2022-11-14T12:02:16-06:00 2021-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2021-01-01 391904975 REGIONAL WEST GARDEN COUNTY REGI 3087723283 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO 3087723283 2022-11-11 1 MICHAEL ICKOWSKI 999009999 WENDY R COOLEY CPA P01523804 4023302660 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MICHAEL ICKOWSKI 4021 AVENUE B SCOTTSBLUFF NE 69361 9390272 0 X WWW.GCHEALTH.ORG X 1984 NE THE MISSION OF REGIONAL WEST GARDEN COUNTY IS TO PROVIDE HIGH QUALITY HEALTH CARE BY COMBINING CLINICAL AND SERVICE EXCELLENCE TO ENHANCE THE QUALITY OF LIFE OF THE COMMUNITIES SERVED. 8 4 122 4 0 0 1602762 69585 8848957 9304414 12109 5807 320 4309 10464148 9384115 0 0 0 0 6074834 5811763 0 0 0 3805766 4949825 9880600 10761588 583548 -1377473 9598650 8237628 11300518 11316969 -1701868 -3079341 X THE MISSION OF REGIONAL WEST GARDEN COUNTY IS TO PROVIDE HIGH QUALITY HEALTH CARE BY COMBINING CLINICAL AND SERVICE EXCELLENCE TO ENHANCE THE QUALITY OF LIFE OF THE COMMUNITIES SERVED. 0 0 3493388 6056566 REGIONAL WEST GARDEN COUNTY IS A NON-PROFIT FACILITY CRITICIAL ACCESS HOSPITAL THAT INCLUDES A 10 BED ACUTE CARE UNIT DESIGNED TO PROVIDE SPECIAL CARE FOR ACUTELY ILL PATIENTS. THIS CRITICAL ACCESS HOSPITAL OFFERS A VARIETY OF ANCILLARY SERVICES. 1174463 2167824 REGIONAL WEST GARDEN COUNTY INCLUDES A 40 BED NURSING HOME INTERMEDIATE LONG TERM CARE FACILITY. ITS PURPOSE IS TO PROVIDE 24 HOUR LICENSED NURSING CARE THAT ASSISTS RESIDENTS IN MEETING THEIR DAILY NEEDS AND HELPS THEM MAINTAIN THEIR OPTIMUM FUNCTIONAL LEVEL WITHIN AN ATMOSPHERE OF COMFORT AND DIGNITY. REGIONAL WEST GARDEN COUNTY NURSING HOME ALSO OFFERS ADULT DAY CARE, RESPITE CARE, AND HOSPICE SERVICES. 981277 1009138 REGIONAL WEST GARDEN COUNTY CLINIC IS A RURAL HEALTH CLINIC THAT PROVIDES PHYSICIAN APPOINTMENTS AND WALK IN CARE FOR RESIDENTS IN THE SOUTHEASTERN NEBRASKA PANHANDLE. 3731010 75195 REGIONAL WEST GARDEN COUNTY ALSO PROVIDES ADMINISTRATIVE SUPPORT SERVICES NECESSARY TO ACCOMPLISH THE PRIMARY PROGRAM SERVICES OF THE HOSPITAL. THESE SERVICES ARE ADMINISTRATIVE, TECHNOLOGY, HUMAN RESOURCES, BILLING, HOUSEKEEPING, MEDICAL RECORDS AND OTHER SERVICES NECESSARY TO KEEP OPERATIONS RUNNING. 3731010 75195 9380138 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 12 0 1 122 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL ICKOWSKI 3086301111 4021 AVENUE B SCOTTSBLUFF NE 69361 JOHN MENTGEN PRESIDENT/CEO 1.00 45.00 X X 0 568880 107104 PAUL HOFMEISTER VICE CHAIR 1.00 42.00 X X 0 371715 40874 MIKE ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 334705 45745 LAURIE SOPER APRN 40.00 0.00 X 322492 0 10767 BRAD HOWELL CEO - RWGC/DIRECTOR 40.00 0.00 X X 172010 0 8800 JAMIE DIKEMAN RADIOLOGY MANAGER 40.00 0.00 X 106511 0 5161 STEPHANIE TODD SECRETARY 1.00 40.00 X 0 74463 30125 BEV KRAJEWSKI DIRECTOR 1.00 0.00 X 0 0 0 HOD KOSMAN DIRECTOR 1.00 3.00 X 0 0 0 MARY MATHER DIRECTOR 1.00 0.00 X 0 0 0 TERRY KRAUTER DIRECTOR 1.00 0.00 X 0 0 0 601013 1349763 248576 3 0 1 0 PRIME TIME HEALTHCARE LLC C/O AMERICAN NATIONAL BANK PO BOX 3 OMAHA NE 68103 AGENCY STAFF 675867 STAT STAFFING LLC PO BOX 45 101 E AVE F OSHKOSH NE 69154 AGENCY STAFF 308983 MEDICAL SOLUTIONS 1010 N 102ND STREET STE 300 OMAHA NE 681142300 AGENCY STAFF 238403 KEY WEST CONSULTING 680 S CACHE ST STE 101-10219 JACKSON WY 83001 AGENCY STAFF 225156 4 56703 12882 69585 NET HOSPITAL PATIENT R 623000 6056566 6056566 NURSING HOME PATIENT R 623000 2167824 2167824 HEALTH CLINIC PATIENT 621110 1009138 1009138 OTHER OPERATING REVENU 623000 70886 70886 9304414 10164 10164 1800 6157 -4357 -4357 -4357 OTHER NON-OPERATING RE 900099 4309 4309 4309 9384115 9308723 0 5807 X 180810 180810 4017773 3772780 244993 126834 120632 6202 1216030 1063969 152061 270316 241007 29309 30429 28923 1506 11532 11532 2927704 2545124 382580 9515 2512 7003 179758 167118 12640 7277 7229 48 114520 107008 7512 38616 38360 256 7464 7281 183 6956 6956 199809 164304 35505 55731 8042 47689 MEDICAL SUPPLIES 551784 528531 23253 BAD DEBT EXPENSE 430677 430677 MISCELLANEOUS 344164 115158 229006 DUES & LICENSES 33889 31483 2406 10761588 9380138 1381450 0 2233970 969102 3454010 3464048 3073014 2694553 160757 173529 1118 122013 2044143 1265560 668896 778583 6885 35800 9598650 8237628 1396975 182825 47077 326876 2337089 1783488 7519377 9023780 11300518 11316969 X -1701868 -3079341 -1701868 -3079341 9598650 8237628 -1377473 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7307997 190018 1350185 40956 8807244 6188204 324798 824828 29833 7307997 4837335 719879 1352989 98684 623315 6188204 4551048 538883 -191365 61231 4837335 4507319 106517 296128 358916 4551048 0.00000 0.15219 0.84781 0 1 1 2916 2916 318452 61889 256563 1689780 1203671 486109 32995 32995 778583 DUE TO AFFILIATES 7264516 DUE TO THIRD PARTY PAYOR 899435 SALARIES & BENEFITS PAYABLE 582144 LEASEHOLD PAYABLE GCHS 277685 9023780 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE RESTRICTED FOR HEALTHCARE RESEARCH, HEALTHCARE EDUCATIONAL SCHOLARSHIPS, AND CAPITAL PROJECTS. PART X, LINE 2: RWHS, THE MEDICAL CENTER, THE FOUNDATION, THE VILLAGE, RWPC AND RWGC ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAVE RECEIVED DETERMINATION LETTERS THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER HAS REALIZED CERTAIN INCOME WHICH THE INTERNAL REVENUE SERVICE CONSIDERS TO BE UNRELATED BUSINESS INCOME SUBJECT TO INCOME TAX. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. RCI IS A FOR-PROFIT CORPORATION AND FILES A SEPARATE FEDERAL INCOME TAX RETURN. A PROVISION FOR INCOME TAXES IS PROVIDED FOR THOSE ACTIVITIES THAT CREATE TAXABLE INCOME. RCI RECOGNIZED AN INCOME TAX EXPENSE OF $8,912 IN 2021 AND AN INCOME TAX REFUND OF $180,654 IN 2020. THE INCOME TAX REFUND AND EXPENSE IS INCLUDED IN SUPPLIES AND OTHER EXPENSES IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. RWHS ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740 INCOME TAXES. RWHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2021 AND 2020, RWHS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 0 136895 136895 0.01330 1128918 846535 282383 0.02730 1265813 846535 419278 0.04060 1265813 846535 419278 0.04060 1 430677 0 4248678 4130020 118658 X 1 1 1 1 REGIONAL WEST GARDEN COUNTY 1100 WEST 2ND OSHKOSH NE 69154 8200000 X X X X REGIONAL WEST GARDEN COUNTY 1 0 0 1 X X X X X X X X 20 1 0 1 1 X WWW.GCHEALTH.ORG X 1 20 1 WWW.GCHEALTH.ORG 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X X X X X X 1 X 0 X X X X 1 X 0 0 REGIONAL WEST GARDEN COUNTY PART V, SECTION B, LINE 5: REGIONAL WEST GARDEN COUNTY PARTICIPATED WITH OTHER HOSPITALS IN THE RURAL NEBRASKA HEALTHCARE NETWORK (RNHN) IN A JOINT PLANNING PROCESS FACILITATED BY PANHANDLE PUBLIC HEALTH DISTRICT. MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) IS A PARTNERSHIP-BASED FRAMEWORK TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN. MAPP EMPHASIZES THE PARTNERSHIP WITH ALL SECTORS OF THE PUBLIC HEALTH SYSTEM TO EVALUATE THE HEALTH STATUS OF THE REGION IT SERVES, IDENTIFY PRIORITY AREAS, AND DEVELOP PLANS FOR IMPLEMENTATION. RWGC HOSTED FOCUS GROUPS FOR RESIDENTS OF THE SERVICE AREA IN SPRING 2020 AS PART OF THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT. BECAUSE OF THE COVID-19 PANDEMIC, A HANDFUL OF FOCUS GROUPS WERE COMPLETED VIA OPEN-ENDED SURVEY RATHER THAN IN PERSON. PARTICIPANTS INCLUDED REPRESENTATIVES FROM THE HOSPITAL, PUBLIC SCHOOL SYSTEM, GARDEN COUNTY, AND LOCAL BUSINESSES. REGIONAL WEST GARDEN COUNTY PART V, SECTION B, LINE 6B: GARDEN COUNTY WORKED WITH THE REST OF THE MEMBERS OF THE RNHN NETWORK FOR IDEAS AND WITH THE PANHANDLE PUBLIC HEALTH DISTRICT (PPHD) AND SCOTTSBLUFF COUNTY HEALTH DEPARTMENT. REGIONAL WEST GARDEN COUNTY PART V, SECTION B, LINE 11: NEEDS WERE ADDRESSED USING A PRIORITIZATION MATRIX TO HELP IDENTIFY THE AREAS OF NEED THAT MAY BE BETTER ADDRESSED BY OTHER ORGANIZATIONS OR AGENCIES IN THE REGION WITH A PRIMARY FUNCTION THAT DIRECTLY FOCUSED ON THOSE AREAS, AND ALSO TO IDENTIFY THE NEEDS THAT MOST CLOSELY ALIGNED WITH BOTH THE PURPOSE AND MISSION OF THE HOSPITAL AND COULD BE ADDRESSED EFFECTIVELY WITH THE RESOURCES THAT THE HOSPITAL HAS CURRENTLY. NEEDS THAT WERE NOT ADDRESSED IN THE IMPLEMENTATION STRATEGY EITHER WERE BETTER ADDRESSED BY OTHER AGENCIES OR ORGANIZATIONS IN THE REGION, OR WERE OUTSIDE OF THE SPECIFIC PURPOSE AND MISSION OF THE HOSPITAL AND COULD NOT BE ADDRESSED USING THE CURRENT RESOURCES. NEEDS IDENTIFIED INCLUDE THE FOLLOWING: HEALTHY TRANSITIONAL AGING, ACCESS TO CARE, SUBSTANCE ABUSE PREVENTION, MENTAL WELL-BEING, AND PHYSICAL WELLNESS & DISEASE PREVENTION.HEALTHY TRANSITIONAL AGING: OUR CONCERN FOR OLDER POPULATIONS IS INJURY AND FALL PREVENTION. FALLS ARE THE LEADING CAUSE OF INJURY AND ARE A MAJOR CAUSE OF DEATH FOR OLDER ADULTS AND DEATHS RELATED TO FALLS HAVE INCREASED IN RECENT YEARS. INCREASING PHYSICAL ACTIVITY AMONG THIS GROUP IS A RECOGNIZED APPROACH TO PREVENTING FALLS.MENTAL WELL-BEING: THE PERCENTAGE OF ADULTS IN THE PANHANDLE WHO EXPERIENCED FREQUENT MENTAL DISTRESS HAS BEEN HIGHER THAN THE STATE, HISTORICALLY. THERE WAS A MORE RAPID INCREASE FROM 2014 TO 2018 IN THE PANHANDLE WHEN COMPARED TO THE STATE. THE GOAL IS TO REDUCE DETRIMENTAL HEALTH EFFECTS OF BEHAVIORAL HEALTH CHALLENGES INCLUDING SUICIDAL IDEATION AND ABUSE. THIS WILL BE DONE BY INCREASING THE PROPORTION OF CHILDREN AND ADOLESCENTS WHO GET APPROPRIATE TREATMENT FOR ANXIETY OR DEPRESSION.SUBSTANCE ABUSE: PRELIMINARY DATA SHOWS THAT THERE HAS BEEN AN INCREASE IN USING AND ABUSING SUBSTANCES DURING THE 2020 COVID-19 PANDEMIC. THE GOAL IS TO REDUCE SUBSTANCE ABUSE DISORDERS AND INCREASE THE PROPORTION OF PEOPLE WITH SUBSTANCE USE AND MENTAL HEALTH DISORDERS WHO ARE TREATED FOR BOTH.PHYSICAL WELLNESS AND DISEASE PREVENTION STRATEGIES: THE GOAL IS TO INCREASE COMMUNITY AWARENESS AND EDUCATION ON HEALTHY LIFESTYLE CHOICES BY: 1) INCREASING THE PROPORTION OF ADULTS AGE 19 AND OLDER WHO GET RECOMMENDED VACCINES, 2) INCREASING THE PROPORTION OF ADULTS WITH DIABETES WHO GET FORMAL DIABETES EDUCATION, AND 3) INCREASING THE PROPORTION OF ADULTS WHO GET SCREENED FOR COLORECTAL CANCER.ACCESS TO CARE: THE GOAL IS TO INCREASE COMMUNITY ACCESS TO CARE REGARDLESS OF INCOME LEVEL OR ABILITY TO TRAVEL. THIS CAN BE DONE BY: 1) REDUCING THE PROPORTION OF PERSONS WHO ARE UNABLE TO OBTAIN OR DELAY IN OBTAINING NECESSARY MEDICAL CARE AND 2) INCREASING THE PROPORTION OF ADULTS WHO GET RECOMMENDED EVIDENCE-BASED PREVENTIVE HEALTH CARE. REGIONAL WEST GARDEN COUNTY PART V, SECTION B, LINE 15E: RWGC FOLLOWS THE FINANCIAL ASSISTANCE POLICY OF REGIONAL WEST MEDICAL CENTER, A RELATED TAX-EXEMPT HOSPITAL. 2 1 - REGIONAL WEST GARDEN COUNTY CLINIC 1100 WEST 2ND OSHKOSH NE 69154 RURAL HEALTH CLINIC 2 - REGIONAL WEST GARDEN COUNTY NURSING HOME 1100 WEST 2ND OSHKOSH NE 69154 ASSISTED LIVING FACILITY PART I, LINE 3C: THE ORGANIZATION PRIMARILY USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. IN SOME CASES, THE ORGANIZATION USES INFORMATION ON AVAILABLE ASSETS OR OTHER FINANCIAL RESOURCES OF THE INDIVIDUAL(S). PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT WAS NOT PREPARED DURING THE YEAR. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO. THE RATIO WAS DERIVED FROM WORKSHEET 2. PART I, LINE 7G: THE HOSPITAL DOES NOT REPORT ANY SUBSIDIZED HEALTH SERVICES ON LINE 7(G). PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $430,677. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL DID NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES DURING THE YEAR. PART III, LINE 2: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. RWGC PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. RWGC ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE. FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 3: RWGC PROVIDES CHARITY CARE TO PATIENTS WITH LIMITED TO NO ABILITY TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE GIVEN A DISCOUNT FROM ESTABLISHED CHARGES THROUGH THE COMPLETION OF THE APPLICATION FOR FINANCIAL ASSISTANCE BASED ON THE MOST RECENT PUBLISHED POVERTY GUIDELINES OR THROUGH A PREDICTIVE CHARITY SCORING MODEL. RWGC DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST-TO-CHARGE RATIO AS REPORTED IN THE INTERNAL COST ACCOUNTING SYSTEM. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "FINANCIAL ASSISTANCE/CHARITY CARE" CAN BE FOUND ON PAGES 10, 13, AND 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: APPROXIMATELY 50% OF REVENUE IS FROM PATIENTS PARTICIPATING IN THE MEDICARE PROGRAM, THUS PROVIDING SERVICES TO MEDICARE PATIENTS IS A PROMOTION OF HEALTHCARE SERVICES TO A SIGNIFICANT PORTION OF THE POPULATION OF THE COMMUNITY AND REGION THAT RWGC SERVES. MEDICARE COSTS IS THE ALLOWABLE COSTS AS REPORTED ON THE RWGC COST REPORT FOR 2021. PART III, LINE 9B: THE COLLECTION POLICY AND THE RELATED CHARITY CARE POLICY STATES THAT SINCE A PATIENT'S ABILITY TO PAY FOR HEALTHCARE CAN CHANGE, A CHARITY DETERMINATION CAN BE MADE PRIOR TO, DURING OR FOLLOWING TREATMENT AT RWGC. ONCE A PATIENT HAS DEMONSTRATED OR COMMUNICATED A NEED THROUGH NONPAYMENT, OR THROUGH A COMPLETED FINANCIAL ASSISTANCE APPLICATION, THE FINANCIAL ASSISTANCE TEAM OF RWGC WILL REVIEW THE ACCOUNT AND BASED ON FEDERAL POVERTY GUIDELINES WILL MAKE A DETERMINATION OF WHETHER THE ACCOUNT QUALIFIES FOR CHARITY CARE TREATMENT. SOME ITEMS CONSIDERED IN THE DETERMINATION, ACCORDING TO THE RWGC POLICY, ARE: ABILITY TO PAY, EXHAUSTION OF MEDICARE OR MEDICAID BENEFITS COMBINED WITH INABILITY TO PAY, DISCOUNTED CARE FOR THOSE UNABLE TO PAY; ALL OTHER POSSIBLE SOURCES OF COLLECTION USING SOUND BUSINESS PRACTICES HAVE BEEN MADE TO ENABLE THE PATIENT TO PAY; CARE PROVIDED TO A DECEASED PATIENT WITH NO ESTATE; OR CARE PROVIDED TO A PATIENT AFTER WHICH A NEGOTIATED SETTLEMENT WAS MADE FOR THE PATIENT'S ACCOUNT. PART VI, LINE 2: A COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN IS DEVELOPED THROUGH A PARTNERSHIP WITH PANHANDLE PUBLIC HEALTH DEPARTMENT AND INCLUDES ALL SECTORS OF THE PUBLIC HEALTH SYSTEM TO EVALUATE THE HEALTH STATUS OF THE REGION IT SERVES, IDENTIFY PRIORITY AREAS, AND DEVELOP PLANS FOR IMPLEMENTATION. A LINK/COPY IS AVAILABLE ON THE HOSPITAL WEBSITE. PART VI, LINE 3: AT THE TIME OF PRE-REGISTRATION BY PHONE, OR REGISTRATION ON THE DATE OF SERVICE, THE REGISTRATION CLERK MAKES PAYMENT ARRANGEMENTS WITH THE PATIENT OR GUARANTOR. THE STAFF ARE ALL TRAINED TO EXPLAIN THE FINANCIAL ASSISTANCE POLICY AND HELP THE PATIENT OR GUARANTOR WITH THE APPLICATION. SOCIAL SERVICES IS ALSO CONSULTED FOR HELP WITH THIS PROCESS AND ALSO HELPS WITH APPLYING FOR GOVERNMENT PROGRAMS THAT CAN HELP PAY FOR THE SERVICES. FINANCIAL ASSISTANCE POLICIES AND FORMS ARE ALSO AVAILABLE ON THE HOSPITAL WEBSITE UNDER "ABOUT YOUR BILL". IT IS ALSO LISTED UNDER THE "SERVICES" TAB ON OUR WEBSITE UNDER "FINANCIAL SERVICES." PART VI, LINE 4: RWGC SERVES GARDEN COUNTY NEBRASKA AND PARTS OF SURROUNDING COUNTIES (PRIMARILY DEUEL COUNTY). TOTAL POPULATION IN THE SERVICE AREA IS LESS THAN 5,000. THE COUNTY POPULATION CONTAINED 19.2% UNDER THE AGE OF 19, 15.6% FROM 20 TO 39, 31.3% FROM 40 TO 59, 25.4% FROM 60 TO 79, AND 8.5% WHO WERE 80 YEARS OF AGE OR OLDER. THE PERCENT OF THE POPULATION BELOW THE POVERTY LINE IS SLIGHTLY LESS THAN THE STATEWIDE AVERAGE, AND THE POVERTY RATE FOR CHILDREN UNDER AGE 18 IS ONE OF THE LOWEST IN THE REGION. PART VI, LINE 5: RWGC HAS PRIMARY CARE AND SPECIALTY CARE AVAILABLE THROUGH A RURAL HEALTH CLINIC ON SITE. ADDITIONAL SERVICES ARE ADDED AS AVAILABLE PRIMARILY THROUGH TELEMEDICINE. SERVICES ADDED RECENTLY INCLUDED CHIROPRACTIC CARE ON-SITE AND BEHAVIORAL HEALTH COUNSELING SERVICES ON-SITE. WE ARE LOOKING TO ADD A PAIN MANAGEMENT SPECIALIST THROUGH TELEMEDICINE SOON. IN ADDITION OUTREACH SERVICES TO SURROUNDING COMMUNITIES AND SENIOR CENTERS PROVIDES BLOOD PRESSURE CHECKS AND LAB DRAWS. WE ALSO PROVIDE SEVERAL REMOTE AREAS THAT SURROUND US WITH FLU SHOT CLINICS IN THE COMMUNITIES. WE ALSO PROVIDE EDUCATION THROUGH NEWSPAPER ARTICLES IN THE LOCAL NEWSPAPER. WE PLAN ON ADDING A WALKING TRACK AROUND THE HOSPITAL FOR COMMUNITY USE FOR WELLNESS. PART VI, LINE 6: THE AFFILIATED HEALTH CARE SYSTEM INCLUDES:REGIONAL WEST GARDEN COUNTY - CRITICAL ACCESS HOSPITALREGIONAL WEST HEALTH SERVICES - STRATEGIC PLANNING AND MANAGEMENTREGIONAL WEST MEDICAL CENTER - 182-BED HOSPITAL, LEVEL II TRAUMA CENTER, AND REGIONAL REFERRAL CENTERREGIONAL WEST PHYSICIANS CLINIC - MULTI-SPECIALTY MEDICAL GROUPREGIONAL WEST VILLAGE - INDEPENDENT AND ASSISTED LIVING CENTERREGIONAL WEST FOUNDATION - RAISES FUNDS, MANAGES INVESTMENTS, AND ADMINISTERS SCHOLARSHIP PROGRAMREGIONAL WEST HEALTH SERVICES AND AFFILIATES - 501(C)(9) ORGANIZATION PROVIDING EMPLOYEE HEALTH CAREREGIONAL CARE, INC. - A FOR-PROFIT ORGANIZATION PROVING TPA SERVICES. X X X 0 1 0 0 0 0 0 0 0 JOHN MENTGEN PRESIDENT/CEO 0 559601 0 0 0 9279 0 59646 0 47458 0 675984 0 0 PAUL HOFMEISTER VICE CHAIR 0 332687 0 0 0 39028 0 11587 0 29287 0 412589 0 0 MIKE ICKOWSKI TREASURER/CFO 0 324658 0 0 0 10047 0 41125 0 4620 0 380450 0 0 LAURIE SOPER APRN 159272 0 163220 0 0 0 7581 0 3186 0 333259 0 0 0 BRAD HOWELL CEO - RWGC/DIRECTOR 171038 0 0 0 972 0 6952 0 1848 0 180810 0 0 0 PART I, LINE 3 THE CEO AND CFO ARE COMPENSATED BY REGIONAL WEST HEALTH SERVICES, A RELATED ORGANIZATION. METHODS USED TO ESTABLISH COMPENSATION FOR THESE INDIVIDUALS INCLUDE THE FOLLOWING: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 48,891 MICHAEL ICKOWSKI 29,525 FORM 990, PART VI, SECTION A, LINE 6 REGIONAL WEST HEALTH SERVICES IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A REGIONAL WEST HEALTH SERVICES (RWHS), THE SOLE MEMBER, HAS THE ABILITY TO APPOINT 7 PERSONS TO THE BOARD OF DIRECTORS. THE REMAINING DIRECTORS MUST BE APPROVED BY RWHS. FORM 990, PART VI, SECTION A, LINE 7B REGIONAL WEST HEALTH SERVICES (RWHS), THE SOLE MEMBER, MUST APPROVE ALL MATTERS PERTAINING TO THE MERGER, CONSOLIDATION, LIQUIDATION OR AMENDMENT TO THE ARTICLES OF INCORPORATE OR BYLAWS OF THE CORPORATION. THE ANNUAL BUDGET OF THE CORPORATION IS ALSO SUBJECT TO THE APPROVAL OF RWHS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD WILL HAVE AN OPPORTUNITY TO REVIEW DRAFTS ELECTRONICALLY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL DISCLOSURE BY BOARD MEMBERS OF ANY CONFLICT OF INTEREST, AS SET FORTH IN THE POLICIES, IS REQUIRED. FOR ANY POSSIBLE CONFLICT OF INTEREST IDENTIFIED, THE REMAINING BOARD DETERMINES IF IT ACTUALLY CONSTITUTES A CONFLICT OF INTEREST WITHOUT THE CONFLICTED BOARD MEMBER PRESENT. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE BOARD, LESS THE CONFLICTED MEMBER, WILL THEN DECIDE THE LEVEL OF INVOLVEMENT OF THE MEMBER IN DECISION MAKING FOR THE ENTITY, IF THERE IS AN ALTERNATIVE ARRANGEMENT THAT WILL ELIMINATE THE CONFLICT OF INTEREST, AND THE APPROPRIATENESS OF THE CONFLICTED MEMBER CONTINUING AS A BOARD MEMBER. FAILURE TO DISCLOSE A CONFLICT OF INTEREST CAN RESULT IN DISCIPLINARY AND CORRECTIVE ACTION FOR THE CONFLICTED MEMBER. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIAL: COMPENSATION FOR THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE RWHS BOARD. THE DETERMINATION IS BASED ON MARKET DATA AND RECOMMENDATIONS FROM AN INDEPENDENT CONSULTING FIRM WHO COLLECTS THAT INFORMATION FOR COMPARISON PURPOSES. MINUTES ARE KEPT OF THESE MEETINGS. COMPENSATION PROCESS FOR OFFICERS: COMPENSATION FOR OTHER OFFICERS IS REVIEWED BY AN INDEPENDENT CONSULTANT ON AN ANNUAL BASIS TO ENSURE THE COMPENSATION PLAN MEETS REASONABLENESS TESTING COMPARED TO MGMA COMPENSATION SURVEY. THE COMPENSATION MODEL IS ALSO REVIEWED BY LEGAL COUNSEL FOR REASONABLENESS AND COMPLIANCE WITH IRS REQUIREMENTS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,000,080. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,000,080. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 382,399. MANAGEMENT AND GENERAL EXPENSES 379,424. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 761,823. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 162,645. MANAGEMENT AND GENERAL EXPENSES 3,156. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,801. PART XII, LINE 2C THE CFO OF REGIONAL WEST HEALTH SERVICES, THE SOLE MEMBER OF THE ORGANIZATION, IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT PUBLIC ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. REGIONAL WEST HEALTH SERVICES 4021 AVENUE B SCOTTSBLUFF NE 69361 363314157 ADMIN SUPPORT NE 501(C)(3) LINE 12B, II N/A 0 REGIONAL WEST MEDICAL CENTER 4021 AVENUE B SCOTTSBLUFF NE 69361 470385129 HOSPITAL NE 501(C)(3) LINE 3 REGIONAL WEST HEALTH SERVICES 0 REGIONAL WEST FOUNDATION 4021 AVENUE B SCOTTSBLUFF NE 69361 237171022 FUNDRAISING NE 501(C)(3) LINE 12A, I REGIONAL WEST HEALTH SERVICES 0 REGIONAL WEST VILLAGE 4021 AVENUE B SCOTTSBLUFF NE 69361 363314162 RETIREMENT FACILITY NE 501(C)(3) LINE 10 REGIONAL WEST HEALTH SERVICES 0 REGIONAL WEST PHYSICIANS CLINIC 4021 AVENUE B SCOTTSBLUFF NE 69361 363314159 DR. CLINICS NE 501(C)(3) LINE 10 REGIONAL WEST HEALTH SERVICES 0 REGIONAL WEST HEALTH SERVICES & AFFILIATES 4021 AVENUE B SCOTTSBLUFF NE 69361 470658690 HEALTH PLAN NE 501(C)(9) REGIONAL WEST HEALTH SERVICES 0 REGIONAL CARE INC 4201 AVENUE B SCOTTSBLUFF NE 69361 470760050 TPA NE N/A C 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 REGIONAL WEST HEALTH SERVICES & AFFILIATE R 1045798 CASH