2019-11-14T08:03:24-06:00 2018-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2018-01-01 363314157 REGIONAL WEST HEALTH SERVICES REGI 3086353711 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO/TREASURER 3086353711 2019-11-13 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2019-11-13 16:54:00 CS P 06718D1991FB6EEBEB7ECD4F00D4AA79CF05A929 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2018 2020-03-31 21:24:44Z JOHN MENTGEN 4021 AVENUE B SCOTTSBLUFF NE 69361 22693112 0 X WWW.RWHS.ORG X 1984 NE HEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING. 17 11 115 164 0 0 0 0 11163644 11283916 12077407 116972 5684 11258519 23246735 22659407 4059309 7032990 0 0 11471115 11106997 0 0 0 1405249 2144132 16935673 20284119 6311062 2375288 47584482 47670406 8875401 6898940 38709081 40771466 X HEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING. 0 0 20284119 7032990 22542435 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. 20284119 1 0 0 0 0 0 0 0 0 1 0 1 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 1 1 1 0 1 33 0 1 115 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 11 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 HOD KOSMAN CHAIR 1.00 3.00 X X 0 0 0 JOHN MENTGEN CEO 40.00 6.00 X X 519155 0 116443 MICHAEL ICKOWSKI CFO/TREASURER 40.00 6.00 X X 329384 0 76104 VINCE BJORLING MD DIRECTOR 1.00 41.00 X 0 573621 46482 MATTHEW BRUNER MD DIRECTOR 1.00 41.00 X 0 524758 56614 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 TODD HOLCOMB EDD DIRECTOR 1.00 1.00 X 0 0 0 DAVID HOLDT MD DIRECTOR THRU 10/2018 1.00 42.00 X 0 590706 47272 JEFFREY HOLLOWAY MD DIRECTOR THRU 05/2018 1.00 41.00 X 0 714410 56665 THOMAS HOLYOKE DIRECTOR 1.00 1.00 X 0 0 0 DENNIS MILLER DIRECTOR 1.00 1.00 X 0 0 0 DORISA POLK MD DIRECTOR 1.00 41.00 X 0 473793 55644 DONALD THOMAS MD DIRECTOR 1.00 2.00 X 0 0 0 JIM TRUMBULL DIRECTOR 1.00 1.00 X 0 0 0 SHEILA WEBB-BOWLES MD DIRECTOR 1.00 41.00 X 0 478931 56572 EVIE YORK SECRETARY THRU 11/2018 40.00 2.00 X 63059 0 41762 MELODY BIBB SECRETARY 40.00 2.00 X 55031 0 46662 DAVID CORNUTT DIRECTOR OF OUTREACH 40.00 0.00 X 508926 0 47170 LISA SCHEPPERS CHIEF MEDICAL OFFICER 40.00 0.00 X 400302 0 95779 PAUL HOFMEISTER GENERAL COUNSEL 40.00 3.00 X 329505 0 48641 ANNA TURMAN CHIEF EXECUTIVE OFFICER - OUTREACH 40.00 0.00 X 194413 0 47580 SUMMER PARKER VICE-PRESIDENT OF HUMAN RESOURCES 40.00 1.00 X 177377 0 64333 2577152 3356219 903723 13 0 1 0 SULLIVAN COTTER HOLDINGS INC 90 SOUTH SEVENTH STREET STE 3750 MINNEAPOLIS MN 55402 CONSULTING 1059545 AON CONSULTING INC 200 EAST RANDOLPH STREET CHICAGO IL 60601 CONSULTING 163394 PINNACLE HEALTHCARE CONSULTING LLC 9085 EAST MINERAL CIRCLE STE 110 CENTENNIAL CO 80112 CONSULTING 151201 3 MANAGEMENT SERVICES REVENUE 561000 11283916 11283916 11283916 100916 100916 49761 33705 16056 16056 16056 MEDICAL CENTER OF THE ROCKIES 523000 11394611 11394611 OTHER REVENUE 900099 5640 5640 RCI INCOME 523000 -141732 -141732 11258519 22659407 22542435 0 116972 7032990 7032990 1247600 1247600 7188385 7188385 132919 132919 2018110 2018110 519983 519983 996309 996309 607 607 6701 6701 1032 1032 410 410 232 232 PHYSICIAN RECRUITMENT 1124620 1124620 TAXES 7715 7715 TELEPHONE 4757 4757 1749 1749 20284119 20284119 0 0 880900 433281 125884 96663 1197696 1248739 3484029 3660808 34693337 35234263 7202636 6996652 47584482 47670406 71654 908612 8803747 5990328 8875401 6898940 X 38709081 40771466 38709081 40771466 47584482 47670406 2375288 -312903 0 X X 0 1 X 1 0 X X X 5 REGIONAL WEST MEDICAL CENTER 470385129 3 1 7032990 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 7032990 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. 4551048 538883 -191365 61231 4837335 4507319 106517 296128 358916 4551048 4546780 153000 72629 265090 4507319 4853177 255505 -56366 505590 4546726 5289569 452644 179311 1068347 4853177 0.00000 0.24700 0.75300 0 1 1 0 INVESTMENT IN MED CTR OF THE 27693958 C EXECUTIVE BENEFIT PLANS 5690328 F INVESTMENT IN REGIONAL CARE INC 1835150 C INVESTMENT IN RPN, LLC 14827 C 35234263 DUE FROM AFFILIATES 6994642 ACCRUED INTEREST 2010 6996652 DEFERRED COMPENSATION 5990328 5990328 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE RESTRICTED FOR HEALTHCARE RESEARCH, HEALTHCARE EDUCATIONAL SCHOLARSHIPS, AND CAPITAL PROJECTS. PART X, LINE 2: REGIONAL WEST HEALTH SERVICES (RWHS), REGIONAL WEST MEDICAL CENTER, REGIONAL WEST FOUNDATION, REGIONAL WEST VILLAGE, REGIONAL WEST PHYSICIAN CLINICS (RWPC) AND REGIONAL WEST GARDEN COUNTY (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. REGIONAL CARE, INC. (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 2018 AND 2017, 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, 2018 AND 2017, RWHS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 REGIONAL WEST MEDICAL CENTER 4021 AVENUE B SCOTTSBLUFF NE 69361 470385129 501(C)(3) 7032990 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 0 1 0 0 0 0 0 0 0 JOHN MENTGEN CEO 509882 0 0 0 9273 0 70118 0 46325 0 635598 0 0 0 MICHAEL ICKOWSKI CFO/TREASURER 305004 0 15000 0 9380 0 58410 0 17694 0 405488 0 0 0 VINCE BJORLING MD DIRECTOR 0 354594 0 216540 0 2487 0 11000 0 35482 0 620103 0 0 MATTHEW BRUNER MD DIRECTOR 0 430565 0 93730 0 463 0 11000 0 45614 0 581372 0 0 DAVID HOLDT MD DIRECTOR THRU 10/2018 0 397245 0 0 0 193461 0 11800 0 35472 0 637978 0 0 JEFFREY HOLLOWAY MD DIRECTOR THRU 05/2018 0 575669 0 137483 0 1258 0 11000 0 45665 0 771075 0 0 DORISA POLK MD DIRECTOR 0 358692 0 114557 0 544 0 11000 0 44644 0 529437 0 0 SHEILA WEBB-BOWLES MD DIRECTOR 0 478427 0 0 0 504 0 11000 0 45572 0 535503 0 0 DAVID CORNUTT DIRECTOR OF OUTREACH 507842 0 0 0 1084 0 11000 0 36170 0 556096 0 0 0 LISA SCHEPPERS CHIEF MEDICAL OFFICER 391590 0 0 0 8712 0 50000 0 45779 0 496081 0 0 0 PAUL HOFMEISTER GENERAL COUNSEL 319314 0 0 0 10191 0 20265 0 28376 0 378146 0 0 0 ANNA TURMAN CHIEF EXECUTIVE OFFICER - OUTREACH 194252 0 0 0 161 0 7193 0 40387 0 241993 0 0 0 SUMMER PARKER VICE-PRESIDENT OF HUMAN RESOURCES 169146 0 0 0 8231 0 32956 0 31377 0 241710 0 0 0 PART I, LINE 1A IN THE CURRENT YEAR, THE ORGANIZATION 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 MICHAEL ICKOWSKI, DAVID HOLDT, AND JEFFREY HOLLOWAY. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 59,118 MICHAEL ICKOWSKI 47,410 LISA SCHEPPERS 39,000 PAUL HOFMEISTER 9,265 SUMMER PARKER 25,700 DAVID HOLDT 800 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 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 COO 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 THE CEO AND KEY EMPLOYEES 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 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 CAH 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 4794342 3225812 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 REGIONAL WEST MEDICAL CENTER B 7032990 CASH REGIONAL WEST MEDICAL CENTER L 10066912 FMV REGIONAL WEST HEALTH SERVICES & AFFILIATE R 1799428 CASH REGIONAL WEST PHYSICIANS CLINIC L 81180