2020-11-16T09:25:35-06:00 2019-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-01-01 363314159 REGIONAL WEST PHYSICIANS CLINIC REGI 3086302877 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO 3086302877 2020-11-13 1 WENDY R COOLEY P01523804 4023302660 163.116.133.113 2020-11-13 08:35:14 CS P B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C 2019 2021-01-29 14:40:06Z MICHAEL ICKOWSKI 4021 AVENUE B SCOTTSBLUFF NE 69361 77196463 0 X WWW.RWHS.ORG X 1984 NE PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 11 0 387 25 11588 -30839 32693950 35237795 42387061 41921817 640 1811 17764 11588 75099415 77173011 29928 24560 0 0 49638421 48557660 0 0 0 24718668 28741300 74387017 77323520 712398 -150509 8696596 6916096 8546087 6916096 150509 0 PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 0 0 69840868 24560 41921817 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. 69840868 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 55 0 1 387 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 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 929018 0 60623 OMAR JIMENEZ MD PHYSICIAN 40.00 0.00 X 850695 0 59129 ROMMIE HUGHES MD PHYSICIAN 40.00 0.00 X 844751 0 60573 RAQEEB HAQUE MD PHYSICIAN 40.00 0.00 X 848714 0 26195 TIMOTHY FRIEDLEIN MD PHYSICIAN 40.00 0.00 X 755871 0 42515 JASON LATOWSKY MD PHYSICIAN 40.00 0.00 X 736162 0 59573 PROUSKEH EBRAHIMPOUR MD PHYSICIAN 40.00 0.00 X 746496 0 36478 JEFFREY HOLLOWAY MD PRESIDENT 40.00 3.00 X X 722004 0 59473 MARK HARTMAN MD DIRECTOR 40.00 1.00 X 641460 0 54685 MICHAL TAYLOR MD PHYSICIAN 40.00 0.00 X 616131 0 55414 JOHN MENTGEN PRESIDENT/CEO 1.00 45.00 X X 0 516678 115947 MATTHEW BRUNER MD PHYSICIAN 40.00 2.00 X 534315 0 59535 BRENNAN MOSCH MD PHYSICIAN 40.00 0.00 X 532614 0 49348 JEFFREY SALISBURY MD PHYSICIAN 40.00 0.00 X 484947 0 62206 TROY DEAN MD PHYSICIAN 40.00 0.00 X 471480 0 59248 JOSEPH MARGHEIM MD DIRECTOR 40.00 0.00 X 421371 0 67204 VINCENT BJORLING MD CHAIR 40.00 2.00 X X 439334 0 48901 DORISA POLK MD DIRECTOR 40.00 0.00 X 430903 0 54044 MICHAEL ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 314245 90566 DAVID HOLDT MD PRESIDENT THRU 02/2019 40.00 1.00 X X 369812 0 6404 KENT LACEY MD DIRECTOR 40.00 0.00 X 324009 0 46968 MARK SCANLAN MD DIRECTOR 40.00 0.00 X 308963 0 59401 SEROZAN AMROLIWALLA MD DIRECTOR 40.00 0.00 X 312276 0 29157 BRENT ELLISON MD DIRECTOR THRU 09/2019 40.00 0.00 X 243952 0 30490 KAYLA MISNER SECRETARY 40.00 0.00 X 27678 0 16436 12592956 830923 1310513 101 0 1 0 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 3004003 RURAL PARTNERS IN MEDICINE 11880 AIRPORT WAY BROOMFIELD CO 80021 MEDICAL SERVICES 1642669 HEALTH MOUNT LLC 1326 MONTGOMERY LN SOUTHLAKE TX 76092 MEDICAL SERVICES 1070200 GLOBAL HOSPITALIST SOLUTIONS 5865 RIDGEWAY CENTER PARKWAY MEMPHIS TN 38120 MEDICAL SERVICES 860572 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 797392 26 35237795 35237795 PHYSICIAN SERVICES 621110 35810876 35810876 CONSULTING SERVICES 621110 6024881 6024881 86060 86060 41921817 1811 1811 35040 23452 11588 11588 77173011 41921817 11588 1811 X 24560 24560 10252380 10252380 30263553 29662769 600784 930188 909485 20703 4931282 4638539 292743 2180257 1947702 232555 3288 3288 86580 86580 14565073 13466641 1098432 57178 6520 50658 2647487 2299257 348230 229769 229563 206 1801715 1686084 115631 173964 167983 5981 5124 3153 1971 199708 197987 1721 427361 417261 10100 CORPORATE ALLOCATION 4547206 4547206 MEDICAL EXPENSES 3700259 3700089 170 DUES & LICENSES 215580 149887 65693 LABORATORY EXPENSES 80707 80707 301 301 77323520 69840868 7482652 0 18012 37560 6436404 5505246 289777 273627 212805 214839 4233825 3656871 734716 576954 1004882 307870 8696596 6916096 4818019 4379636 3728068 2536460 8546087 6916096 X 150509 0 150509 0 8696596 6916096 -150509 0 X X 0 1 X 1 0 X 22959200 23359200 32693950 35237795 114250145 53716029 52147499 44101030 42387061 41921817 234273436 53716029 75106699 67460230 75081011 77159612 348523581 0 0 0 348523581 -1970 566 966 640 1811 2013 -1970 566 966 640 1811 2013 117528 77890 38114 17764 11588 262884 344570 304246 77620 726436 54176157 75489401 67576930 75099415 77173011 349514914 0.99720 0.99620 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4837335 719879 1352989 98684 623315 6188204 4551048 538883 -191365 61231 4837335 4507319 106517 296128 358916 4551048 4546780 153000 72629 265090 4507319 4853177 255505 -56366 505590 4546726 0.00000 0.20240 0.79760 0 1 1 194446 134563 59883 3981947 3465018 516929 57432 57290 142 576954 DUE TO AFFILIATES 2536460 2536460 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 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. X 1 1 1 1 0 0 0 0 0 0 0 ARMANDO MAGANA MD DIRECTOR 723382 0 202072 0 3564 0 11200 0 49423 0 989641 0 0 0 OMAR JIMENEZ MD PHYSICIAN 850695 0 0 0 0 0 11200 0 47929 0 909824 0 0 0 ROMMIE HUGHES MD PHYSICIAN 808170 0 34259 0 2322 0 11200 0 49373 0 905324 0 0 0 RAQEEB HAQUE MD PHYSICIAN 848110 0 0 0 604 0 11200 0 14995 0 874909 0 0 0 TIMOTHY FRIEDLEIN MD PHYSICIAN 448400 0 305386 0 2085 0 11200 0 31315 0 798386 0 0 0 JASON LATOWSKY MD PHYSICIAN 708501 0 27175 0 486 0 11200 0 48373 0 795735 0 0 0 PROUSKEH EBRAHIMPOUR MD PHYSICIAN 745924 0 0 0 572 0 11200 0 25278 0 782974 0 0 0 JEFFREY HOLLOWAY MD PRESIDENT 692777 0 27985 0 1242 0 11200 0 48273 0 781477 0 0 0 MARK HARTMAN MD DIRECTOR 639138 0 0 0 2322 0 7332 0 47353 0 696145 0 0 0 MICHAL TAYLOR MD PHYSICIAN 615653 0 0 0 478 0 10080 0 45334 0 671545 0 0 0 JOHN MENTGEN PRESIDENT/CEO 0 507405 0 0 0 9273 0 67145 0 48802 0 632625 0 0 MATTHEW BRUNER MD PHYSICIAN 480885 0 52967 0 463 0 11200 0 48335 0 593850 0 0 0 BRENNAN MOSCH MD PHYSICIAN 522595 0 9733 0 286 0 11200 0 38148 0 581962 0 0 0 JEFFREY SALISBURY MD PHYSICIAN 484393 0 0 0 554 0 11200 0 51006 0 547153 0 0 0 TROY DEAN MD PHYSICIAN 470977 0 0 0 503 0 11200 0 48048 0 530728 0 0 0 JOSEPH MARGHEIM MD DIRECTOR 420869 0 0 0 502 0 11200 0 56004 0 488575 0 0 0 VINCENT BJORLING MD CHAIR 352375 0 84472 0 2487 0 11200 0 37701 0 488235 0 0 0 DORISA POLK MD DIRECTOR 357191 0 73168 0 544 0 11200 0 42844 0 484947 0 0 0 MICHAEL ICKOWSKI TREASURER/CFO 0 304228 0 0 0 10017 0 55778 0 34788 0 404811 0 0 DAVID HOLDT MD PRESIDENT THRU 02/2019 16701 0 7777 0 345334 0 3196 0 3208 0 376216 0 0 0 KENT LACEY MD DIRECTOR 319094 0 3943 0 972 0 9443 0 37525 0 370977 0 0 0 MARK SCANLAN MD DIRECTOR 209383 0 99130 0 450 0 11200 0 48201 0 368364 0 0 0 SEROZAN AMROLIWALLA MD DIRECTOR 312136 0 0 0 140 0 11200 0 17957 0 341433 0 0 0 BRENT ELLISON MD DIRECTOR THRU 09/2019 243752 0 0 0 200 0 9963 0 20527 0 274442 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 BRENNAN MOSCH, RAQEEB HAQUE, JEFFREY SALISBURY, PROUSKEH EBRAHIMPOUR, MICHAL TAYLOR AND SEROZAN AMROLIWALLA. 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, LINES 4A-B DAVID HOLDT, PRESIDENT, RECEIVED A SEVERANCE PAYMENT OF $344,620 DURING THE YEAR. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 55,945 MICHAEL ICKOWSKI 44,578 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 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 13,466,641. MANAGEMENT AND GENERAL EXPENSES 1,098,432. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,565,073. 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 5096354 CASH