2016-08-10T17:14:00-05:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-07-01 205970239 BULLHOOK COMMUNITY HEALTH CENTER INC BULL 4063954305 521 4TH STREET HAVRE MT 59501 CAROL REIFSCHNEIDER BOARD CHAIR 4063954305 2016-08-05 1 KURT BENNION P01469618 4252506100 2014 2016-12-15 16:53:06Z CYNTHIA SMITH 521 4TH STREET HAVRE MT 59501 4673505 0 X WWW.BULLHOOK.COM X 2007 MT EXCELLENCE IN PATIENT-CENTERED, ACCESSIBLE, COST-EFFECTIVE AND TIMELY PRIMARY HEALTH CARE FOR ALL. 10 10 55 16 0 0 4862630 2730203 1591619 1637862 0 50128 380778 255249 6835027 4673442 0 0 0 0 1523536 2103908 0 0 0 1906394 1100581 3429930 3204489 3405097 1468953 5307151 5932242 1307856 282302 3999295 5649940 X WE ARE COMMITTED TO EXCELLENCE IN PATIENT-CENTERED, ACCESSIBLE, COST-EFFECTIVE AND TIMELY PRIMARY HEALTH CARE FOR ALL. 1 0 2630306 0 1637862 BULLHOOK COMMUNITY HEALTH CENTER IS COMMITTED TO EXCELLENCE IN PATIENT-CENTERED, ACCESSIBLE, COST-EFFECTIVE AND TIMELY PRIMARY HEALTHCARE FOR ALL. OUR SHARED VISION IS: PEOPLE TRUST US TO TAKE CARE OF THEM; WE HONOR AND RESPECT ALL CULTURES; OUR PROVIDERS ARE CHAMPIONS OF EXCELLENCE IN CARE; OUR STAFF ARE KNOWLEDGEABLE, COMPETENT, CARING AND HAPPY; WE HONOR OUR PATIENT'S TIME AND TAXPAYER DOLLARS BY OUR COMMITMENT TO EFFICIENCY; WE STRIVE TO BE A COMMUNITY LEADER IN HEALTHCARE; WE PROVIDE A SUCCESSFUL MEDICAL HOME FOR ALL; WE ARE DETERMINED TO BE SELF-SUFFICIENT AND FINANCIALLY VIABLE. BULLHOOK COMMUNITY HEALTH CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). HEALTH CENTERS ARE IMPORTANT SAFETY NET PROVIDERS IN RURAL AND URBAN AREAS. IN ORDER TO QUALIFY AS A FQHC, AN ORGANIZATION MUST:1. PROVIDE SERVICES TO ALL PERSONS, REGARDLESS OF THE PERSON'S ABILITY TO PAY;2. ESTABLISH A SLIDING FEE DISCOUNT PROGRAM;3. BE A NONPROFIT OR PUBLIC ORGANIZATION;4. BE COMMUNITY-BASED, WITH THE MAJORITY OF THEIR GOVERNING BOARD OF DIRECTORS COMPOSED OF THEIR PATIENTS;5. SERVE A MEDICALLY UNDERSERVED AREA OR POPULATION;6. PROVIDE COMPREHENSIVE PRIMARY CARE SERVICES; AND7. HAVE AN ONGOING QUALITY ASSURANCE PROGRAM. BULLHOOK COMMUNITY HEALTH CENTER'S COMMITMENT TO QUALITY CARE MAKES A DIFFERENCE IN THE LIVES OF THE COMMUNITY. OUR COMMITMENT STEMS FROM OUR GOAL TO PROVIDE COMPLETE HEALTHCARE FOR OUR PATIENTS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. AS A CERTIFIED PATIENT CENTERED MEDICAL HOME (PCMH) WE PUT YOU, THE PATIENT, AT THE CENTER OF THE HEALTHCARE SYSTEM. OUR TEAM OF FAMILY PHYSICIANS AND FAMILY NURSE PRACTITIONERS, DENTISTS, PHARMACISTS, ADDICTION COUNSELORS, LICENSED CLINICAL SOCIAL WORKERS, AND THEIR STAFF, ARE TRAINED IN PROVIDING HEALTHCARE SERVICES TO PEOPLE OF ALL AGES. WE PROVIDE A WIDE RANGE OF SERVICES INCLUDING ROUTINE PREVENTATIVE CARE, INCLUDING IMMUNIZATIONS, EDUCATION, WELL CHILD CHECKS, AND MEN'S AND WOMEN'S HEALTH PHYSICALS, AS WELL AS MANAGEMENT OF ACUTE AND CHRONIC DISEASES, DENTAL CARE, MENTAL HEALTH COUNSELING, ADDICTION COUNSELING, AND PHARMACY SERVICES INCLUDING DIABETIC EDUCATION AND MEDICATION MANAGEMENT. WE PROVIDE THESE SERVICES TO ENSURE THAT OUR PATIENTS AND THEIR FAMILIES HAVE THE INFORMATION AND TOOLS NECESSARY TO TAKE CONTROL OF THEIR HEALTH AND INCREASE THEIR QUALITY OF LIFE. 2630306 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 4 0 55 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X CYNTHIA SMITH 4063954305 521 4TH STREET HAVRE MT 59501 JESSICA ALCORN-WINDYBOY BOARD CHAIR 2.00 0.00 X X 0 0 0 TODD HANSON BOARD CHAIR (THROUGH AUG 2014) 2.00 1.00 X X 0 0 0 ANGELA TWOMBLY VICE CHAIR 2.00 0.00 X X 0 0 0 CAROL REIFSCHNEIDER SECRETARY 2.00 0.00 X X 0 0 0 GUS SHARP TREASURER 2.00 0.00 X X 0 0 0 HEATHER ADKINS DIRECTOR (THROUGH JAN 2015) 1.00 0.00 X 0 0 0 DANA FISHER SPRING DIRECTOR 1.00 0.00 X 0 0 0 ERNEST GOETTLICH III DIRECTOR 1.00 0.00 X 0 0 0 DENNIS JOHNSON DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM LANIER DIRECTOR 1.00 0.00 X 0 0 0 JIM LYONS DIRECTOR (THROUGH SEP 2014) 1.00 0.00 X 0 0 0 JANA MCPHERSON DIRECTOR (THROUGH JULY 2014) 1.00 0.00 X 0 0 0 MARY PAPPAS DIRECTOR 1.00 0.00 X 0 0 0 DANA PYETTE DIRECTOR (THROUGH SEP 2014) 1.00 0.00 X 0 0 0 DEBI RHINES DIRECTOR 1.00 0.00 X 0 0 0 NORMA TESKE DIRECTOR 1.00 0.00 X 0 0 0 CYNTHIA SMITH CEO 39.00 1.00 X 65609 0 20875 BEATRIZ FRAUSTO CFO 39.00 1.00 X 14115 0 0 LINDA PATRICK-HAYES CONTROLLER 39.00 1.00 X 25169 0 0 ZACHARY RAMBERG CHIEF DENTAL OFFICER 40.00 0.00 X 125308 0 3122 230201 0 23997 1 0 0 0 STAFF CARE INC PO BOX 281923 ATLANTA GA 30384 LOCUMS SERVICES 131664 EHS PO BOX 204485 DALLAS TX 75320 ELECTRONIC HEALTH RECORD SERVICES 109865 2 1139605 1462789 127809 21268 2730203 NET PATIENT SERVICES 621400 1637862 1637862 1637862 50191 50191 63 -63 -63 -63 DEVELOPMENT FEES 900099 250250 250250 MISCELLANEOUS 900099 4999 4999 255249 4673442 1637862 0 305377 122607 122607 1613079 1469673 143406 31048 27530 3518 178944 144373 34571 158230 127661 30569 5606 5606 22150 22150 256822 209525 47297 30104 26135 3969 51228 40982 10246 88981 86149 2832 78157 59399 18758 -2418 -15656 13238 17342 17342 18346 18346 BAD DEBTS 250073 225066 25007 SUPPLIES 218286 163782 54504 RECRUITMENT AND RETENTI 44173 44173 DUES AND SUBSCRIPTIONS 21731 21514 217 3204489 2630306 574183 0 47651 326182 427077 120808 4473244 5112810 63416 91800 3932 6340 382533 114231 281831 268302 10000 6000 5307151 5932242 283314 282302 1024542 1307856 282302 X 3979539 5626251 19756 23689 3999295 5649940 5307151 5932242 1468953 181692 0 X 0 1 X 1 1 1 X 1.00000 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 258500 258500 124033 114231 9802 268302 X 3647242 0 3647242 1026200 1026200 4673442 3204489 0 3204489 0 3204489 PART X, LINE 2: THE CLINIC IS A TAX EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND COMPARABLE STATE LAW. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS INCLUDED IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CLINIC'S TAX POSITIONS AND CONCLUDED THAT THE CLINIC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE CLINIC'S FEDERAL EXEMPT ORGANIZATION INCOME TAX RETURNS (FORM 990) ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM RELATED ORGANIZATION 1,026,200. TAMI MILLER CEO'S DAUGHTER 80524 EMPLOYMENT 0 FORM 990, PART III, LINE 2 DURING THE FISCAL YEAR, THE ORGANIZATION MOVED TO A SINGLE LOCATION AND OPENED A PHARMACY. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS AND THE PAST-CHAIR IF THEY REMAIN A CURRENT BOARD MEMBER. THE EXECUTIVE COMMITTEE CONVENES AS NECESSARY AND, UNDER THE DIRECTION OF THE BOARD, ACTS FOR THE ORGANIZATION IN ALL MATTERS DURING THE INTERIM PERIOD BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE CONDUCTS THE PRELIMINARY EVALUATION OF THE CEO AND MAKES RECOMMENDATIONS TO THE FULL BOARD ACCORDINGLY. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 WAS REVIEWED BY THE ORGANIZATION'S CEO AND CFO, BY THE FINANCE COMMITTEE, AND BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS, MEMBERS OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND OFFICERS. IF A PERSON HAS AN ACTUAL OR POTENTIAL CONFLICT, THEY DISCLOSE ITS EXISTENCE AND ALL MATERIAL FACTS. THAT INDIVIDAUL THEN LEAVES THE MEETING WHILE THE REMAINING INDIVIDUALS VOTE ON WHETHER A CONFLIC EXISTS. IF A CONFLICT EXISTS, THE BOARD OR A COMMITTEE TAKES APPROPRIATE STEPS TO DETERMINE WHETHER THE TRANSACTION WOULD BE IN THE ORGANIZATION'S BEST INTEREST. IF NO BETTER TRANSACTION CAN BE IDENTIFIED, THE DISINTERESTED BOARD OF COMMITTEE MEMBERS VOTE ON WHETHER TO ENTER THE TRANSACTION. IF AN INDIVIDUAL VIOLATES THE CONFLICT OF INTEREST POLICY, THE BOARD OF DIRECTORS WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTIONS. EACH INDIVIDUAL IS REQUIRED TO SIGN A STATEMENT WHEN THEY ARE ELECTED OR APPOINTED TO THE POSITION. PERIODIC REVIEWS ARE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 15A TO EVALUATE THE CEO'S COMPENSATION, THE BOARD OF DIRECTORS REVIEWS THE CHAMPS SALARY SURVERY. THE PROCESS AND CONCLUSIONS ARE DOCUMENTED. THE REVIEW PROCESS LAST OCCURED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S MAIN OFFICE. BULLHOOK QALICB INC 521 4TH STREET HAVRE MT 59501 900943022 SUPPORT BULLHOOK COMMUNITY HEALTH CENTER, INC. MT 501(C)(3) LINE 11D, III-NFI BULLHOOK COMMUNITY HEALTH CENTER INC 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 BULLHOOK QALICB C 1139605 GAAP BULLHOOK QALICB D 6964796 GAAP BULLHOOK QALICB L 363655 GAAP BULLHOOK QALICB N 68701 GAAP