2021-11-23T10:46:32-06:00 2020-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-01-01 363314157 REGIONAL WEST HEALTH SERVICES REGI 3086353711 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO/TREASURER 3086353711 2021-11-22 1 MICHAEL ICKOWSKI 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOHN MENTGEN 4021 AVENUE B SCOTTSBLUFF NE 69361 28320489 0 X WWW.RWHS.ORG X 1984 NE HEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING. 13 10 130 10 0 0 0 0 11686051 13618052 83767 87849 15890683 14614588 27660501 28320489 6675929 6729481 0 0 12521768 12866580 0 0 0 5443656 5161160 24641353 24757221 3019148 3563268 54221427 60804964 9961788 12650752 44259639 48154212 X HEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING. 0 0 24757221 6729481 28232640 REGIONAL WEST HEALTH SERVICES, (RWHS), PROVIDES A CONTINUUM OF CARE THROUGH PROGRAMS DEVELOPED IN ACUTE, SKILLED, INTERMEDIATE, RESIDENTIAL, HOME AND AMBULATORY CARE FOR THE PEOPLE IN THE REGION OF WESTERN NEBRASKA AND EASTERN WYOMING. RWHS IS A SUPPORTING ORGANIZATION TO REGIONAL WEST MEDICAL CENTER, REGIONAL WEST GARDEN COUNTY, REGIONAL WEST PHYSICIANS CLINIC, REGIONAL WEST FOUNDATION, AND REGIONAL WEST VILLAGE. REGIONAL WEST MEDICAL CENTER PROVIDES COMPREHENSIVE AND ADVANCED MEDICAL CARE TO THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING THROUGH A LICENSED 182-BED HOSPITAL WHICH IS A REGIONAL REFERRAL CENTER AND LEVEL II TRAUMA CENTER. REGIONAL WEST MEDICAL CENTER ALSO PROVIDES ANCILLARY SERVICES TO SUPPORT ITS PRIMARY MISSION OF COMPREHENSIVE AND ADVANCED MEDICAL CARE. REGIONAL WEST GARDEN COUNTY IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES HIGH QUALITY HEALTH CARE TO THE REGION THROUGH A 10-BED ACUTE CARE UNIT, A 40-BED NURSING HOME FACILITY, AND A RURAL HEALTH CLINIC. REGIONAL WEST PHYSICIANS CLINIC IS A MULTI-SPECIALTY MEDICAL GROUP OF MORE THAN 70 PHYSICIANS AND ASSOCIATED HEALTH CARE PROVIDERS. REGIONAL WEST VILLAGE OPERATES A RETIREMENT AND ASSISTED LIVING FACILITY ADJACENT TO THE REGIONAL WEST MEDICAL CENTER CAMPUS. REGIONAL WEST VILLAGE PROVIDES TWENTY FOUR HOUR COVERAGE OF ITS FACILITY AND ASSISTS RESIDENTS WITH MEALS, TRANSPORTATION, AND MEDICATIONS IN AN EFFORT TO PROVIDE A CONTINUUM OF CARE TO THE ELDERLY IN THE NEBRASKA PANHANDLE. 24757221 1 0 0 0 0 0 0 0 0 1 0 1 0 0 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 1 1 1 0 1 38 0 1 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X MICHAEL ICKOWSKI 3086301111 4021 AVENUE B SCOTTSBLUFF NE 69361 JEFFREY HOLLOWAY MD DIRECTOR 1.00 42.00 X 0 691683 60597 JOHN MENTGEN CEO/PRESIDENT 40.00 6.00 X X 516364 0 119620 DAVID CORNUTT DIRECTOR OF OUTREACH 40.00 0.00 X 457401 0 37850 TIMOTHY OSTERHOLM EVP AND CHIEF OPERATING OF 40.00 1.00 X 309302 0 101363 PAUL HOFMEISTER GENERAL COUNSEL 40.00 3.00 X 347817 0 51604 MICHAEL ICKOWSKI CFO/TREASURER 40.00 6.00 X X 317385 0 59669 SUMMER PARKER VICE PRESIDENT OF HUMAN RE 40.00 1.00 X 270100 0 39540 AMANDA VICK VICE PRESIDENT OF PATIENT CARE SERVICES 40.00 0.00 X 221537 0 32284 MELODY BIBB SECRETARY 40.00 2.00 X 63514 0 49759 HOD KOSMAN CHAIR 1.00 3.00 X X 0 0 0 REV LAUREN EKDAHL DIRECTOR 1.00 2.00 X 0 0 0 CAROLYN ESCAMILLA DIRECTOR 1.00 1.00 X 0 0 0 MARK GILLAM DIRECTOR 1.00 1.00 X 0 0 0 LEE GLENN DIRECTOR 1.00 1.00 X 0 0 0 DENNIS HADDEN DIRECTOR 1.00 3.00 X 0 0 0 JOHN MASSEY DIRECTOR 1.00 2.00 X 0 0 0 THOMAS HOLYOKE DIRECTOR 1.00 1.00 X 0 0 0 DENNIS MILLER DIRECTOR 1.00 1.00 X 0 0 0 JIM TRUMBULL DIRECTOR 1.00 1.00 X 0 0 0 2503420 691683 552286 20 0 1 0 SULLIVAN COTTER HOLDINGS INC 62272 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CONSULTING 1076472 TRUST HEALTHCARE CONSULTING SERVICES LLC 2042 SOUTH BRENTWOOD SPRINGFIELD MO 65804 CONSULTING 218981 ALERUS RETIREMENT AND BENEFITS PO BOX 64535 ST PAUL MN 55164 EMPLOYEE BENEFIT ADMINISTRATION 202952 CHANGE HEALTHCARE PO BOX 98347 CHICAGO IL 60693 CONSULTING 138358 4 MANAGEMENT SERVICES REVENUE 561000 13618052 13618052 13618052 87849 87849 MEDICAL CENTER OF THE ROCKIES 523000 13377002 13377002 RCI INCOME 523000 1231946 1231946 5640 5640 14614588 28320489 28232640 0 87849 X 6729481 6729481 1126311 1126311 8678077 8678077 155127 155127 2324350 2324350 582715 582715 3610961 3610961 1436 1436 6362 6362 50 50 40 40 252 252 PHYSICIAN RECRUITMENT 1218972 1218972 LICENSES AND ASSOCIATIO 305635 305635 TAXES 10068 10068 TELEPHONE 7384 7384 24757221 24757221 0 0 98156 100099 1190195 1008662 257430 133333 4199785 4318737 44539669 53270594 3936192 1973539 54221427 60804964 2209064 3352427 7752724 9298325 9961788 12650752 X 44259639 48154212 44259639 48154212 54221427 60804964 3563268 331305 0 X X 0 1 X 1 0 X X X 5 REGIONAL WEST MEDICAL CENTER 470385129 3 1 6729481 0 REGIONAL WEST GARDEN COUNTY 391904975 3 0 0 0 REGIONAL WEST FOUNDATION 237171022 10 0 0 0 REGIONAL WEST PHYSICIANS CLINIC 363314159 10 0 0 0 REGIONAL WEST VILLAGE 363314162 10 0 0 0 5 6729481 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV, SECTION A, LINE 1: REGIONAL WEST HEALTH SERVICES' (RWHS') ARTICLES OF ORGANIZATION PROVIDE THAT IT WILL SUPPORT REGIONAL WEST MEDICAL CENTER AND RWHS' "OTHER TAX EXEMPT SUBSIDIARIES IN THEIR COLLECTIVE MISSION OF THE OPERATION, MANAGEMENT AND CONTROL OF A REGIONAL MEDICAL FACILITY PROVIDING HEALTH CARE AND RELATED SERVICES". ALL OF THE SUPPORTED ORGANIZATIONS ARE CONTROLLED BY RWHS. 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 0 INVESTMENT IN MED CTR OF THE 40543928 C EXECUTIVE BENEFIT PLANS 9221034 F INVESTMENT IN REGIONAL CARE INC 3505632 C 53270594 DEFERRED COMPENSATION 9221034 CASH OVERDRAFT 77291 9298325 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 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 MEDICAL CENTER 4021 AVENUE B SCOTTSBLUFF NE 69361 470385129 501(C)(3) 6729481 TO PROVIDE SUPPORT TO AFFILIATED ORGANIZATION. 1 0 PART I, LINE 2: ALL GRANTS ARE TO THE SUPPORTED ORGANIZATION OF RWHS, WHICH CAN BE EASILY MONITORED THROUGH THE USE OF SHARED ACCOUNTING SERVICES. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 JEFFREY HOLLOWAY MD DIRECTOR 0 486202 0 202994 0 2487 0 11400 0 49197 0 752280 0 0 JOHN MENTGEN CEO/PRESIDENT 507091 0 0 0 9273 0 70438 0 49182 0 635984 0 0 0 DAVID CORNUTT DIRECTOR OF OUTREACH 455738 0 0 0 1663 0 0 0 37850 0 495251 0 0 0 TIMOTHY OSTERHOLM EVP AND CHIEF OPERATING OF 299804 0 0 0 9498 0 53576 0 47787 0 410665 0 0 0 PAUL HOFMEISTER GENERAL COUNSEL 308826 0 0 0 38991 0 21314 0 30290 0 399421 0 0 0 MICHAEL ICKOWSKI CFO/TREASURER 307368 0 0 0 10017 0 58810 0 859 0 377054 0 0 0 SUMMER PARKER VICE PRESIDENT OF HUMAN RE 264603 0 0 0 5497 0 20279 0 19261 0 309640 0 0 0 AMANDA VICK VICE PRESIDENT OF PATIENT CARE SERVI 213291 0 0 0 8246 0 31466 0 818 0 253821 0 0 0 PART I, LINE 1A REGIONAL WEST HEALTH SERVICES 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. THE ONLY DIRECTOR, OFFICER, OR HIGHEST COMPENSATED EMPLOYEE WHO RECEIVED THIS BENEFIT IN THE CURRENT YEAR WAS AMANDA VICK. PART I, LINES 4A-B SUMMER PARKER RECEIVED A SEVERANCE PAYMENT OF $60,815 DURING THE YEAR. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 59,038 MICHAEL ICKOWSKI 47,410 TIMOTHY OSTERHOLM 42,176 PAUL HOFMEISTER 9,914 SUMMER PARKER 14,267 AMANDA VICK 23,732 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 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, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 1,887,985. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,887,985. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,722,976. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,722,976. PART XII, LINE 2C THE CFO 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 & AFFILIATES 4021 AVENUE B SCOTTSBLUFF NE 69361 470658690 HEALTH PLAN NE 501(C)(9) REGIONAL WEST HEALTH SERVICES 1 REGIONAL WEST GARDEN COUNTY 4021 AVENUE B SCOTTSBLUFF NE 69361 391904975 CRITICAL ACCESS HOSPITAL NE 501(C)(3) LINE 3 REGIONAL WEST HEALTH SERVICES 1 REGIONAL WEST FOUNDATION 4021 AVENUE B SCOTTSBLUFF NE 69361 237171022 FUNDRAISING NE 501(C)(3) LINE 12A, I REGIONAL WEST HEALTH SERVICES 1 REGIONAL WEST PHYSICIANS CLINIC 4021 AVENUE B SCOTTSBLUFF NE 69361 363314159 DR. CLINICS NE 501(C)(3) LINE 10 REGIONAL WEST HEALTH SERVICES 1 REIONAL WEST VILLAGE 4021 AVENUE B SCOTTSBLUFF NE 69361 363314162 RETIREMENT FACILITY NE 501(C)(3) LINE 10 REGIONAL WEST HEALTH SERVICES 1 REGIONAL WEST MEDICAL CENTER 4021 AVENUE B SCOTTSBLUFF NE 69361 470385129 HOSPITAL NE 501(C)(3) LINE 3 REGIONAL WEST HEALTH SERVICES 1 REGIONAL CARE INC 4021 AVENUE B SCOTTSBLUFF NE 69361 470760050 TPA NE REGIONAL WEST HEALTH SERVICES C 4825406 4136410 1.00000 1 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 REGIONAL WEST MEDICAL CENTER B 6729481 CASH REGIONAL WEST MEDICAL CENTER L 12676117 FMV REGIONAL WEST HEALTH SERVICES & AFFILIATE R 2749630 CASH REGIONAL WEST PHYSICIANS CLINIC L 81180 FMV REGIONAL CARE INC L 56400 FMV