REGIONAL WEST GARDEN COUNTY: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- REGIONAL WEST GARDEN COUNTY (EIN 39-1904975)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-16
- IRS object ID
- 202033219349304413
- Schema version
- 2019v5.1
- 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 | 2020-11-16T09:26:37-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 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 | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391904975 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL WEST GARDEN COUNTY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | REGI | BusinessNameControlTxt |
| Phone | 3087723283 | 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 | 3087723283 | PhoneNum |
| Signature | 2020-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 163.116.133.113 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-13 | IPDt |
| IP Tm | 08:21:47 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | 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 | $9,416,532 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GCHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 115 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $83,541 | PYContributionsGrantsAmt |
| CY Contributions Grants | $65,414 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,149,376 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,345,926 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,009 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,130 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,413 | PYOtherRevenueAmt |
| CY Other Revenue | $2,062 | CYOtherRevenueAmt |
| PY Total Revenue | $8,241,339 | PYTotalRevenueAmt |
| CY Total Revenue | $9,416,532 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,743,204 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,969,994 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,976,401 | PYOtherExpensesAmt |
| CY Other Expenses | $3,513,102 | CYOtherExpensesAmt |
| PY Total Expenses | $8,719,605 | PYTotalExpensesAmt |
| CY Total Expenses | $9,483,096 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$478,266 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$66,564 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,102,927 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,148,031 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,321,779 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,433,447 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$2,218,852 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,285,416 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,073,858 | ExpenseAmt |
| Revenue | $6,092,166 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,288,417 | ExpenseAmt |
| Revenue | $2,164,015 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,017,078 | ExpenseAmt |
| Revenue | $958,878 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,815,730 | ExpenseAmt |
| Revenue | $132,929 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,815,730 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $132,929 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $8,195,083 | 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 | 0 | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| 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 | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 115 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL ICKOWSKI | PersonNm |
| 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 (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN MENTGEN | ||||||||
| CHAIR/CEO | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $516,678 | $115,947 | |
| PAUL HOFMEISTER | ||||||||
| VICE CHAIR | 1.00 | 42.00 | Yes (X) | Yes (X) | $0 | $370,120 | $51,120 | |
| MIKE ICKOWSKI | ||||||||
| TREASURER/CFO | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $314,245 | $90,566 | |
| LAURIE SOPER | ||||||||
| APRN | 40.00 | 0.00 | $290,110 | $0 | $11,945 | Yes (X) | ||
| WILLIAM GILES | ||||||||
| BOARD MEMBER THRU 07/2019 | 40.00 | 0.00 | Yes (X) | $143,461 | $0 | $18,967 | ||
| STEPHANIE TODD | ||||||||
| SECRETARY | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $67,035 | $28,934 | |
| FREDA DAVIS | ||||||||
| SECRETARY THRU 02/2019 | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $23,504 | $30,800 | |
| CASPER CORFIELD | ||||||||
| BOARD MEMBER THRU 01/2019 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BEV KRAJEWSKI | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| HOD KOSMAN | ||||||||
| BOARD MEMBER | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY MATHER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ALLEN GAMBLE | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $433,571 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,291,582 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $348,279 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | 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 |
|---|---|---|---|---|---|
| STAT STAFFING LLC | |||||
| PO BOX 45 | OSHKOSH | NE | 69154 | AGENCY STAFF | $308,567 |
| PRIME TIME HEALTHCARE LLC | |||||
| C/O AMERICAN NATIONAL BANK PO BOX 3 | OMAHA | NE | 68103 | AGENCY STAFF | $237,074 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND STREET STE 300 | OMAHA | NE | 681142300 | AGENCY STAFF | $205,157 |
| QUADRA MED | |||||
| PO BOX 74008556 | CHICAGO | IL | 606748556 | MAINTENANCE CON | $153,171 |
| KEY WEST CONSULTING | |||||
| 680 S CACHE ST STE 101-10219 | JACKSON | WY | 83001 | AGENCY STAFF | $124,402 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,500 | RelatedOrganizationsAmt |
| Government Grants | $12,281 | GovernmentGrantsAmt |
| All Other Contributions | $51,633 | AllOtherContributionsAmt |
| Total Contributions | $65,414 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET HOSPITAL PATIENT R | 623000 | $6,092,166 | $6,092,166 |
| NURSING HOME PATIENT R | 623000 | $2,164,015 | $2,164,015 |
| HEALTH CLINIC PATIENT | 621110 | $958,878 | $958,878 |
| OTHER OPERATING REVENU | 623000 | $130,867 | $130,867 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,345,926 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,780 | TotalRevenueColumnAmt |
| Exclusion | $2,780 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $350 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $350 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $350 | TotalRevenueColumnAmt |
| Exclusion | $350 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER NON-OPERATING RE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,062 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,062 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,062 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,416,532 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,347,988 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,130 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,428 | TotalAmt |
| Program Services | $162,428 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,014,741 | TotalAmt |
| Program Services | $3,562,338 | ProgramServicesAmt |
| Management And General | $452,403 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,864 | TotalAmt |
| Program Services | $112,916 | ProgramServicesAmt |
| Management And General | $15,948 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,397,776 | TotalAmt |
| Program Services | $1,131,010 | ProgramServicesAmt |
| Management And General | $266,766 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $266,185 | TotalAmt |
| Program Services | $232,686 | ProgramServicesAmt |
| Management And General | $33,499 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,773 | TotalAmt |
| Program Services | $24,217 | ProgramServicesAmt |
| Management And General | $2,556 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,229 | TotalAmt |
| Management And General | $35,229 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,819,942 | TotalAmt |
| Program Services | $1,725,894 | ProgramServicesAmt |
| Management And General | $94,048 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,735 | TotalAmt |
| Program Services | $4,407 | ProgramServicesAmt |
| Management And General | $9,328 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,091 | TotalAmt |
| Program Services | $88,030 | ProgramServicesAmt |
| Management And General | $10,061 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,871 | TotalAmt |
| Program Services | $5,794 | ProgramServicesAmt |
| Management And General | $77 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,454 | TotalAmt |
| Program Services | $112,217 | ProgramServicesAmt |
| Management And General | $3,237 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,390 | TotalAmt |
| Program Services | $28,202 | ProgramServicesAmt |
| Management And General | $5,188 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,755 | TotalAmt |
| Program Services | $8,376 | ProgramServicesAmt |
| Management And General | $379 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,398 | TotalAmt |
| Management And General | $7,398 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,066 | TotalAmt |
| Program Services | $152,625 | ProgramServicesAmt |
| Management And General | $37,441 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,760 | TotalAmt |
| Program Services | $219 | ProgramServicesAmt |
| Management And General | $48,541 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $428,069 | $411,818 | $16,251 |
| MISCELLANEOUS | $354,474 | $108,356 | $246,118 |
| BAD DEBT EXPENSE | $298,172 | $298,172 | |
| DUES & LICENSES | $28,923 | $25,378 | $3,545 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,483,096 | TotalAmt |
| Program Services | $8,195,083 | ProgramServicesAmt |
| Management And General | $1,288,013 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $504,635 | BOYAmt |
| EOY | $336,600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,676 | BOYAmt |
| EOY | $232,795 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,494,378 | BOYAmt |
| EOY | $1,697,665 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,842 | BOYAmt |
| EOY | $138,429 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,118 | BOYAmt |
| EOY | $1,118 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,613,577 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $900,880 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $671,278 | BOYAmt |
| EOY | $712,697 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $28,727 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,102,927 | BOYAmt |
| EOY | $3,148,031 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,762 | BOYAmt |
| EOY | $365,043 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,847 | BOYAmt |
| EOY | $111,043 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,934,170 | BOYAmt |
| EOY | $4,957,361 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,321,779 | BOYAmt |
| EOY | $5,433,447 | 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 | -$2,218,852 | BOYAmt |
| EOY | -$2,285,416 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,218,852 | BOYAmt |
| EOY | -$2,285,416 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,102,927 | BOYAmt |
| EOY | $3,148,031 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$66,564 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 | $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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,546,780 | BeginningYearBalanceAmt |
| Contributions | $153,000 | ContributionsAmt |
| Investment Earnings Or Losses | $72,629 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $265,090 | GrantsOrScholarshipsAmt |
| End Year Balance | $4,507,319 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,853,177 | BeginningYearBalanceAmt |
| Contributions | $255,505 | ContributionsAmt |
| Investment Earnings Or Losses | -$56,366 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $505,590 | GrantsOrScholarshipsAmt |
| End Year Balance | $4,546,726 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.20240 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.79760 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,916 | OtherCostOrOtherBasisAmt |
| Book Value | $2,916 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $220,528 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,473 | DepreciationAmt |
| Book Value | $191,055 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,351,020 | OtherCostOrOtherBasisAmt |
| Depreciation | $871,407 | DepreciationAmt |
| Book Value | $479,613 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,113 | OtherCostOrOtherBasisAmt |
| Book Value | $39,113 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $712,697 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $2,405,922 |
| DUE TO THIRD PARTY PAYOR | $1,730,539 |
| SALARIES & BENEFITS PAYABLE | $543,215 |
| LEASEHOLD PAYABLE GCHS | $277,685 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,957,361 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 FEDERAL AND STATE INCOME TAX EXPENSE OF APPROXIMATELY $681 AND $2,953 IN 2019 AND 2018, RESPECTIVELY. THE INCOME TAX 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, 2019 AND 2018, RWHS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $106,653 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $106,653 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $571,255 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $505,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $65,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $677,908 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $505,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $172,144 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01870 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $677,908 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $505,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $172,144 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01870 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $298,172 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,811,562 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,856,411 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$44,849 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL WEST GARDEN COUNTY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 WEST 2ND | AddressLine1Txt |
| City | OSHKOSH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 8200000 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIONAL WEST GARDEN COUNTY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.GCHEALTH.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.GCHEALTH.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 OCTOBER 2017 AS PART OF THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT. 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). |
| 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 FOR THE IMPLEMENTATION STRATEGY WERE THOSE THE BOARD BELIEVED THAT THE HOSPITAL COULD MOST EFFECTIVELY ADDRESS WITH THE RESOURCES AVAILABLE. |
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $298,172. |
| 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. RWHS 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, 2019 AND 2018, 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. RWHS 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. THE COST OF CARING FOR CHARITY CARE PATIENTS FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018 WAS APPROXIMATELY $5,100,000 AND $7,600,000, RESPECTIVELY. |
| 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, 12, AND 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | APPROXIMATELY 35% 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 2019. |
| 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 21.80% UNDER THE AGE OF 18, 4.60% FROM 18 TO 24, 22.70% FROM 25 TO 44, 27.00% FROM 45 TO 64, AND 24.00% WHO WERE 65 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 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN MENTGEN | ||||||||||||||
| CHAIR/CEO | $0 | $507,405 | $0 | $0 | $0 | $9,273 | $0 | $67,145 | $0 | $48,802 | $0 | $632,625 | $0 | $0 |
| PAUL HOFMEISTER | ||||||||||||||
| VICE CHAIR | $0 | $331,129 | $0 | $0 | $0 | $38,991 | $0 | $21,075 | $0 | $30,045 | $0 | $421,240 | $0 | $0 |
| MIKE ICKOWSKI | ||||||||||||||
| TREASURER/CFO | $0 | $304,228 | $0 | $0 | $0 | $10,017 | $0 | $55,778 | $0 | $34,788 | $0 | $404,811 | $0 | $0 |
| LAURIE SOPER | ||||||||||||||
| APRN | $290,110 | $0 | $0 | $0 | $0 | $0 | $10,161 | $0 | $1,784 | $0 | $302,055 | $0 | $0 | $0 |
| WILLIAM GILES | ||||||||||||||
| BOARD MEMBER THRU 07/2019 | $100,317 | $0 | $0 | $0 | $43,144 | $0 | $4,104 | $0 | $14,863 | $0 | $162,428 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO, CFO, AND BOARD VICE CHAIR 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 55,945 MICHAEL ICKOWSKI 44,578 PAUL HOFMEISTER 9,875 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 3 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 REQURIED. 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 1,350,080. MANAGEMENT AND GENERAL EXPENSES 91,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,441,547. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 247,359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 247,359. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 128,455. MANAGEMENT AND GENERAL EXPENSES 2,581. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,036. |
| 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 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 PHYSICIANS CLINIC | |||||||||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | 363314159 | DR. CLINICS | 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 | 4201 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 | 0 | 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 | 0 | 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 | $1,064,159 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments