed and reported with the Tulsa World, covers 2011 and 2012. Some hospitals reported spending below 1 percent during both years while only one year of data was available for others.

Most of the hospitals with charity care below 1 percent had negative operating margins but a few did not.

Wagoner Community Hospital spent less than half of 1 percent of patient revenues on charity care in 2011 and 2012. Meanwhile, the hospital reported a 22 percent operating margin in 2012.

Rod Shook, CFO of Wagoner Community Hospital, said the hospital has difficulty getting patients to take advantage of charity care available to them.

“We offer the applications and the patients take them. However it’s very difficult to get it back from them. We would prefer that they be charity care rather than bad debt.”

Integris Baptist Medical Center in Oklahoma City and Integris Blackwell Regional Hospital also made the list of hospitals that spent less than 1 percent of patient revenue on charity care in 2011 or 2012.

Non-profit hospitals receive a tax exemption from the federal government in exchange for providing benefits to the communities they serve. Several years ago, the Internal Revenue Service expressed concern about the wide variety of ways non-profit hospitals were counting the community benefits they provided.

An IRS study of nearly 500 hospitals found that a small group of them accounted for about 80 percent of the funds spent to benefit the community.

In 2009, the IRS began requiring non-profit hospitals to file a report that states how much they spend on each type of community benefit provided.

Steve Petty, systems administrator and director of community and employee wellness for Integris Baptist, said the hospital provides millions of dollars worth of community benefits each year, including free clinics, support groups and life skills training.

Among the smaller hospitals that spent less than 1 percent of its patient revenues on charity care in 2011 and 2012 was Fairview Regional Medical Center, a 25-bed, city-controlled hospital.

Roger Knak, the hospital’s CEO, however, said it wasn’t for lack of trying.

The hospital’s charity-care policy offers graduated discounts tied to income, with people at or below 100 percent of the federal poverty level having their whole bill written off, Knak said.

“Part of the problem we really struggle with is some of the people that really should qualify for charity care don’t take the time to fill out, or refuse to fill out, the paperwork or provide the documentation we need to prove charity care,” Knak said.

The hospital has made an effort since 2012 to get more self-pay patients to sign up for charity care to avoid classifying the account as bad debt, which it will try to collect, Knak said.

“I would much rather recognize it on the front as charity care than wind up going through the process of bad debt,” Knak said.

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