2016-02-15T13:13:33-06:00 2015-05-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-06-01 820324100 Health West Inc HEAL 2082327862 PO Box 2377 Pocatello ID 83206 Mindy Stosich-Benedetti CEO 2082327862 2016-01-28 1 Kim Hunwardsen CPA P00484560 6122536500 2016-01-28 2014 2016-08-17 19:52:53Z Mindy Stosich-Benedetti PO Box 2377 Pocatello ID 83206 13762348 0 X www.healthwestinc.org X 1975 ID Empowering our patients and communities by proactively providing patient -centered, quality, and affordable healthcare regardless of a patient's ability to pay. 10 10 123 10 0 0 4265341 5593763 5933186 8168415 -232290 170 0 0 9966237 13762348 0 0 0 0 4686258 6471316 0 0 0 4654574 6492665 9340832 12963981 625405 798367 4196866 6832848 1337746 3175361 2859120 3657487 X Empowering our patients and communities by proactively providing patient-centered, quality, and affordable healthcare regardless of a patient's ability to pay. 1 0 8407567 6016402 Federally Qualified Health Center Program: Provides primary health care in designated medically underserved areas. Health West currently has 8 different community health centers. We added a new CHC site in the Fall of 2015 in Preston, ID. This site is estimated to see 700 patients within its first fiscal year. 1250169 2016879 Pharmaceutical Services: Health West works with local pharmacies through the 340B Drug Discount Program to help get patient medicines at a lower cost. In addition, Health West offers prescription drug assistance for patients who qualify for free medications directly from the drug manufacturers if the medicine doesn't come in generic form. Health West also provides medication reconciliation, therapeutic monitoring, wellness promotion, and disease prevention. 398384 135134 Dental Services: Health West provides preventive dental services to prevent diseases of the oral cavity and related structures. Services include application of sealants, and diagnostic screening for caries and periodontal disease through the use of dental x-rays. In addition, Health West provides basic general dentistry to diagnose and treat disease, injury, or impairment in teeth including fillings and single unit crowns; non-surgical-endodontic, extractions, and periodontal therapies. 10056120 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 123 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Nancy Wright 2082327862 PO Box 2377 Pocatello ID 83204 Adam Waldron President 2.00 X X 0 0 0 Barbara Bybee Past President 1.00 X X 0 0 0 Norma Ramirez Secretary 2.00 X X 0 0 0 Lloyd Curry Vice President 1.00 X X 0 0 0 Doug Balfour Director 1.00 X 0 0 0 Thomas Ottaway Director 1.00 X 0 0 0 Robert Picard Director 2.00 X 0 0 0 Gloria Whiteside Director 1.00 X 0 0 0 Gabriel Rivas Director 1.00 X 0 0 0 Jennifer Seaich Director 1.00 X 0 0 0 Mindy Stosich-Benedetti CEO (Dec 2014-May 2015) 40.00 X 62435 0 9766 Beth Mahoney CEO (thru Nov 2014) 40.00 X 175432 0 18542 Don Herbert CFO/COO (thru Nov 2014) 40.00 X 103942 0 213 Shauna Croft CFO/COO (thru Aug 2014) 40.00 X 40103 0 5479 Courtland Carbol Provider 40.00 X 193580 0 21271 Joseph Ragan Provider 40.00 X 153861 0 17551 Dean Smith Provider 40.00 X 168033 0 18949 Mark Horrock CMO 40.00 X 186171 0 11168 1083557 0 102939 6 0 1 0 Greenway 4301 W Boy Scout Blvd Ste 800 Tampa FL 33607 Software and Billing Services 173290 1 8464 3723779 1861520 1816177 5593763 Patient Revenue 622110 5474375 5474375 Pharmacy Revenue 900099 2016879 2016879 Meaningful Use Revenue 900099 531250 531250 Dental Revenue 900099 135134 135134 Miscellaneous Revenue 900099 10777 10777 8168415 170 170 13762348 8168415 0 170 397279 397279 4982658 3942407 1040251 643844 444269 199575 447535 324583 122952 8785 3265 5520 21049 21049 812860 789827 23033 525549 169849 355700 425987 33682 392305 422641 323016 99625 44861 16661 28200 63596 40111 23485 24734 9312 15422 174992 153217 21775 22513 22513 Medical Supplies 3443002 3443002 Bad Debt Expense 289027 289027 Repairs and Maintenance 98385 68074 30311 Outreach 63868 63868 50816 5818 44998 12963981 10056120 2907861 0 1658405 2420014 711912 858549 112189 133827 4476907 1166875 1657524 3310032 56836 110426 4196866 6832848 1072406 1409740 1765621 265340 1337746 3175361 X 2859120 3657487 2859120 3657487 4196866 6832848 798367 0 X 0 1 X 1 1 1 X 1630536 1629075 4535293 4265341 5593763 17654008 1630536 1629075 4535293 4265341 5593763 17654008 17654008 170 170 17654178 8168415 1.00000 1.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 282061 282061 3403465 684698 2718767 43726 29095 14631 712249 453082 259167 35406 35406 3310032 X 13473321 -289027 -289027 13762348 0 13762348 12674954 0 12674954 289027 289027 12963981 Part X, Line 2: The Organization is a charitable organization under the State of Idaho tax regulations and under 501(c)(3) of the Internal Revenue Code is exempt from state or local income taxes. The Organization is required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS annually. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Organization's federal Form 990 filings are no longer subject to federal tax examinations by tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Reported in Revenue on Financial Statements -289,027. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Reported in Revenue on Financial Statements 289,027. X X 1 0 0 0 0 0 0 0 0 Beth Mahoney CEO (thru Nov 2014) 130295 0 125 0 45012 0 2698 0 15844 0 193974 0 0 0 Courtland Carbol Provider 191790 0 125 0 1665 0 1788 0 19483 0 214851 0 0 0 Joseph Ragan Provider 152435 0 125 0 1301 0 2348 0 15202 0 171411 0 0 0 Dean Smith Provider 166639 0 125 0 1269 0 2591 0 16358 0 186982 0 0 0 Mark Horrock CMO 184525 0 125 0 1521 0 2771 0 8396 0 197338 0 0 0 Part I, Line 4a Beth Mahoney received $44,018.39 in severance payment. X 3 1816177 replacement price 0 0 0 0 Form 990, Part III, line 2 Health West, Inc. has expanded its dental services, behavioral health program, and care management services. Form 990, Part VI, Section A, line 1 The Executive Committee has the authority to act on behalf of the full governing board, but the actions of the Executive Committee must not supersede the full health center governing board's authorities, functions, and responsibilities. The Executive Committee must report all actions taken independently and on behalf of the board to the full governing board. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the board. Form 990, Part VI, Section B, line 11 The Board of Directors has left the authority of reviewing the 990 to the CFO and CEO. The Form 990 was presented at a board meeting prior to filing with the IRS. Form 990, Part VI, Section B, line 12c It is the policy of Health West that interests shall be fully disclosed by any individual regardless of whether a Conflict of Interest is determined to exist. Health West requires that all Individuals Affiliated with Health West and persons seeking to affiliate with Health West disclose in writing (and update at least annually): (1) all Interests that may create an actual or potential Conflict of Interest, and (2) where applicable, provide a statement suggesting how such Conflict of Interest could be avoided or mitigated. Members of, and candidates for membership on, the Board of Directors shall make disclosures to the Chair of the Board of Directors. If the Chair has such an Interest, he or she must make disclosure to the Vice Chair, respectively, who will, in turn, be responsible for advising the Board. The CEO shall make disclosures to the Chair of the Board who will, then, be responsible for advising the Board of such disclosure. In the case of a potentially conflicted person who is a Board member (including the CEO), that person may make a presentation to the Board regarding whether he or she has a Conflict of Interest, and may respond to related questions from the Board. However, after such presentation, he or she shall leave the meeting during any discussion of, or vote on, whether a Conflict of Interest exists, and if such Conflict of Interest is determined by the Board to exist, he or she shall leave the meeting during any discussion of, and voting on, the transaction or arrangement that involves the Conflict of Interest. After exercising due diligence, the Board or CEO, as applicable, shall determine whether Health West can obtain an equivalent transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a Conflict of Interest. In circumstances where there are material continuing or pervasive Conflicts of Interest, an individual may be required by the Board of Health West or the CEO, as applicable, to withdraw from his or her position with Health West unless the individual, family member or business associate chooses to disassociate from the outside position that causes the Conflict of Interest. If there is an individual who failed to disclose an Interest the Board or CEO may take appropriate corrective and/or disciplinary action, including removal of the individual from the selection, negotiation, or administration of any contracts or grants. Form 990, Part VI, Section B, line 15a The Board of Directors uses comparability data from surveys and historical data in approving the CEO salary. The same methods are used for the CEO to approve the salaries of all remaining employees, including the CFO. The board periodically reviews professional staff salaries. Compensation was last reviewed in 2014. Form 990, Part VI, Section C, line 19 The organization made its governing documents, conflict of interest policy, and financial statements available to the public upon request.