2015-05-05T15:28:32-05:00 2014-06-30 KPMG LLP 210 Park Ave Suite 2850 Oklahoma City OK 73102 990 2013-07-01 731047338 INTEGRIS HEALTH FOUNDATION INC % BARBARA DEAN INTE 4059512747 5300 N INDEPENDENCE AVENUE SUITE Suite OKLAHOMA CITY OK 73112 DAVID R HADLEY CFO 4059493172 2015-04-20 true MORGAN L SOUZA P00652612 4059493172 2013 2016-02-25 16:41:14Z DAVID HADLEY 5300 N INDEPENDENCE AVE OKLAHOMA CITY OK 73112 8500193 false X WWW.INTEGRISOK.COM X 1978 OK THE FOUNDATION PROMOTES THE PHILANTHROPIC SUPPORT AND MISSION OF INTEGRIS HEALTH, INC. TO IMPROVE THE HEALTH AND WELFARE OF THE PEOPLE AND THE COMMUNITIES WE SERVE. 8 8 14 220 103160 8521 3898349 2817303 0 0 2377850 5536439 -136142 -121859 6140057 8231883 2944774 1384078 0 0 1227210 1196201 0 0 1833545 1157877 846531 5329861 3426810 810196 4805073 53895725 57439872 4254508 1075265 49641217 56364607 X INTEGRIS HEALTH FOUNDATION, INC. PROMOTES THE PHILANTHROPIC SUPPORT AND MISSION OF INTEGRIS HEALTH, INC. TO IMPROVE THE HEALTH AND WELFARE OF THE PEOPLE AND THE COMMUNITIES WE SERVE. false false 1384078 1384078 0 SEE SCHEDULE O - GENERAL STATEMENT 1 1384078 true true false false false false false false true true true true false false true false false true false false true false false false true false false true true true false false false false false false false false true false false false false true true false false false true X 0 0 false 14 true true true false false false false true true false false false false X 8 8 true false false false true true true true true false false true true true true true true true false false CA OK X BARBARA DEAN 4059512747 5300 N INDEPENDENCE AVE STE 130 OKLAHOMA CITY OK 73112 X JOEL CHAMPLIN DIRECTOR 1.0 0.0 X 0 0 0 ARTHUR F HOGE III DIRECTOR 1.0 0.0 X 0 0 0 HARRISON LEVY DIRECTOR 1.0 0.0 X 0 0 0 JERRY MCNEIL DIRECTOR 1.0 0.0 X 0 0 0 SUSAN MORITZ DIRECTOR 1.0 0.0 X 0 0 0 RON MCCORD CHAIRMAN 1.0 0.0 X X 0 0 0 JO DOWNING VICE CHAIRMAN 1.0 0.0 X X 0 0 0 JIM WALLIS SECRETARY 1.0 0.0 X X 0 0 0 DAVID HADLEY ASST. TREASURER 1.0 39.0 X 0 0 0 WENTZ MILLER ASST. TREASURER 1.0 39.0 X 0 474352 84325 BETH A PAUCHNIK ASST. SECRETARY 1.0 39.0 X 0 413087 84304 BRADLEY A WALKER EXECUTIVE DIRECTOR 40.0 0.0 X 185349 0 25107 C BRUCE LAWRENCE FORMER DIRECTOR 0.0 40.0 X 0 936668 64355 MARY ANN BAUMAN MD FORMER DIRECTOR 0.0 40.0 X 0 386243 44139 STANLEY F HUPFELD FORMER OFFICER & DIRECTOR 0.0 13.0 X 0 55846 11994 JAMES L HENRY FORMER DIRECTOR 0.0 0.0 X 0 24000 0 185349 2290196 314224 1 true true false SEE SCHEDULE O GENERAL STATEMENT 9 118085 1 10000 1550127 30000 1227176 55676 2817303 0 5536530 103160 5433370 0 0 0 0 0 0 91 -91 -91 -91 143861 1550127 268219 -124358 -124358 0 0 MISC. INCOME 900099 2499 2499 2499 8231883 103160 5311420 1347328 1347328 36750 36750 0 0 149217 149217 0 846891 846891 62078 62078 72624 72624 65391 65391 0 1298 1298 919 919 0 0 0 198658 135459 63199 5424 4969 455 470840 4136 466704 0 0 136284 6236 130048 10816 1211 9605 0 8034 868 7166 675 675 0 5897 488 5409 522 -170 692 PURCHASED SERVICES 218751 46659 172092 DUES & MEMBERSHIPS 8298 274 8024 RECLASS: EVENTS EXPENSE -268219 -268219 UNRELATED BUS.INCOME TAX 43600 -43 43643 4734 6208 -1474 3426810 1384078 209187 1833545 0 0 1470829 1426685 2537571 2354289 0 0 0 0 0 0 0 0 0 0 0 0 1393665 433940 957981 959725 0 0 48740645 52501571 0 0 0 0 188699 197602 53895725 57439872 3986644 678969 0 0 0 0 0 0 163917 153910 0 0 0 0 0 0 103947 242386 4254508 1075265 X 21165170 25673768 23454314 24383821 5021733 6307018 49641217 56364607 53895725 57439872 X 4805073 1919427 -1110 X false true X true false X 836759 1479949 1467003 3898349 2817303 10499363 0 0 836759 1479949 1467003 3898349 2817303 10499363 607958 9891405 1048889 1042045 1052265 1204996 791547 5139742 0 0 0 0 0 0 232 434 1315 3337 2499 7817 15646922 0.63216 0.59930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true X 5021733 938576 464828 118119 6307018 4061831 586066 376243 2407 5021733 3485995 690515 27925 142604 4061831 3027122 99516 359357 0 3485995 3142090 99532 311645 526145 3027122 0.88690 0.11310 0.00000 false false 925890 925890 36172 26920 9252 431603 407020 24583 959725 BOARD DESIGNATED INVESTMENTS 29855918 F RESTRICTED FUND INVESTMENTS 22645653 F 52501571 0 DUE TO AFFILIATES 242386 242386 SUPPLEMENTAL INFORMATION 1 SCHEDULE D, PART IV, LINE 2B GIFT ANNUITIES AND CHARITABLE REMAINDER TRUSTS CONSIST OF CONTRIBUTED AMOUNTS SUBJECT TO OBLIGATIONS TO MAKE PERIODIC PAYMENTS TO BENEFICIARIES OVER A SPECIFIED PERIOD. THE LIABILITIES SHOWN ARE RECORDED AT THE ACTUARIAL PRESENT VALUES OF THE AGGREGATE LIABILITY BASED ON THE SPECIFIED PERIOD. A DISCOUNT RATE WAS USED TO DETERMINE THE PRESENT VALUE OF THE LIABILITIES. SUPPLEMENTAL INFORMATION 2 SCHEDULE D, PART V, LINE 4 THE MAJORITY OF THE ENDOWMENT FUNDS ARE RESTRICTED FOR USE IN FUNDING THE INTEGRIS HEALTH SYSTEM'S CENTERS FOR EXCELLENCE. SPECIALIZED CENTERS OF EXCELLENCE HAVE BEEN DEVELOPED THROUGH VARIOUS INTEGRIS ENTITIES TO PROVIDE THE HIGHEST STANDARD OF CARE FOR OUR COMMUNITIES. CENTERS OF EXCELLENCE INCLUDE THE PAUL SILVERSTEIN BURN CENTER, INTEGRIS HEART HOSPITAL, NAZIH ZUHDI TRANSPLANT INSTITUTE, TROY & DOLLIE SMITH CANCER CENTER, WOMEN'S CENTER, HENRY G. BENNETT JR. FERTILITY INSTITUTE, SLEEP DISORDERS CENTER OF OKLAHOMA, THE HOUGH EAR INSTITUTE, THE CENTRAL OKLAHOMA CANCER CENTER, SOUTHWEST BREAST HEALTH AND IMAGING CENTER, INTEGRIS JIM THORPE REHABILITATION NETWORK, INTEGRIS NEUROMUSCULAR CENTER, SLEEP DISORDERS CENTER OF OKLAHOMA AND THE JAMES R. DANIEL STROKE CENTER OF OKLAHOMA. false Central America and the Caribbean Investments 164000 Europe (Including Iceland and Greenland) Investments 86000 250000 250000 false false true false false false JTR COURAGE 779058 734058 45000 6171 70082 2600 20379 IH FDN GALA 668197 622921 45276 7995 42918 4275 34727 4 246733 193148 53585 2674 12758 27896 1800 33944 1693988 1550127 143861 2674 26924 140896 8675 89050 268219 -124358 true INTEGRIS BAPTIST MEDICAL CENTER INC 5300 N INDEPENDENCE AVE OKC OK 73112 731034824 501(c)(3) 154391 64362 FMV SUPPLIES & EQUIPMENT TO FUND OPERATIONS WESTERN VILLAGE ACADEMY INC 5300 N INDEPENDENCE AVE OKC OK 73112 731588764 501(c)(3) 114847 2880 FMV UNIFORMS & SUPPLIES TO FUND OPERATIONS INTEGRIS HOSPICE INC 5300 N INDEPENDENCE AVE OKC OK 73112 731369586 501(c)(3) 213954 24700 FMV PLAYGROUND EQUIPMENT TO FUND OPERATIONS INTEGRIS AMBULATORY CARE CORPORATION 5300 N INDEPENDENCE AVE OKC OK 73112 731192765 501(c)(3) 86575 550 FMV UNIFORMS & SUPPLIES TO FUND OPERATIONS INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORP 5300 N INDEPENDENCE AVE OKC OK 73112 731089149 501(c)(3) 298955 10500 FMV EQUIPMENT TO FUND OPERATIONS INTEGRIS HEALTH INC 5300 N INDEPENDENCE AVE OKC OK 73112 731192764 501(c)(3) 87835 98001 FMV PLAYGRND & MED EQUIP TO FUND OPERATIONS INTEGRIS HEALTH EDMOND INC 5300 N INDEPENDENCE AVE OKC OK 73112 451027361 501(c)(3) 9755 TO FUND OPERATIONS INTEGRIS RURAL HEALTH INC 5300 N INDEPENDENCE AVE OKC OK 73112 731444504 501(c)(3) 128935 51088 FMV REMODEL OF GIFT SHOP TO FUND OPERATIONS 8 MOORE, OKLAHOMA TORNADO DISASTER RELIEF 41 36750 SUPPLEMENTAL INFORMATION 1 SCHEDULE I, PART I, LINE 2 INTEGRIS HEALTH FOUNDATION, INC. (IH FDN OR FOUNDATION) WAS ESTABLISHED TO SUPPORT, THROUGH FUNDRAISING AND GRANT MAKING ACTIVITIES, THE NOT-FOR-PROFIT CHARITABLE AFFILIATES OF INTEGRIS HEALTH, INC. (AFFILIATE OR AFFILIATES OF INTEGRIS HEALTH SYSTEM), INCLUDING BUT NOT LIMITED TO INTEGRIS BAPTIST MEDICAL CENTER, INC. THE PROCESS FOR PROVIDING GRANTS TO AFFILIATES OF INTEGRIS HEALTH SYSTEM BEGINS WITH A REQUEST FOR FUNDING FROM THE AFFILIATE TO THE IH FDN. A DEPARTMENT DIRECTOR OF THE AFFILIATE MAKES AN INITIAL REQUEST TO THE ADMINISTRATIVE DIRECTOR OR VICE PRESIDENT OF THE AFFILIATE. THE ADMINISTRATIVE DIRECTOR OR VICE PRESIDENT VALIDATES THE DEPARTMENT'S NEED FOR THE FUNDS AND APPROVES THE REQUEST. THIS APPROVAL INDICATES THAT THE REQUESTED FUNDS ARE IN KEEPING WITH THE AFFILIATE'S OVERALL CHARITABLE GOALS. ONCE VALIDATED, THE REQUEST IS SENT TO IH FDN'S OFFICE TO VERIFY THE FUNDS ARE AVAILABLE. IH FDN'S PRESIDENT THEN REVIEWS THE REQUEST TO CONFIRM THE REQUESTED USE OF FUNDS ARE IN KEEPING WITH THE FOUNDATION'S CHARITABLE PURPOSES AND WITH THE INTENT OF DONORS TO THE FOUNDATION. ASSUMING THIS IS THE CASE, THE FOUNDATION PRESIDENT APPROVES THE REQUEST. FUNDS REQUESTED BY THE AFFILIATES GENERALLY FALL INTO TWO CATEGORIES: CAPITAL AND NON-CAPITAL. THE REQUEST FOR FUNDS FORM MEMORIALIZES THE MOVEMENT OF FUNDS FROM THE FOUNDATION TO THE AFFILIATE FOR REIMBURSEMENT OF ITEMS PURCHASED. false true false false false false false true false C BRUCE LAWRENCE FORMER DIRECTOR 0 910895 0 2086 0 23687 0 49827 0 14528 0 1001023 0 0 BRADLEY A WALKER EXECUTIVE DIRECTOR 176639 0 0 0 8710 0 7913 0 17194 0 210456 0 0 0 WENTZ MILLER ASST. TREASURER 0 453867 0 0 0 20485 0 71432 0 12893 0 558677 0 0 BETH A PAUCHNIK ASST. SECRETARY 0 399604 0 0 0 13483 0 71629 0 12675 0 497391 0 0 MARY ANN BAUMAN MD FORMER DIRECTOR 0 253513 0 122285 0 10445 0 32274 0 11865 0 430382 0 0 STANLEY F HUPFELD FORMER OFFICER & DIRECTOR 0 36273 0 9108 0 10465 0 6486 0 5508 0 67840 0 0 JAMES L HENRY FORMER DIRECTOR 0 24000 0 0 0 0 0 0 0 0 0 24000 0 0 SUPPLEMENTAL INFORMATION 1 SCHEDULE J, PART I, LINE 3 INTEGRIS HEALTH FOUNDATION, INC. (IHF) IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (INTEGRIS). AS PART OF THIS SYSTEM, IHF RELIES UPON INTEGRIS TO ESTABLISH THE COMPENSATION FOR ITS TOP MANAGEMENT OFFICIALS. INTEGRIS UTILIZES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THIS COMPENSATION. SUPPLEMENTAL INFORMATION 2 SCHEDULE J, PART I, LINE 4B THE FILING ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (INTEGRIS). INTEGRIS PROVIDES TO CERTAIN EXECUTIVES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PURPOSE OF THE PLAN IS TO SUPPLEMENT THE SPONSOR-PROVIDED RETIREMENT BENEFITS TO BE PAID TO SENIOR EXECUTIVES PURSUANT TO THE DEFINED BENEFIT PENSION PLAN, THE TAX DEFERRED ANNUITY PLAN AND OTHER QUALIFIED OR NON QUALIFIED RETIREMENT PLANS WHICH ARE MAINTAINED BY THE SPONSOR. THE PLAN PROVIDES AN OPPORTUNITY TO EARN SUPPLEMENTAL INCENTIVE INCOME BY PROVIDING ANNUAL CONTRIBUTIONS TO THE ACCOUNT SO LONG AS THE EXECUTIVE REMAINS EMPLOYED BY THE SPONSOR TO RETIREMENT AGE OF 65. THE FOLLOWING INDIVIDUALS LISTED IN PART VII OF FORM 990 PARTICIPATED IN THIS PLAN BUT DID NOT RECEIVE A PAYMENT DURING THE YEAR. C. BRUCE LAWRENCE WENTZ MILLER BETH A. PAUCHNIK SUPPLEMENTAL INFORMATION 3 SCHEDULE J, PART I, LINE 7 THE FILING ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (INTEGRIS). INTEGRIS HEALTH HAS ESTABLISHED A FINANCIAL INCENTIVE PLAN THAT ENCOURAGES THE EXECUTIVE OFFICER'S PARTICIPATION IN THE SIGNIFICANT IMPROVEMENTS OF THE QUALITY AND FINANCIAL OPERATIONS OF THE ORGANIZATION. THE QUALITY COMPONENT IS DEFINED AS IMPROVEMENT IN PATIENT SAFETY, PATIENT SATISFACTION AND REDUCTION OF EMPLOYEE TURNOVER. THE FINANCIAL COMPONENT CONSISTS OF ACHIEVEMENT IN NET OPERATING INCOME THRESHOLD TO BE ACHIEVED TO ACTIVATE THE PLAN. A PREDETERMINED THRESHOLD IS CREATED WITHIN ALL ASPECTS OF THE PLAN BEFORE FINANCIAL ACHIEVEMENT IS PAYABLE. ALL PLANS ARE WRITTEN ACCORDING TO EXECUTIVE LEVEL AND ADOPTED BY INTEGRIS HEALTH BOARD RESOLUTION EACH PLAN YEAR AND PAYABLE AFTER INDEPENDENT AUDIT RESULTS ARE DETERMINED. X 1 10000 FMV X GIFT SHOP REMODEL 1 45676 FMV false true false GENERAL STATEMENT 1 PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS INTEGRIS HEALTH FOUNDATION, INC. WAS ESTABLISHED TO FACILITATE FINANCIAL SUPPORT FOR THE ORGANIZATION BY CONNECTING DONORS TO THEIR INTEGRIS PASSIONS AS IT RELATES TO THE MYRIAD OF PROGRAMS AND SERVICES OF INTEGRIS HEALTH, INC. AND ITS CHARITABLE AFFILIATES. THE INTEGRIS HEALTH FOUNDATION ACCOMPLISHED THE FOLLOWING FOR FY2014: *THE INTEGRIS GALA DREW A CROWD OF MORE THAN 600 PEOPLE AND SECURED A GRAND TOTAL OF OVER $569,000, PROVIDING THE MAJORITY TO BURN SERVICES AT INTEGRIS BAPTIST MEDICAL CENTER. *THE YOU&I ANNUAL CAMPAIGN RAISED MORE THAN $400,000. *FUNDS RAISED THROUGH ANNUAL AND MAJOR GIFTS BENEFITED SEVERAL PROJECTS INCLUDING SURVIVOR FIT FOR CANCER SURVIVORS, WHEELCHAIRS AND EQUIPMENT FOR NEUROMUSCULAR PATIENTS, LIFENET FOR RURAL HOSPITALS, WOMEN'S HEALTH INITIATIVES AND CARDIAC CARE EQUIPMENT. GENERAL STATEMENT 2 PART V: QUESTION 1A AND 2A QUESTION 1A - INTEGRIS HEALTH, INC., AS THE PARENT ENTITY OF THE INTEGRIS HEALTH SYSTEM, PAYS ALL VENDORS FOR SERVICES PROVIDED TO ALL ENTITIES WITHIN THE SYSTEM. ACCORDINGLY, COMPENSATION PAID TO INDEPENDENT CONTRACTORS IS REPORTED ON THE FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS OF INTEGRIS HEALTH, INC., EIN 73-1192764. EXPENSES ARE ALLOCATED TO AND REIMBURSED BY INDIVIDUAL ENTITIES WITHIN THE SYSTEM, AND REPORTED ON THEIR RESPECTIVE FORMS 990, PART VII, SECTION B AND PART IX, AS APPROPRIATE. PART V: QUESTION 2A - THE SALARIES REFLECTED ON FORM 990, PART IX, LINE 7, WERE ALL REPORTED ON THE FORM 941 EMPLOYER'S QUARTERLY FEDERAL TAX RETURN, OF INTEGRIS HEALTH, INC., EIN 73-1192764. THESE SALARIES WERE REIMBURSED TO INTEGRIS HEALTH, INC. AND WERE INCLUDED IN THE NUMBER OF EMPLOYEES ON INTEGRIS HEALTH, INC.'S FORM W-3. THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A REPRESENTS THE NUMBER OF FULL TIME EMPLOYEES, AS DETERMINED BY FTE HOURS WORKED, FOR THE FILING ORGANIZATION DURING THE 2013 TAX YEAR. GENERAL STATEMENT 3 PART VI: SECTION A. GOVERNING BODY AND MANAGEMENT PART VI: QUESTION 2 - THE FILING ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (SYSTEM). THE FOLLOWING OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION HAVE A BUSINESS RELATIONSHIP WITH ONE ANOTHER BY VIRTUE OF THEIR POSITIONS AS OFFICERS, DIRECTORS, OR EMPLOYEES OF RELATED ENTITIES WITHIN THE SYSTEM: WENTZ MILLER BETH A. PAUCHNIK DAVID HADLEY GENERAL STATEMENT 4 PART VI: SECTION A. GOVERNING BODY AND MANAGEMENT PART VI: QUESTIONS 6, 7A & 7B - INTEGRIS HEALTH, INC. IS THE SOLE MEMBER OF INTEGRIS HEALTH FOUNDATION, INC. AS SUCH IT HAS THE POWER (1) TO SELECT AND REMOVE ALL OFFICERS, AGENTS AND EMPLOYEES OF THE CORPORATION, PRESCRIBE SUCH POWERS AND DUTIES FOR THEM AS MAY BE CONSISTENT WITH LAW, WITH THE AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OR THE BYLAWS, (2) TO CONDUCT, MANAGE AND CONTROL THE AFFAIRS AND BUSINESS OF THE CORPORATION, AND TO MAKE SUCH RULES AND REGULATIONS THEREFORE CONSISTENT WITH LAW, OR WITH THE AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OR THE BYLAWS, AS THEY MAY DEEM BEST, SUBJECT TO THE APPROVAL OF THE SOLE MEMBER, (3) TO FIX AND LOCATE FROM TIME TO TIME ONE OR MORE SUBSIDIARY OFFICES OF THE CORPORATION WITHIN OR WITHOUT THE STATE OF OKLAHOMA; AND TO ADOPT, MAKE AND USE A CORPORATE SEAL, AND TO ALTER THE FORM OF SUCH SEAL FROM TIME TO TIME, AS IN THEIR JUDGEMENT THEY MAY DEEM BEST, PROVIDED SUCH SEAL AT ALL TIMES COMPLY WITH THE PROVISIONS OF LAW, THE CERTIFICATE OF INCORPORATION AND THESE BYLAWS. GENERAL STATEMENT 5 PART VI: SECTION B. POLICIES PART VI: QUESTION 11B - THE ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (SYSTEM). THE SYSTEM HAS A SINGLE AUDIT COMPLIANCE COMMITTEE WHICH OVERSEES THE CONSOLIDATED FINANCIAL STATEMENT AUDIT AS WELL AS THE FILING OF FEDERAL AND STATE TAX FORMS. THE SYSTEM ENGAGES A PAID PREPARER EXPERIENCED IN THE PREPARATION OF FORM 990 TO PREPARE THE FORM. A DRAFT FORM 990 IS PROVIDED TO THE SYSTEM VICE PRESIDENT OF FINANCIAL REPORTING FOR REVIEW. A FINAL FORM 990 IS GIVEN TO THE SYSTEM CHIEF FINANCIAL OFFICER FOR REVIEW, APPROVAL, AND SIGNATURE. THE FINAL FORM 990 IS MADE AVAILABLE TO THE ORGANIZATION'S BOARD OF DIRECTORS, AS WELL AS TO THE SYSTEM'S AUDIT/COMPLIANCE COMMITTEE, FOR REVIEW PRIOR TO FILING THE RETURN. GENERAL STATEMENT 6 PART VI: SECTION B. POLICIES PART VI: QUESTION 12C - THE FILING ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (INTEGRIS OR SYSTEM). CONFLICT OF INTEREST IS ADDRESSED IN THE INTEGRIS CODE OF CONDUCT. ALL SYSTEM EMPLOYEES RECEIVE TRAINING DURING NEW EMPLOYEE ORIENTATION AND ARE INSTRUCTED TO REPORT ANY POSSIBLE CONFLICTS, TO REFER ANY CONFLICT OF INTEREST QUESTIONS TO THE SYSTEM'S COMPLIANCE OFFICER OR THROUGH THE ANONYMOUS INTEGRITY LINE. ALL NEW MANAGERS RECEIVE ADDITIONAL TRAINING ON CONFLICT OF INTEREST POLICES DURING LEADERSHIP TRAINING. LEGAL SERVICES REVIEWS ALL CONTRACTS FOR CONFLICTS OF INTEREST. INTERNAL AUDIT CONDUCTS AUDITS FOR POSSIBLE CONFLICTS OF INTEREST BASED ON THEIR ANNUAL RISK ASSESSMENT. CORPORATE COMPLIANCE INCLUDES ASSESSMENTS FOR CONFLICTS OF INTEREST IN ITS ANNUAL WORK PLAN AND CONDUCTS SPECIALIZED TRAINING FOR HIGH RISK AREAS. THE GOVERNANCE COMMITTEE, A COMMITTEE OF THE INTEGRIS HEALTH BOARD COMPRISED OF INDEPENDENT BOARD MEMBERS, REVIEWS AND APPROVES ANY AND ALL PROPOSED BUSINESS TRANSACTIONS BETWEEN ANY ENTITY OF INTEGRIS AND A DISQUALIFIED PERSON. GENERAL STATEMENT 7 PART VI: SECTION B. POLICIES PART VI: QUESTION 15A - THE FILING ORGANIZATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY INTEGRIS HEALTH, INC. (INTEGRIS OR SYSTEM). COMPENSATION FOR THE EXECUTIVE DIRECTOR IS ANALYZED BY AN INDEPENDENT HEALTH CARE CONSULTING FIRM. THE ANALYSIS INCLUDES A FAIR MARKET VALUE ASSESSMENT AND ESTABLISHMENT OF A RANGE FOR EACH POSITION BASED ON RESEARCH OF COMPARABLE HEALTH CARE SYSTEMS OF SIMILAR SIZE. THE REPORT AND RECOMMENDED COMPENSATION LEVELS FOR EACH EXECUTIVE MANAGEMENT POSITION IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE INTEGRIS HEALTH BOARD OF DIRECTORS AND ULTIMATELY THE FULL BOARD OF DIRECTORS. THE MINUTES OF BOTH THE COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REFLECTS A REVIEW OF THE COMPARABILITY DATA, THE EXECUTIVE PERFORMANCE REVIEWS AND THE DECISION-MAKING PROCESS. GENERAL STATEMENT 8 PART VI: SECTION C. DISCLOSURE PART VI: QUESTION 19 - THE ORGANIZATION DOES NOT MAKE ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY AVAILABLE TO THE PUBLIC. HOWEVER, THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE INCLUDED IN THE CONSOLIDATED FINANCIALS FOR INTEGRIS HEALTH, INC., A RELATED CORPORATION. THESE CONSOLIDATED FINANCIALS ARE DISCLOSED FOR BOND COMPLIANCE PURPOSES USING DIGITAL ASSURANCE CERTIFICATION. GENERAL STATEMENT 9 PART VII: SECTION B. INDEPENDENT CONTRACTORS DINI PARTNERS INC. PROFESSIONAL/CONSULTING $118,085 2727 ALLEN PARKWAY SERVICES SUITE 1650 HOUSTON, TX 77019 GENERAL STATEMENT 10 PART XI: RECONCILIATION OF NET ASSETS, LINE 9 ALLOCATION FROM AFFILIATE < 1,110> INTEGRIS AMBULATORY CARE CORPORATION 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731192765 HEALTH CARE OK 501(c)(3) LINE 3 IH false BAPTIST HEALTHCARE OF OKLAHOMA INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 237456301 HEALTH CARE OK 501(c)(3) LINE 3 IH false INTEGRIS HOSPICE INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731369586 HEALTH CARE OK 501(c)(3) LINE 9 IH false INTEGRIS BAPTIST MEDICAL CENTER INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731034824 HEALTH CARE OK 501(c)(3) LINE 3 IH false INTEGRIS RURAL HEALTH INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731444504 HEALTH CARE OK 501(c)(3) LINE 3 IH false INTEGRIS SOUTHWEST MEDICAL CENTER INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731089149 HEALTH CARE OK 501(c)(3) LINE 3 IH false INTEGRIS HEALTH INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731192764 HEALTH CARE OK 501(c)(3) LINE 11 -I NA false WESTERN VILLAGE ACADEMY INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731588764 SCHOOL OK 501(c)(3) LINE 2 IACC false INTEGRIS HEALTH EDMOND INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 451027361 HEALTH CARE OK 501(c)(3) LINE 3 IH false INTEGRIS MENTAL HEALTH INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 730738716 HEALTH CARE OK 501(c)(3) LINE 3 IH false BMPA LTD 73-1228665 MED. 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OK NA N/A GRAND LAKE 73-1622843 MEDICAL OK NA N/A QC-III 20-8723857 MEDICAL OK NA N/A DIAGNOSTIC LAB 73-1560760 CLINICAL LAB NJ NA N/A MPI CENTER 73-1283942 MEDICAL OK NA N/A HILLCRESTINTEGRIS HEALTH LLC DORMANT OK NA N/A LAKESIDE 73-1493662 MEDICAL OK NA N/A INTEGRIS PROHEALTH INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 731046179 RETAIL PHARMACY OK NA C Corp false THE STANLEY F HUPFELD CHAR REMAIN TRUST 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 266238051 FINANCIAL OK NA Trust 0 89639 1.00000 true QUALITY ALLIANCE ASSURANCE CO PO BOX 10027 GRAND CAYMAN CJ KYI-1001 981060671 INSURANCE CJ NA C Corp false BAPTIST HEALTH SYSTEM INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 DORMANT OK NA C Corp false ONE CARE INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 DORMANT OK NA C Corp false VADOVATIONS INC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 270821922 HEALTH CARE OK NA C Corp false INTEGRIS HEALTH PARTNERS LLC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 453482852 HEALTH CARE OK NA C Corp false INTEGRIS CARDIOVASCULAR PHYSICIANS LLC 5300 N INDEPENDENCE AVE STE 130 OKLA CITY OK 73112 452867352 HEALTH CARE OK NA C Corp false false true true false false false false false false false false false true false false true true false false