2022-11-14T12:04:00-06:00 2021-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2021-01-01 363314159 REGIONAL WEST PHYSICIANS CLINIC REGI 3086302877 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO 3086302877 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 77287786 0 X WWW.RWHS.ORG X 1984 NE PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 12 0 342 14 8271 0 40691016 32538292 40176927 44741223 2847 0 9312 8271 80880102 77287786 11787 6682 0 0 46929100 43185285 0 0 0 26239215 29698531 73180102 72890498 7700000 4397288 15840788 19988979 8140788 7891691 7700000 12097288 PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 0 0 66362890 6682 44741223 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. 66362890 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 61 0 1 342 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 0 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 OMAR JIMENEZ MD PHYSICIAN 40.00 0.00 X 1014461 0 59256 ARMANDO MAGANA MD DIRECTOR 40.00 0.00 X 935501 0 61754 ROMMIE HUGHES MD PHYSICIAN 40.00 0.00 X 820906 0 60065 MARK HARTMAN MD CHAIR 40.00 1.00 X X 815764 0 57837 TIMOTHY FRIEDLEIN MD PHYSICIAN 40.00 0.00 X 803777 0 48395 RAQEEB HAQUE MD PHYSICIAN 40.00 0.00 X 795032 0 23217 JASON LATOWSKY MD PHYSICIAN 40.00 0.00 X 712612 0 59248 JEFFREY HOLLOWAY MD PRESIDENT 40.00 3.00 X X 693501 0 61805 JOHN MENTGEN PRESIDENT/CEO 1.00 45.00 X X 0 568880 107104 VINCENT BJORLING MD CHAIR THRU 10/2021 40.00 0.00 X X 616915 0 49355 BRADLEY HERTZLER MD DIRECTOR 40.00 0.00 X 531929 0 61011 SAED AWADALLAH MD PHYSICIAN 40.00 0.00 X 532860 0 59065 JOHN BLOMSTEDT MD PHYSICIAN 40.00 0.00 X 508579 0 59027 MATTHEW BRUNER MD PHYSICIAN 40.00 0.00 X 503566 0 59006 TROY DEAN MD DIRECTOR 40.00 0.00 X 479551 0 58275 SEROZAN AMROLIWALLA MD DIRECTOR 40.00 0.00 X 505989 0 29138 DORISA POLK MD DIRECTOR 40.00 0.00 X 405954 0 55190 JOSEPH MARGHEIM MD DIRECTOR 40.00 0.00 X 382218 0 59328 KENT LACEY MD DIRECTOR THRU 10/21 40.00 0.00 X 313679 0 43226 MICHAEL ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 334705 45745 ELIZABETH CLEMENS DIRECTOR 40.00 0.00 X 118512 0 50084 MARY ADAMS DIRECTOR 40.00 0.00 X 117836 0 20043 KAYLA BARGE SECRETARY 1.00 40.00 X 0 26854 30685 11609142 930439 1217859 82 0 1 0 RURAL PARTNERS IN MEDICINE 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 2352884 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 MEDICAL SERVICES 1071135 VIRTUAL MEDICAL STAFF LLC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 MEDICAL SERVICES 889706 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 886385 NATHAN ULLRICH DBA HSWT LLC 3845 ROCKY RIDGE CT HOOD RIVER OR 97031 MEDICAL SERVICES 569619 27 31659200 879092 32538292 PHYSICIAN SERVICES 621110 38446766 38446766 CONSULTING SERVICES 621110 5790034 5790034 504423 504423 44741223 8271 0 8271 8271 77287786 44741223 8271 0 X 6682 6682 8739798 8739798 27368610 26549134 819476 840857 812821 28036 4386503 4085970 300533 1849517 1592277 257240 86580 86580 15250247 14927591 322656 19029 19029 2976236 2629366 346870 256876 256876 1752996 1676601 76395 85388 85388 397 344 53 28312 28312 166141 165301 840 377866 375580 2286 CORPORATE ALLOCATION 4198231 26 4198205 MEDICAL EXPENSES 4159515 4159133 382 DUES & LICENSES 221153 133097 88056 LABORATORY EXPENSES 73164 73164 46400 46400 72890498 66362890 6527608 0 7790825 10460658 4963880 6204857 418151 483913 724766 160393 4474395 3958861 560646 515534 1382520 2163624 15840788 19988979 5062932 5113260 49461 49462 3028395 2728969 8140788 7891691 X 7700000 12097288 7700000 12097288 15840788 19988979 4397288 0 X X 0 1 X 1 1 1 X 23359200 32693950 35237795 40691016 32538292 164520253 44101030 42387061 41921817 40176927 44741223 213328058 67460230 75081011 77159612 80867943 77279515 377848311 0 0 0 377848311 966 640 1811 2847 0 6264 966 640 1811 2847 6264 38114 17764 11588 9312 8271 85049 77620 77620 67576930 75099415 77173011 80880102 77287786 378017244 0.99960 0.99860 0.00000 0.00000 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 203353 151231 52122 4206123 3750198 455925 64919 57432 7487 515534 PATIENT CUSTOMER CONTRACTS 2163624 2163624 DUE TO AFFILIATES 2545666 LEASE LIABILITY 183303 2728969 X 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. X 1 1 0 1 0 0 0 0 0 0 0 OMAR JIMENEZ MD PHYSICIAN 655349 0 359112 0 0 0 11600 0 47656 0 1073717 0 0 0 ARMANDO MAGANA MD DIRECTOR 744937 0 187000 0 3564 0 11600 0 50154 0 997255 0 0 0 ROMMIE HUGHES MD PHYSICIAN 801696 0 16888 0 2322 0 11600 0 48465 0 880971 0 0 0 MARK HARTMAN MD CHAIR 809986 0 3456 0 2322 0 7295 0 50542 0 873601 0 0 0 TIMOTHY FRIEDLEIN MD PHYSICIAN 800577 0 0 0 3200 0 11600 0 36795 0 852172 0 0 0 RAQEEB HAQUE MD PHYSICIAN 662854 0 131750 0 428 0 11600 0 11617 0 818249 0 0 0 JASON LATOWSKY MD PHYSICIAN 700958 0 11114 0 540 0 11600 0 47648 0 771860 0 0 0 JEFFREY HOLLOWAY MD PRESIDENT 687261 0 3918 0 2322 0 11600 0 50205 0 755306 0 0 0 JOHN MENTGEN PRESIDENT/CEO 0 559601 0 0 0 9279 0 59646 0 47458 0 675984 0 0 VINCENT BJORLING MD CHAIR THRU 10/2021 613873 0 0 0 3042 0 11600 0 37755 0 666270 0 0 0 BRADLEY HERTZLER MD DIRECTOR 527081 0 4064 0 784 0 11600 0 49411 0 592940 0 0 0 SAED AWADALLAH MD PHYSICIAN 488857 0 43517 0 486 0 11600 0 47465 0 591925 0 0 0 JOHN BLOMSTEDT MD PHYSICIAN 508077 0 0 0 502 0 11600 0 47427 0 567606 0 0 0 MATTHEW BRUNER MD PHYSICIAN 502489 0 750 0 327 0 11600 0 47406 0 562572 0 0 0 TROY DEAN MD DIRECTOR 479551 0 0 0 0 0 11600 0 46675 0 537826 0 0 0 SEROZAN AMROLIWALLA MD DIRECTOR 505763 0 0 0 226 0 11600 0 17538 0 535127 0 0 0 DORISA POLK MD DIRECTOR 405173 0 0 0 781 0 11600 0 43590 0 461144 0 0 0 JOSEPH MARGHEIM MD DIRECTOR 381716 0 0 0 502 0 11600 0 47728 0 441546 0 0 0 KENT LACEY MD DIRECTOR THRU 10/21 312911 0 0 0 768 0 9552 0 33674 0 356905 0 0 0 MICHAEL ICKOWSKI TREASURER/CFO 0 324658 0 0 0 10047 0 41125 0 4620 0 380450 0 0 ELIZABETH CLEMENS DIRECTOR 118384 0 0 0 128 0 5158 0 44926 0 168596 0 0 0 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 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. 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 GARDEN COUNTY 4021 AVENUE B SCOTTSBLUFF NE 69361 391904975 CAH 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 HEALTH SERVICES & AFFILIATES 4021 AVENUE B SCOTTSBLUFF NE 69361 470658690 HEALTH PLAN NE 501(C)(9) REGIONAL WEST HEALTH SERVICES 0 REGIONAL CARE INC 4021 AVENUE B SCOTTSBLUFF NE 69361 470760050 TPA NE N/A C 0 0 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 REGIONAL WEST HEALTH SERVICES & AFFILIATE R 4464455 CASH