2021-11-23T10:47:07-06:00 2020-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-01-01 363314159 REGIONAL WEST PHYSICIANS CLINIC REGI 3086302877 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO 3086302877 2021-11-22 1 MICHAEL ICKOWSKI 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL ICKOWSKI 4021 AVENUE B SCOTTSBLUFF NE 69361 80891127 0 X WWW.RWHS.ORG X 1984 NE PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 13 0 368 25 9312 0 35237795 40691016 41921817 40176927 1811 2847 11588 9312 77173011 80880102 24560 11787 0 0 48557660 46929100 0 0 0 28741300 26239215 77323520 73180102 -150509 7700000 6916096 15840788 6916096 8140788 0 7700000 PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 0 0 66273681 11787 40176927 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. 66273681 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 71 0 1 368 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 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 ARMANDO MAGANA MD DIRECTOR 40.00 0.00 X 897803 0 61536 JEFFREY HOLLOWAY MD PRESIDENT 40.00 3.00 X X 691683 0 60597 MARK HARTMAN MD DIRECTOR 40.00 1.00 X 639264 0 57101 JOHN MENTGEN PRESIDENT/CEO 1.00 45.00 X X 0 516364 119620 JOSEPH MARGHEIM MD DIRECTOR 40.00 0.00 X 389370 0 67855 VINCENT BJORLING MD CHAIR 40.00 0.00 X X 521086 0 49548 DORISA POLK MD DIRECTOR 40.00 0.00 X 441571 0 55822 MICHAEL ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 317385 59669 MARY ADAMS DIRECTOR 40.00 0.00 X 110046 0 19684 KENT LACEY MD DIRECTOR 40.00 0.00 X 312239 0 39451 MARK SCANLAN MD DIRECTOR (THRU 01/2020) 40.00 0.00 X 49614 0 912 SEROZAN AMROLIWALLA MD DIRECTOR 40.00 0.00 X 461126 0 29561 ELIZABETH CLEMENS DIRECTOR 40.00 0.00 X 114372 0 51289 KAYLA BARGE SECRETARY 40.00 0.00 X X 26410 0 17853 ROMMIE HUGHES MD PHYSICIAN 40.00 0.00 X 816233 0 61266 JASON LATOWSKY MD PHYSICIAN 40.00 0.00 X 701271 0 60267 MATTHEW BRUNER MD PHYSICIAN 40.00 1.00 X 537864 0 60235 BRADLEY HERTZLER MD PHYSICIAN 40.00 0.00 X 432196 0 59831 OMAR JIMENEZ MD PHYSICIAN 40.00 0.00 X 971812 0 60638 RAQEEB HAQUE MD PHYSICIAN 40.00 0.00 X 797911 0 26459 TIMOTHY FRIEDLEIN MD PHYSICIAN 40.00 0.00 X 669212 0 49594 MATTHEW MALAMET MD PHYSICIAN 40.00 0.00 X 545035 0 26454 MICHAL TAYLOR MD PHYSICIAN 40.00 0.00 X 637710 0 60594 10763828 833749 1155836 91 0 1 0 RURAL PARTNERS IN MEDICINE 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 1747571 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 1634635 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 MEDICAL SERVICES 1308612 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 611760 TEXAS LUNG RANGER PA 10924 SMOKY OAK TRAIL FLOWER MOUND TX 76226 MEDICAL SERVICES 509255 26 34264327 6426689 40691016 PHYSICIAN SERVICES 621110 34026517 34026517 CONSULTING SERVICES 621110 5673615 5673615 476795 476795 40176927 2847 2847 20337 11025 9312 9312 80880102 40176927 9312 2847 X 11787 11787 7894956 7894956 31168289 30348439 819850 920314 874607 45707 4892076 4565284 326792 2053465 1819324 234141 6944 6944 89280 89280 12492188 12231316 260872 40844 15336 25508 2588730 2240764 347966 260855 260855 1748812 1672417 76395 62953 62618 335 1285 1126 159 38429 38429 165609 165308 301 429050 424649 4401 CORPORATE ALLOCATION 4600053 31 4600022 MEDICAL EXPENSES 3430992 3430418 574 DUES & LICENSES 219857 152683 67174 LABORATORY EXPENSES 63334 63334 73180102 66273681 6906421 0 37560 7790825 5505246 4963880 273627 418151 214839 724766 4383126 3822480 576954 560646 307870 1382520 6916096 15840788 4379636 5062932 49461 2536460 3028395 6916096 8140788 X 7700000 0 7700000 6916096 15840788 7700000 0 X X 0 1 X 1 0 X 22959200 23359200 32693950 35237795 40691016 154941161 52147499 44101030 42387061 41921817 40176927 220734334 75106699 67460230 75081011 77159612 80867943 375675495 0 0 0 375675495 566 966 640 1811 2847 6830 566 966 640 1811 2847 6830 77890 38114 17764 11588 9312 154668 304246 77620 381866 75489401 67576930 75099415 77173011 80880102 376218859 0.99860 0.99720 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6188204 324798 824828 29833 7307997 4837335 719879 1352989 98684 623315 6188204 4551048 538883 -191365 61231 4837335 4507319 106517 296128 358916 4551048 4546780 153000 72629 265090 4507319 0.00000 0.17810 0.82190 0 1 1 194445 142823 51622 4131249 3622225 509024 57432 57432 0 560646 PATIENT CUSTOMER CONTRACTS 1382520 1382520 DUE TO AFFILIATES 2913069 LEASE LIABILITY 115326 3028395 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 AN INCOME TAX REFUND OF $180,654 IN 2020 AND INCOME TAX EXPENSE OF $204,055 IN 2019. 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, 2020 AND 2019, RWHS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 REGIONAL WEST FOUNDATION 4021 AVENUE B SCOTTSBLUFF NE 69361 237171022 501(C)(3) 5574 TO PROVIDE SUPPORT TO AFFILIATED ORGANIZATION. 1 0 PART I, LINE 2: ALL GRANTS ARE PAID TO AFFILIATED ORGANIZATIONS OF REGIONAL WEST PHYSICIANS CLINIC, WHICH CAN BE EASILY MONITORED THROUGH THE USE OF SHARED ACCOUNTING SERVICES. X 1 1 0 1 0 0 0 0 0 0 0 OMAR JIMENEZ MD PHYSICIAN 971812 0 0 0 0 0 11400 0 49238 0 1032450 0 0 0 ARMANDO MAGANA MD DIRECTOR 668481 0 225758 0 3564 0 11400 0 50136 0 959339 0 0 0 ROMMIE HUGHES MD PHYSICIAN 813911 0 0 0 2322 0 11400 0 49866 0 877499 0 0 0 RAQEEB HAQUE MD PHYSICIAN 797304 0 0 0 607 0 11400 0 15059 0 824370 0 0 0 JASON LATOWSKY MD PHYSICIAN 700917 0 0 0 354 0 11400 0 48867 0 761538 0 0 0 JEFFREY HOLLOWAY MD PRESIDENT 486202 0 202994 0 2487 0 11400 0 49197 0 752280 0 0 0 TIMOTHY FRIEDLEIN MD PHYSICIAN 437968 0 228044 0 3200 0 11400 0 38194 0 718806 0 0 0 MICHAL TAYLOR MD PHYSICIAN 637119 0 0 0 591 0 11400 0 49194 0 698304 0 0 0 MARK HARTMAN MD DIRECTOR 637552 0 0 0 1712 0 7235 0 49866 0 696365 0 0 0 JOHN MENTGEN PRESIDENT/CEO 0 507091 0 0 0 9273 0 70438 0 49182 0 635984 0 0 MATTHEW BRUNER MD PHYSICIAN 535277 0 2124 0 463 0 11400 0 48835 0 598099 0 0 0 MATTHEW MALAMET MD PHYSICIAN 544405 0 0 0 630 0 11400 0 15054 0 571489 0 0 0 VINCENT BJORLING MD CHAIR 315605 0 202994 0 2487 0 11400 0 38148 0 570634 0 0 0 DORISA POLK MD DIRECTOR 336434 0 104593 0 544 0 11400 0 44422 0 497393 0 0 0 BRADLEY HERTZLER MD PHYSICIAN 431716 0 0 0 480 0 11400 0 48431 0 492027 0 0 0 SEROZAN AMROLIWALLA MD DIRECTOR 269652 0 191266 0 208 0 11400 0 18161 0 490687 0 0 0 JOSEPH MARGHEIM MD DIRECTOR 388868 0 0 0 502 0 11400 0 56455 0 457225 0 0 0 MICHAEL ICKOWSKI TREASURER/CFO 0 307368 0 0 0 10017 0 58810 0 859 0 377054 0 0 KENT LACEY MD DIRECTOR 284168 0 27099 0 972 0 9618 0 29833 0 351690 0 0 0 ELIZABETH CLEMENS DIRECTOR 114219 0 0 0 153 0 4987 0 46302 0 165661 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, MICHAL TAYLOR, ELIZABETH CLEMENS, 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 59,038 MICHAEL ICKOWSKI 47,410 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 12,231,316. MANAGEMENT AND GENERAL EXPENSES 260,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,492,188. 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 4970972 CASH