2024-05-15T18:06:34-05:00 2023-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 80202 990 2022-07-01 731588764 WESTERN VILLAGE ACADEMY INC WEST 4059496026 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 MICHAEL L WEED CFO 4059496026 2024-05-15 1 MICHAEL WEED XXX-XX-XXXX 0 KIMBERLY MAC NAMEE P02479140 2253444000 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SEE SCHEDULE O MICHAEL L WEED 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 4159539 0 X WWW.INTEGRISOK.COM X 2000 OK TO PROVIDE EFFECTIVE LEARNING OPPORTUNITIES FOR ALL STUDENTS. 14 12 41 62 0 0 2847411 4146129 28563 2147 0 500 4298 10763 2880272 4159539 0 0 0 0 2060355 2244115 0 0 0 941434 1403152 3001789 3647267 -121517 512272 3399494 3911766 0 0 3399494 3911766 TO PROVIDE EFFECTIVE LEARNING OPPORTUNITIES FOR ALL STUDENTS. 0 0 3647267 12910 OPERATE AN ELEMENTARY SCHOOL SERVING A PRIMARILY LOW-INCOME, AT RISK, MINORITY POPULATION. ALL STUDENTS LIVING WITHIN THE GEOGRAPHICAL BOUNDARIES ESTABLISHED BY THE DISTRICT FOR THE SCHOOL ARE ELIGIBLE TO ATTEND THE SCHOOL, CAPACITY ALLOWING.THE ACADEMY IS RESPONSIBLE FOR ALL ASPECTS OF SCHOOL OPERATIONS, INCLUDING ADMINISTRATION, TEACHING STAFF AND PROGRAMS. THE ACADEMY OFFERS ITS STUDENTS A LARGE POOL OF ADULT MENTORS FROM THE LOCAL COMMUNITY AND FURNISHES AN AFTER-SCHOOL PROGRAM THAT PROVIDES SUPPLEMENTAL EDUCATIONAL OPPORTUNITIES TO PARTICIPATING STUDENTS. 3647267 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 41 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 12 1 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 0 0 OK X DONNA WALLACE 6363594890 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 JOHN VERA DIRECTOR 1.00 39.00 X 0 0 0 DAVID JACKSON DIRECTOR 1.00 0.00 X 0 0 0 KEN LAWSON DIRECTOR 1.00 0.00 X 0 0 0 PAM MILLINGTON DIRECTOR & CHAIRMAN 1.00 0.00 X X 0 0 0 TIMOTHY PEHRSON DIRECTOR & PRESIDENT/CEO 1.00 39.00 X X 0 2539008 286936 ERIC HARMON DIRECTOR 1.00 0.00 X 0 0 0 SUZAN WHALEY DIRECTOR 1.00 0.00 X 0 0 0 CRYSTAL HURD DIRECTOR & SECRETARY 40.00 0.00 X X 0 0 0 KYLIE LYONS DIRECTOR 1.00 0.00 X 0 0 0 MILISHA HENDERSON DIRECTOR 1.00 0.00 X 0 0 0 SHARI DIXON DIRECTOR 1.00 0.00 X 0 0 0 SKIP LEONARD DIRECTOR 1.00 0.00 X 0 445196 19856 TOM CASSIDY DIRECTOR 1.00 0.00 X 0 0 0 STANLEY F HUPFELD DIRECTOR 1.00 0.00 X 0 0 0 DOUGLAS M SMITH PART YEAR CFO OF IH 1.00 39.00 X 0 907662 130539 JAY JENKINS TREASURER 1.00 0.00 X 0 0 0 RUTH M RAYNER COMMUNITY BENEFITS DIRECTO 40.00 0.00 X 101694 0 2505 101694 3891866 439836 1 0 1 0 0 4146129 4146129 TEXTBOOK 611430 1939 1939 EDUCATION SERVICES 611710 208 208 2147 500 0 500 500 500 BOOK FAIR INCOME 900099 8184 8184 MISC. INCOME 900099 2579 2579 10763 4159539 12910 0 500 1636233 1636233 272712 272712 237634 237634 97536 97536 428384 428384 161391 161391 448 448 2244 2244 58288 58288 12713 12713 PURCHASED SERVICES 730014 730014 DUES AND MEMBERSHIPS 9653 9653 LICENSES AND PERMITS 17 17 3647267 3647267 0 0 478343 994153 2009231 2009231 500000 500000 1612961 1223267 393232 389694 18688 18688 3399494 3911766 0 0 X 3399494 3911766 3399494 3911766 3399494 3911766 512272 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 831889 665318 166571 5130 5130 615242 433209 182033 160700 124740 35960 389694 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 SCHEDULE E, PART I, LINE 3 NO NEWSPAPER OR BROADCAST MEDIA NOTICES HAVE BEEN USED TO PUBLICIZE THE ACADEMY'S RACIALLY NON-DISCRIMINATORY POLICIES BECAUSE THE ACADEMY STUDENT BODY IS DERIVED WHOLLY FROM THE GEOGRAPHIC BOUNDARIES SET FOR PUBLIC SCHOOLS BY THE LOCAL METROPOLITAN SCHOOL DISTRICT, INDEPENDENT SCHOOL DISTRICT NO. 89 OF OKLAHOMA COUNTY, OKLAHOMA. THE ACADEMY USED DISTRICT ENROLLMENT FORMS FOR OKLAHOMA CITY PUBLIC SCHOOLS AND ACCEPTS EVERYONE WHO ENROLLS UNTIL THE ACADEMY REACHES CAPACITY. ADDITIONALLY THE ACADEMY IS AN AFFIRMATIVE ACTION EMPLOYER AND HAS POSTED NON-DISCRIMINATORY NOTICES IN COMPLIANCE WITH ITS AFFIRMATIVE ACTION PLANS AND AS REQUIRED BY STATE LAW. SCHEDULE E, PART I, LINE 6 THE SCHOOL IS PRIMARILY FUNDED THROUGH THE STATE'S PER-PUPIL ALLOCATION MONIES. IN ADDITION, FEDERALLY FUNDED GRANT PROGRAMS SUCH AS TITLE I, READING SUFFICIENCY, READING EXCELLENCE ACT, AND COMPREHENSIVE SCHOOL REFORM MAKE MONIES AVAILABLE FOR STAFFING AND LEARNING MATERIALS. 0 1 0 0 0 0 0 1 0 TIMOTHY PEHRSON DIRECTOR & PRESIDENT/CEO 0 1230472 0 1003444 0 305092 0 280336 0 6600 0 2825944 0 286003 DOUGLAS M SMITH PART YEAR CFO OF IH 0 613208 0 149498 0 144956 0 123939 0 6600 0 1038201 0 131709 SKIP LEONARD DIRECTOR 0 314781 0 48668 0 81747 0 11046 0 8810 0 465052 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS PAID BY INTEGRIS HEALTH, INC. , A RELATED TAX-EXEMPT ORGANIZATOIN. THE INTEGRIS HEALTH, INC. BOARD OF DIRECTORS DESIGNATES AN EXECUTIVE COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE EXECUTIVE DIRECTOR'S COMPENSATION PERIODICALLY. THE EXECUTIVE COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION SURVEY FROM AN INDEPENDENT CONSULTANT. THE COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMMITTEE AND KEPT AS CORPORATE RECORD. 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 AND RECEIVED PAYMENTS IN THE CURRENT REPORTING YEAR: TIMOTHY PEHRSON - $286,003 DOUGLAS SMITH - $131,709 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 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. FORM 990, BOX C: DOING BUSINESS AS THE STANLEY F. HUPFELD ACADEMY AT WESTERN VILLAGE FORM 990, PART VI, SECTION A, LINE 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: DOUGLAS M. SMITH TIMOTHY PEHRSON STANLEY F. HUPFELD JOHN VERA FORM 990, PART VI, SECTION A, LINE 6 INTEGRIS AMBULATORY CARE CORPORATION IS THE SOLE MEMBERS OF WESTERN VILLAGE ACADEMY, INC. FORM 990, PART VI, SECTION A, LINE 7A INTEGRIS AMBULATORY CARE CORPORATION, AS THE SOLE MEMBERS OF WESTERN VILLAGE ACADEMY, INC., HAS THE POWER (1) TO ELECT OR REMOVE MEMBERS OF THE BOARD; (2) APPROVE THE ORGANIZATION'S STATEMENT OF PHILOSOPHY, PURPOSE, OBJECTIVES OR MISSION; (3) APPROVE LONG TERM CAPITAL IMPROVEMENTS IN EXCESS OF $100,000; (4) APPROVE ANY INCURRENCE OF ANY INDEBTEDNESS IN EXCESS OF $100,000, (5) APPROVE EXECUTION OF LEASES OR MANAGEMENT AGREEMENTS IN EXCESS OF $25,000, AND (6) APPROVE ANY AMENDMENT, MODIFICATION, OR RESTATEMENT OF THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B INTEGRIS AMBULATORY CARE CORPORATION IS THE SOLE MEMBERS OF WESTERN VILLAGE ACADEMY, INC. AS SUCH IT HAS THE POWER (1) TO ELECT OR REMOVE MEMBERS OF THE BOARD; (2) APPROVE THE ORGANIZATION'S STATEMENT OF PHILOSOPHY, PURPOSE, OBJECTIVES OR MISSION; (3) APPROVE LONG TERM CAPITAL IMPROVEMENTS IN EXCESS OF $100,000; (4) APPROVE ANY INCURRENCE OF ANY INDEBTEDNESS IN EXCESS OF $100,000, (5) APPROVE EXECUTION OF LEASES OR MANAGEMENT AGREEMENTS IN EXCESS OF $25,000, AND (6) APPROVE ANY AMENDMENT, MODIFICATION, OR RESTATEMENT OF THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 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, FINANCE 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. FORM 990, PART VI, SECTION B, LINE 15A PART VI: QUESTION 15A & 15B - THE SECRETARY, RUTH M. RAYNER, ALSO SERVES AS THE PRINCIPAL OF WESTERN VILLAGE ACADEMY, INC. HER COMPENSATION IS BASED ON THE OKC PUBLIC SCHOOL ADMINISTRATOR'S PAY SCALE, TAKING INTO CONSIDERATION HER EDUCATION, EXPERIENCE AND TENURE. LIKE THE OTHER SCHOOL EMPLOYEES, HER PAY AND PERFORMANCE ARE EVALUATED ANNUALLY, AND PAY ADJUSTMENTS ARE APPROVED BY THE PRESIDENT/CEO, AS RECOMMENDED BY THE SCHOOL DIRECTOR. SHE RECEIVES NO COMPENSATION FOR SERVING ON THE ADVISORY BOARD, OR FOR SERVING AS CORPORATE SECRETARY. THE OTHER OFFICERS OF WESTERN VILLAGE ACADEMY, INC. ARE NOT COMPENSATED BY THE ORGANIZATION. AS SUCH, A PROCESS FOR DETERMINING THE COMPENSATION FOR THESE INDIVIDUALS IS NOT REQUIRED. FORM 990, PART VI, SECTION C, LINE 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. PART XII, LINE 2B WESTERN VILLAGE ACADEMY IS INCLUDED IN THE COMBINED AUDITED FINANCIAL STATEMENT OF INTEGRIS HEALTH, INC. THESE COMBINED FINANCIAL STATEMENTS ARE PREPARED ON THE BASIS OF GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION WESTERN VILLAGE ACADEMY, 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 20, 2023. 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). SECTION 1.263(A)-3(N) ELECTION - BOOK CONFORMITY ELECTION WESTERN VILLAGE ACADEMY, 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, 2023. INTEGRIS AMBULATORY CARE CORPORATION 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731192765 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS HOSPICE INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731369586 HEALTH CARE OK 501(C)(3) LINE 10 IH 0 INTEGRIS BAPTIST MEDICAL CENTER INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731034824 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS RURAL HEALTH INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731444504 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS SOUTHWEST MEDICAL CENTER INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731089149 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS HEALTH INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731192764 HEALTH CARE OK 501(C)(3) LINE 12A, I N/A 0 INTEGRIS HEALTH FOUNDATION INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731047338 FUNDRAISING OK 501(C)(3) LINE 7 IH 0 INTEGRIS HEALTH EDMOND INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 451027361 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS MENTAL HEALTH INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 730738716 HEALTH CARE OK 501(C)(3) LINE 3 IH 0 INTEGRIS HEALTH ALLSET URGENT CARE LLC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 923075963 HEALTH CARE OK 501(C)(3) LINE 3 0 BMPA LTD 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731228665 MED. OFFICE BLDG. OK N/A N/A 0 0 QC-III 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 208723857 MEDICAL OK N/A N/A 0 0 DIAGNOSTIC LAB 500 PLAZA DR TAX DEPT FL 8 SECAUCUS NJ 07094 731560760 CLINICAL LAB NJ N/A N/A 0 0 LAKESIDE HOSPITAL 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731493662 MEDICAL OK N/A N/A 0 0 INTEGRISUSP HLTH 14201 DALLAS PARKWAY DALLAS TX 75254 352632292 MEDICAL SERVICES TX N/A N/A 0 0 INTEGRIS EMERGENCY HOSPITAL 8686 NEW TRAILS DRIVE THE WOODLANDS TX 77381 901215089 HEALTH CARE TX N/A N/A 0 0 INTEGRIS DDSI ENDOSCOPY CENTERS LLC 3366 NORTHWEST EXPRESSWAY STE 400 OKLAHOMA CITY OK 73112 854253589 HEALTH CARE OK N/A N/A 0 0 INTEGRIS PROHEALTH INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731046179 RETAIL PHARMACY OK N/A C 0 THE STANLEY F HUPFELD CHARITABLE REMAINDER TRUST 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 266238051 FINANCIAL OK N/A T 0 QUALITY ALLIANCE ASSURANCE CO PO BOX 10027 GRAND CAYMAN CJ KYI-1001 981060671 INSURANCE CJ N/A C 0 BAPTIST HEALTH SYSTEM INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 731477468 DORMANT OK N/A C 0 ONE CARE INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 DORMANT OK N/A C 0 VADOVATIONS INC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 270821922 HEALTH CARE OK N/A C 0 INTEGRIS HEALTH PARTNERS LLC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 453482852 HEALTH CARE OK N/A C 0 INTEGRIS CARDIOVASCULAR PHYSICIANS LLC 3001 QUAIL SPRINGS PARKWAY OKLAHOMA CITY OK 73134 452867352 HEALTH CARE OK N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0