REGIONAL WEST PHYSICIANS CLINIC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- REGIONAL WEST PHYSICIANS CLINIC (EIN 36-3314159)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202223189349307887
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T12:04:00-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363314159 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL WEST PHYSICIANS CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | REGI | BusinessNameControlTxt |
| Phone | 3086302877 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4021 AVENUE B | AddressLine1Txt |
| City | SCOTTSBLUFF | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69361 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL ICKOWSKI | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3086302877 | PhoneNum |
| Signature | 2022-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MICHAEL | PersonFirstNm |
| Person Last | ICKOWSKI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2022-11-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL ICKOWSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4021 AVENUE B | AddressLine1Txt |
| City | SCOTTSBLUFF | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69361 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $77,287,786 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RWHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 342 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $8,271 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $40,691,016 | PYContributionsGrantsAmt |
| CY Contributions Grants | $32,538,292 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $40,176,927 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,741,223 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,847 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,312 | PYOtherRevenueAmt |
| CY Other Revenue | $8,271 | CYOtherRevenueAmt |
| PY Total Revenue | $80,880,102 | PYTotalRevenueAmt |
| CY Total Revenue | $77,287,786 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $11,787 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,682 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $46,929,100 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $43,185,285 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,239,215 | PYOtherExpensesAmt |
| CY Other Expenses | $29,698,531 | CYOtherExpensesAmt |
| PY Total Expenses | $73,180,102 | PYTotalExpensesAmt |
| CY Total Expenses | $72,890,498 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,700,000 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,397,288 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,840,788 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,988,979 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,140,788 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,891,691 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,700,000 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,097,288 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $66,362,890 | ExpenseAmt |
| Grant | $6,682 | GrantAmt |
| Revenue | $44,741,223 | RevenueAmt |
| Desc | REGIONAL WEST PHYSICIANS CLINIC IS A MULTI-SPECIALTY MEDICAL GROUP OF MORE THAN 70 PHYSICIANS AND ASSOCIATED HEALTH CARE PROVIDERS. THE CLINIC IS A PHYSICIAN-LED, PHYSICIAN-GOVERNED SUBSIDIARY OF REGIONAL WEST HEALTH SERVICES. IN THE TRADITION OF THE MAYO CLINIC AND OTHER SUCCESSFUL EXAMPLES OF PHYSICIAN HOSPITAL INTEGRATION, REGIONAL WEST PHYSICIANS CLINIC IS COMMITTED TO PROVIDING THE HIGHEST QUALITY PATIENT CARE AND SERVICE, PATIENT-DRIVEN HEALTH CARE GOVERNANCE AND LEADERSHIP, AND COMMUNITY OUTREACH TO THE REGION. | Desc |
| Total Program Service Expenses | $66,362,890 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 61 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 342 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL ICKOWSKI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3086301111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4021 AVENUE B | AddressLine1Txt |
| City | SCOTTSBLUFF | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69361 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Key EmployeeKeyEmployeeInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|---|
| OMAR JIMENEZ MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $1,014,461 | $0 | $59,256 | |||
| ARMANDO MAGANA MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $935,501 | $0 | $61,754 | Yes (X) | |||
| ROMMIE HUGHES MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $820,906 | $0 | $60,065 | Yes (X) | |||
| MARK HARTMAN MD | |||||||||
| CHAIR | 40.00 | 1.00 | $815,764 | $0 | $57,837 | Yes (X) | Yes (X) | ||
| TIMOTHY FRIEDLEIN MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $803,777 | $0 | $48,395 | |||
| RAQEEB HAQUE MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $795,032 | $0 | $23,217 | |||
| JASON LATOWSKY MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $712,612 | $0 | $59,248 | Yes (X) | |||
| JEFFREY HOLLOWAY MD | |||||||||
| PRESIDENT | 40.00 | 3.00 | $693,501 | $0 | $61,805 | Yes (X) | Yes (X) | ||
| JOHN MENTGEN | |||||||||
| PRESIDENT/CEO | 1.00 | 45.00 | $0 | $568,880 | $107,104 | Yes (X) | Yes (X) | ||
| VINCENT BJORLING MD | |||||||||
| CHAIR THRU 10/2021 | 40.00 | 0.00 | $616,915 | $0 | $49,355 | Yes (X) | Yes (X) | ||
| BRADLEY HERTZLER MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $531,929 | $0 | $61,011 | Yes (X) | |||
| SAED AWADALLAH MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $532,860 | $0 | $59,065 | |||
| JOHN BLOMSTEDT MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $508,579 | $0 | $59,027 | |||
| MATTHEW BRUNER MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $503,566 | $0 | $59,006 | Yes (X) | |||
| TROY DEAN MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $479,551 | $0 | $58,275 | Yes (X) | |||
| SEROZAN AMROLIWALLA MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $505,989 | $0 | $29,138 | Yes (X) | |||
| DORISA POLK MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $405,954 | $0 | $55,190 | Yes (X) | |||
| JOSEPH MARGHEIM MD | |||||||||
| DIRECTOR | 40.00 | 0.00 | $382,218 | $0 | $59,328 | Yes (X) | |||
| KENT LACEY MD | |||||||||
| DIRECTOR THRU 10/21 | 40.00 | 0.00 | $313,679 | $0 | $43,226 | Yes (X) | |||
| MICHAEL ICKOWSKI | |||||||||
| TREASURER/CFO | 1.00 | 45.00 | $0 | $334,705 | $45,745 | Yes (X) | Yes (X) | ||
| ELIZABETH CLEMENS | |||||||||
| DIRECTOR | 40.00 | 0.00 | $118,512 | $0 | $50,084 | Yes (X) | |||
| MARY ADAMS | |||||||||
| DIRECTOR | 40.00 | 0.00 | $117,836 | $0 | $20,043 | Yes (X) | |||
| KAYLA BARGE | |||||||||
| SECRETARY | 1.00 | 40.00 | $0 | $26,854 | $30,685 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $11,609,142 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $930,439 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,217,859 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 82 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RURAL PARTNERS IN MEDICINE | |||||
| 8181 ARISTA PLACE SUITE 100 | BROOMFIELD | CO | 80021 | MEDICAL SERVICES | $2,352,884 |
| LOCUMTENENSCOM | |||||
| PO BOX 405547 | ATLANTA | GA | 30384 | MEDICAL SERVICES | $1,071,135 |
| VIRTUAL MEDICAL STAFF LLC | |||||
| 2655 NORTHWINDS PARKWAY | ALPHARETTA | GA | 30009 | MEDICAL SERVICES | $889,706 |
| COMPHEALTH ASSOCIATES INC | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | MEDICAL SERVICES | $886,385 |
| NATHAN ULLRICH DBA HSWT LLC | |||||
| 3845 ROCKY RIDGE CT | HOOD RIVER | OR | 97031 | MEDICAL SERVICES | $569,619 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 27 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $31,659,200 | RelatedOrganizationsAmt |
| Government Grants | $879,092 | GovernmentGrantsAmt |
| Total Contributions | $32,538,292 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PHYSICIAN SERVICES | 621110 | $38,446,766 | $38,446,766 |
| CONSULTING SERVICES | 621110 | $5,790,034 | $5,790,034 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $504,423 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $504,423 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,741,223 | TotalProgramServiceRevenueAmt |
| Gross Sales Of Inventory | $8,271 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,271 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $8,271 | UnrelatedBusinessRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,287,786 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,741,223 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $8,271 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,682 | TotalAmt |
| Program Services | $6,682 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,739,798 | TotalAmt |
| Program Services | $8,739,798 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,368,610 | TotalAmt |
| Program Services | $26,549,134 | ProgramServicesAmt |
| Management And General | $819,476 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $840,857 | TotalAmt |
| Program Services | $812,821 | ProgramServicesAmt |
| Management And General | $28,036 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,386,503 | TotalAmt |
| Program Services | $4,085,970 | ProgramServicesAmt |
| Management And General | $300,533 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,849,517 | TotalAmt |
| Program Services | $1,592,277 | ProgramServicesAmt |
| Management And General | $257,240 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,580 | TotalAmt |
| Management And General | $86,580 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,250,247 | TotalAmt |
| Program Services | $14,927,591 | ProgramServicesAmt |
| Management And General | $322,656 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,029 | TotalAmt |
| Program Services | $19,029 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,976,236 | TotalAmt |
| Program Services | $2,629,366 | ProgramServicesAmt |
| Management And General | $346,870 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,876 | TotalAmt |
| Program Services | $256,876 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,752,996 | TotalAmt |
| Program Services | $1,676,601 | ProgramServicesAmt |
| Management And General | $76,395 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,388 | TotalAmt |
| Program Services | $85,388 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397 | TotalAmt |
| Program Services | $344 | ProgramServicesAmt |
| Management And General | $53 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,312 | TotalAmt |
| Program Services | $28,312 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,141 | TotalAmt |
| Program Services | $165,301 | ProgramServicesAmt |
| Management And General | $840 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $377,866 | TotalAmt |
| Program Services | $375,580 | ProgramServicesAmt |
| Management And General | $2,286 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CORPORATE ALLOCATION | $4,198,231 | $26 | $4,198,205 |
| MEDICAL EXPENSES | $4,159,515 | $4,159,133 | $382 |
| DUES & LICENSES | $221,153 | $133,097 | $88,056 |
| LABORATORY EXPENSES | $73,164 | $73,164 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,400 | TotalAmt |
| Program Services | $46,400 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,890,498 | TotalAmt |
| Program Services | $66,362,890 | ProgramServicesAmt |
| Management And General | $6,527,608 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,790,825 | BOYAmt |
| EOY | $10,460,658 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,963,880 | BOYAmt |
| EOY | $6,204,857 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $418,151 | BOYAmt |
| EOY | $483,913 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $724,766 | BOYAmt |
| EOY | $160,393 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,474,395 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,958,861 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $560,646 | BOYAmt |
| EOY | $515,534 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,382,520 | BOYAmt |
| EOY | $2,163,624 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,840,788 | BOYAmt |
| EOY | $19,988,979 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,062,932 | BOYAmt |
| EOY | $5,113,260 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,461 | BOYAmt |
| EOY | $49,462 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,028,395 | BOYAmt |
| EOY | $2,728,969 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,140,788 | BOYAmt |
| EOY | $7,891,691 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,700,000 | BOYAmt |
| EOY | $12,097,288 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,700,000 | BOYAmt |
| EOY | $12,097,288 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,840,788 | BOYAmt |
| EOY | $19,988,979 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,397,288 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $23,359,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $32,693,950 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,237,795 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $40,691,016 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $32,538,292 | CurrentTaxYearAmt |
| Total | $164,520,253 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44,101,030 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $42,387,061 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $41,921,817 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $40,176,927 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $44,741,223 | CurrentTaxYearAmt |
| Total | $213,328,058 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $67,460,230 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $75,081,011 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $77,159,612 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $80,867,943 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $77,279,515 | CurrentTaxYearAmt |
| Total | $377,848,311 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $377,848,311 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $966 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $640 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,811 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,847 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $6,264 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $966 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $640 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,811 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,847 | CurrentTaxYearMinus1YearAmt |
| Total | $6,264 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38,114 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,764 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,588 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,312 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,271 | CurrentTaxYearAmt |
| Total | $85,049 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $77,620 | CurrentTaxYearMinus4YearsAmt |
| Total | $77,620 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $67,576,930 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $75,099,415 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $77,173,011 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $80,880,102 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $77,287,786 | CurrentTaxYearAmt |
| Total | $378,017,244 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99960 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99860 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,307,997 | BeginningYearBalanceAmt |
| Contributions | $190,018 | ContributionsAmt |
| Investment Earnings Or Losses | $1,350,185 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $40,956 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,807,244 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,188,204 | BeginningYearBalanceAmt |
| Contributions | $324,798 | ContributionsAmt |
| Investment Earnings Or Losses | $824,828 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $29,833 | GrantsOrScholarshipsAmt |
| End Year Balance | $7,307,997 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,837,335 | BeginningYearBalanceAmt |
| Contributions | $719,879 | ContributionsAmt |
| Investment Earnings Or Losses | $1,352,989 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $98,684 | GrantsOrScholarshipsAmt |
| Other Expenditures | $623,315 | OtherExpendituresAmt |
| End Year Balance | $6,188,204 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,551,048 | BeginningYearBalanceAmt |
| Contributions | $538,883 | ContributionsAmt |
| Investment Earnings Or Losses | -$191,365 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $61,231 | GrantsOrScholarshipsAmt |
| End Year Balance | $4,837,335 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,507,319 | BeginningYearBalanceAmt |
| Contributions | $106,517 | ContributionsAmt |
| Investment Earnings Or Losses | $296,128 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $358,916 | GrantsOrScholarshipsAmt |
| End Year Balance | $4,551,048 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.15219 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.84781 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $203,353 | OtherCostOrOtherBasisAmt |
| Depreciation | $151,231 | DepreciationAmt |
| Book Value | $52,122 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,206,123 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,750,198 | DepreciationAmt |
| Book Value | $455,925 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $64,919 | OtherCostOrOtherBasisAmt |
| Depreciation | $57,432 | DepreciationAmt |
| Book Value | $7,487 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $515,534 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT CUSTOMER CONTRACTS | Desc |
| Book Value | $2,163,624 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,163,624 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $2,545,666 |
| LEASE LIABILITY | $183,303 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,728,969 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE RESTRICTED BY DONORS FOR HEALTHCARE RESEARCH, HEALTHCARE EDUCATION SCHOLARSHIPS, AND FOR 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 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (21 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OMAR JIMENEZ MD | ||||||||||||||
| PHYSICIAN | $655,349 | $0 | $359,112 | $0 | $0 | $0 | $11,600 | $0 | $47,656 | $0 | $1,073,717 | $0 | $0 | $0 |
| ARMANDO MAGANA MD | ||||||||||||||
| DIRECTOR | $744,937 | $0 | $187,000 | $0 | $3,564 | $0 | $11,600 | $0 | $50,154 | $0 | $997,255 | $0 | $0 | $0 |
| ROMMIE HUGHES MD | ||||||||||||||
| PHYSICIAN | $801,696 | $0 | $16,888 | $0 | $2,322 | $0 | $11,600 | $0 | $48,465 | $0 | $880,971 | $0 | $0 | $0 |
| MARK HARTMAN MD | ||||||||||||||
| CHAIR | $809,986 | $0 | $3,456 | $0 | $2,322 | $0 | $7,295 | $0 | $50,542 | $0 | $873,601 | $0 | $0 | $0 |
| TIMOTHY FRIEDLEIN MD | ||||||||||||||
| PHYSICIAN | $800,577 | $0 | $0 | $0 | $3,200 | $0 | $11,600 | $0 | $36,795 | $0 | $852,172 | $0 | $0 | $0 |
| RAQEEB HAQUE MD | ||||||||||||||
| PHYSICIAN | $662,854 | $0 | $131,750 | $0 | $428 | $0 | $11,600 | $0 | $11,617 | $0 | $818,249 | $0 | $0 | $0 |
| JASON LATOWSKY MD | ||||||||||||||
| PHYSICIAN | $700,958 | $0 | $11,114 | $0 | $540 | $0 | $11,600 | $0 | $47,648 | $0 | $771,860 | $0 | $0 | $0 |
| JEFFREY HOLLOWAY MD | ||||||||||||||
| PRESIDENT | $687,261 | $0 | $3,918 | $0 | $2,322 | $0 | $11,600 | $0 | $50,205 | $0 | $755,306 | $0 | $0 | $0 |
| JOHN MENTGEN | ||||||||||||||
| PRESIDENT/CEO | $0 | $559,601 | $0 | $0 | $0 | $9,279 | $0 | $59,646 | $0 | $47,458 | $0 | $675,984 | $0 | $0 |
| VINCENT BJORLING MD | ||||||||||||||
| CHAIR THRU 10/2021 | $613,873 | $0 | $0 | $0 | $3,042 | $0 | $11,600 | $0 | $37,755 | $0 | $666,270 | $0 | $0 | $0 |
| BRADLEY HERTZLER MD | ||||||||||||||
| DIRECTOR | $527,081 | $0 | $4,064 | $0 | $784 | $0 | $11,600 | $0 | $49,411 | $0 | $592,940 | $0 | $0 | $0 |
| SAED AWADALLAH MD | ||||||||||||||
| PHYSICIAN | $488,857 | $0 | $43,517 | $0 | $486 | $0 | $11,600 | $0 | $47,465 | $0 | $591,925 | $0 | $0 | $0 |
| JOHN BLOMSTEDT MD | ||||||||||||||
| PHYSICIAN | $508,077 | $0 | $0 | $0 | $502 | $0 | $11,600 | $0 | $47,427 | $0 | $567,606 | $0 | $0 | $0 |
| MATTHEW BRUNER MD | ||||||||||||||
| PHYSICIAN | $502,489 | $0 | $750 | $0 | $327 | $0 | $11,600 | $0 | $47,406 | $0 | $562,572 | $0 | $0 | $0 |
| TROY DEAN MD | ||||||||||||||
| DIRECTOR | $479,551 | $0 | $0 | $0 | $0 | $0 | $11,600 | $0 | $46,675 | $0 | $537,826 | $0 | $0 | $0 |
| SEROZAN AMROLIWALLA MD | ||||||||||||||
| DIRECTOR | $505,763 | $0 | $0 | $0 | $226 | $0 | $11,600 | $0 | $17,538 | $0 | $535,127 | $0 | $0 | $0 |
| DORISA POLK MD | ||||||||||||||
| DIRECTOR | $405,173 | $0 | $0 | $0 | $781 | $0 | $11,600 | $0 | $43,590 | $0 | $461,144 | $0 | $0 | $0 |
| JOSEPH MARGHEIM MD | ||||||||||||||
| DIRECTOR | $381,716 | $0 | $0 | $0 | $502 | $0 | $11,600 | $0 | $47,728 | $0 | $441,546 | $0 | $0 | $0 |
| KENT LACEY MD | ||||||||||||||
| DIRECTOR THRU 10/21 | $312,911 | $0 | $0 | $0 | $768 | $0 | $9,552 | $0 | $33,674 | $0 | $356,905 | $0 | $0 | $0 |
| MICHAEL ICKOWSKI | ||||||||||||||
| TREASURER/CFO | $0 | $324,658 | $0 | $0 | $0 | $10,047 | $0 | $41,125 | $0 | $4,620 | $0 | $380,450 | $0 | $0 |
| ELIZABETH CLEMENS | ||||||||||||||
| DIRECTOR | $118,384 | $0 | $0 | $0 | $128 | $0 | $5,158 | $0 | $44,926 | $0 | $168,596 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | IN THE CURRENT YEAR, REGIONAL WEST HEALTH SERVICES, A RELATED TAX-EXEMPT ENTITY, PAID FOR ONE MONTH OF A MEMBERSHIP TO THE YMCA FOR ANY EMPLOYEE WHO CHOSE TO ENROLL. THIS AMOUNT WAS TREATED AS TAXABLE COMPENSATION TO THE EMPLOYEE. DIRECTORS, OFFICERS AND HIGHEST COMPENSATED EMPLOYEES WHO RECEIVED THIS BENEFIT ARE RAQEEB HAQUE, SAED AWADALLAH, AND KAYLA BARGE. |
| 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 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION'S SOLE MEMBER IS REGIONAL WEST HEALTH SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 7A | REGIONAL WEST HEALTH SERVICES (RWHS), THE SOLE MEMBER, APPOINTS 3 EX-OFFICIO VOTING DIRECTORS TO THE BOARD: THE PRESIDENT/CEO OF RWHS, THE CFO OF RWHS, AND THE PRESIDENT OF THE CORPORATION. |
| 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 INCORPORATION OR BYLAWS OF THE CORPORATION AS WELL AS ANY PROPOSAL TO SELL, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR DISPOSE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION SHALL BE SUBMITTED TO THE VOTE OF THE SOLE VOTING MEMBER. 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 OF THE FORM 990 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 ACTULLY 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, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 14,927,591. MANAGEMENT AND GENERAL EXPENSES 322,656. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,250,247. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | REGIONAL WEST HEALTH SERVICES | |
| REGIONAL WEST GARDEN COUNTY | |||||||||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | 391904975 | CAH | NE | 501(C)(3) | LINE 3 | 0 | REGIONAL WEST HEALTH SERVICES | |
| REGIONAL WEST FOUNDATION | |||||||||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | 237171022 | FUNDRAISING | NE | 501(C)(3) | LINE 12A, I | 0 | REGIONAL WEST HEALTH SERVICES | |
| REGIONAL WEST VILLAGE | |||||||||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | 363314162 | RETIREMENT FACILITY | NE | 501(C)(3) | LINE 10 | 0 | REGIONAL WEST HEALTH SERVICES | |
| REGIONAL WEST HEALTH SERVICES & AFFILIATES | |||||||||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | 470658690 | HEALTH PLAN | NE | 501(C)(9) | 0 | REGIONAL WEST HEALTH SERVICES | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL CARE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4021 AVENUE B | AddressLine1Txt |
| City | SCOTTSBLUFF | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69361 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470760050 | EIN |
| Primary Activities | TPA | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL WEST HEALTH SERVICES & AFFILIATE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionTypeTxt |
| Involved | $4,464,455 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments