The non-profit said it's also considering entering into joint ventures or other business relationships to keep hospital operations in Liliha and 'Ewa financially feasible.

Queen's Health Systems, Hawaii Pacific Health and Kaiser Permanente confirmed that they are in discussions with St. Francis.

St. Francis has operated a hospital in Hawai'i since the 1920s. Even if it decides to sell the hospitals, St. Francis will continue to operate hospices. The non-profit's roots harken back more than a century ago to Mother Marianne Cope and six other Franciscan sisters, who arrived in the Islands to care for victims of leprosy, now called Hansen's disease.

A decision to sell would be a difficult one for St. Francis, but would be financially necessary, said Sister Grace Dillenschneider, member of the Leadership Team at the Sisters of St. Francis in Syracuse, N.Y., which oversees the Hawai'i operations.

"It has to do with our mission and where we believe we need to put our energies at this time," Dillenschneider said.

"There's a lot of difficulty in maintaining acute care hospitals," she said. "All the hospitals struggle now. That's true in Hawai'i, in New York state. It's true across the country."