Integris Hospice Inc.

“Form 990, box c: doing business as integris hospice of grady county integris hospice house”

“Part iii, line 4a: statement of program service accomplishments integris hospice services include integris hospice, inc. And the twelve bed integris hospice house providing a team-oriented approach to medical care, expert pain management, and emotional, spiritual, and bereavement support expressly tailored to the patient and family's needs and wishes. In fiscal year 2016, integris hospice, inc. And the integris hospice house served 1089 patients in hospice care and served over 2,035 individuals providing bereavement care and grief support counseling. The hospice volunteer program provided many hours of supportive care during the year. The integris hospice, inc. Program remains a partner agency of the united way of central oklahoma providing grief support for anyone in the community and hospice care for those without financial assistance. Founded in 1990 by physicians of the oklahoma county medical society, integris hospice, inc. Is certified by medicare, accredited by the joint commission and licensed in oklahoma. An integris health program since 1996, integris hospice, inc. Is a member of the oklahoma hospice and palliative care association, as well as the national hospice and palliative care organization. Integris hospice house is also certified by medicare and accredited by the joint commission. Partnering with the medical universities in the metropolitan area, the integris hospice program provides hospice training to student nurses and medical students.”

“Part v: question 1a and 2a part v: 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 5 and 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 2015 tax year.”

“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 organizations within the system: steve drabeck philip s. Lance c. Bruce lawrence linda l. Merkey, r.n.”

“Part vi: section a. Governing body and management part vi: questions 6, 7a and 7b - integris health, inc. Is the sole member of integris hospice, inc. As such it has the power (1) to confirm or deny the election of each member of the board of directors, (2) to approve or disapprove any action taken by the board of directors amending, altering, changing or repealing the certificate of incorporation or bylaws, (3) to vote on all matters where the authorization or approval of the sole member is required by the certificate of incorporation, the bylaws or state law and (4) to approve certain significant decisions of the board of directors, including but not limited to the adoption of budgets, authorization of significant capital expenditures, disposition of assets, and change of the organization's purpose.”

“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.”

“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 policies 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.”

“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). The executive director's compensation is reviewed by the integris department of human resources. Independent salary survey sources from third party providers are used to determine local and regional fair market competitiveness. Adjustments in salaries based on individual performance standards or any market equity adjustments are approved by the respective vice president or managing director. Part vi: question 15b - integris hospice, inc. Does not have any individuals that fall within the categories of other officers or key employees. As such, a process for determining the compensation for these individuals has not been determined.”

“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.”

“Section 1.263(a)-1(f) De Minimis Safe Harbor Election INTEGRIS Hospice, Inc. hereby makes the de minimis safe harbor election under Section 1.263(a)-1(f) of the Treasury Regulations, effective for the tax year ending June 30, 2016. Taxpayer has an Applicable Financial Statement for the year of the election. This election permits the taxpayer to deduct for tax purposes any item deducted under its book policy that does not exceed $5,000 per invoice (or per item, as substantiated by the invoice) or items having an economic useful life of twelve months or less as described in Section 1.263(a)-1(f)(1)(i). Taxpayer Name: INTEGRIS Hospice, Inc. Address: 5300 N Independence Ave Ste 130 Oklahoma City, OK 73112 Taxpayer Identification Number: 73-1369586 Section 1.263(a)-3(n) Election - Book Conformity Election INTEGRIS Hospice, Inc. is making the election under Treas. Reg. 1.263(a)-3(n) to capitalize those repair and maintenance costs that it treats as capital expenditures on its books and records for the tax year ended June 30, 2016. Taxpayer Name: INTEGRIS Hospice, Inc. Address: 5300 N Independence Ave Ste 130 Oklahoma City, OK 73112 Taxpayer Identification Number: 73-1369586”