(AP) A St. Louis-based Catholic-sponsored health care system that includes St. Francis Hospital and Health Services in Maryville is cutting 586 jobs in four states.

SSM Health Care announced the cuts on Thursday. A spokesman says nearly half of the eliminated positions are through attrition, and most are administrative.

SSM employs more than 30,000 workers in Missouri, Illinois, Oklahoma and Wisconsin. More than 12,000 of those jobs are in the St. Louis area.

A statement from SSM says health care organizations are facing “unprecedented changes and challenges,” including a shift to more outpatient settings, reduced reimbursement from federal payers, increased bad debt and charity care, and the financial impacts from sequestration.

The SSM system includes 18 hospitals, two nursing homes, more than 150 outpatient sites and other units.