2019-11-14T08:04:30-06:00 2018-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2018-01-01 391904975 REGIONAL WEST GARDEN COUNTY REGI 3087723283 4021 AVENUE B SCOTTSBLUFF NE 69361 MICHAEL ICKOWSKI CFO 3087723283 2019-11-13 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2019-11-13 17:01:30 CS P 06718D1991FB6EEBEB7ECD4F00D4AA79CF05A929 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2018 2020-03-31 21:24:44Z MICHAEL ICKOWSKI 4021 AVENUE B SCOTTSBLUFF NE 69361 8250391 0 X WWW.GCHEALTH.ORG X 1984 NE 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. 10 4 121 27 0 0 468431 83541 7283820 8149376 6720 6009 7289 2413 7766260 8241339 0 0 0 0 5865761 5743204 0 0 0 2557801 2976401 8423562 8719605 -657302 -478266 2570209 3102927 4310795 5321779 -1740586 -2218852 X 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. 1 0 3049312 5238479 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. 1335875 2002702 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. 950220 910608 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. 2236218 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. 2236218 7571625 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 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 11 0 1 121 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 4 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 JOHN MENTGEN CHAIRMAN/CEO 1.00 45.00 X X 0 519155 116443 PAUL HOFMEISTER VICE PRESIDENT 1.00 42.00 X X 0 329505 48640 MIKE ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 329384 76104 STEPHANIE TODD SECRETARY 1.00 40.00 X X 0 44695 26719 FREDA DAVIS SECRETARY 40.00 0.00 X X 9544 0 11152 CASPER CORFIELD BOARD MEMBER 1.00 0.00 X 0 0 0 WILLIAM GILES BOARD MEMBER 40.00 0.00 X 172149 0 35098 BEV KRAJEWSKI BOARD MEMBER 1.00 0.00 X 0 0 0 HOD KOSMAN BOARD MEMBER 1.00 3.00 X 0 0 0 MARY MATHER BOARD MEMBER 1.00 0.00 X 0 0 0 LAURIE SOPER APRN 40.00 0.00 X 238283 0 8702 419976 1222739 322858 2 0 1 0 STAT STAFFING LLC PO BOX 45 OSHKOSH NE 69154 AGENCY STAFF 323634 MEDICAL SOLUTIONS 1010 N 102ND STREET STE 300 OMAHA NE 681142300 AGENCY STAFF 273307 QUADRA MED PO BOX 74008556 CHICAGO IL 606748556 MAINTENANCE CON 151382 KEY WEST CONSULTING 250023 AIRPORT TERMINAL ST STE 6 SCOTTSBLUFF NE 69361 AGENCY STAFF 139715 4 14284 2111 67146 83541 NET HOSPITAL PATIENT R 623000 5121963 5121963 NURSING HOME PATIENT R 623000 2002702 2002702 HEALTH CLINIC PATIENT 621110 910608 910608 OTHER OPERATING REVENU 623000 114103 114103 8149376 2427 2427 12634 9052 3582 3582 3582 OTHER NON-OPERATING RE 900099 2413 2413 2413 8241339 8151789 0 6009 X 227943 227943 3774071 3317933 456138 119982 104681 15301 1378187 1143920 234267 243021 213757 29264 27274 24639 2635 24711 24711 1580440 1540899 39541 12879 4464 8415 127821 115640 12181 5345 4779 566 128829 116226 12603 25762 23126 2636 6506 5906 600 7084 7084 168522 156565 11957 34945 6807 28138 MEDICAL SUPPLIES 449381 439708 9673 MISCELLANEOUS 344189 107767 236422 DUES & LICENSES 32713 16865 15848 8719605 7571625 1147980 0 753858 504635 332676 883091 1494378 126382 98842 1118 1118 1394859 723581 805760 671278 2570209 3102927 135415 332762 80673 54847 4094707 4934170 4310795 5321779 X -1740586 -2218852 -1740586 -2218852 2570209 3102927 -478266 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 145917 18500 127417 1248942 705081 543861 671278 DUE TO AFFILIATES 3468893 DUE TO THIRD PARTY PAYOR 754487 SALARIES & BENEFITS PAYABLE 433105 LEASEHOLD PAYABLE GCHS 277685 4934170 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 1 X 1 X 1 X 1 1 0 0 71313 71313 0.00850 513799 358944 154855 0.01840 585112 358944 226168 0.02690 610 610 0.00010 610 610 0.00010 585722 358944 226778 0.02700 1 292930 0 3872468 3919768 -47300 X 1 1 1 1 REGIONAL WEST GARDEN COUNTY 1100 WEST 2ND OSHKOSH NE 69154 8200000 X X X X REGIONAL WEST GARDEN COUNTY 1 0 0 1 X X X X X X X X 17 1 0 1 1 X WWW.GCHEALTH.ORG 1 17 1 WWW.GCHEALTH.ORG 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X HTTP://GCHEALTH.ORG/ABOUT-YOUR-BILL/ X X X X X X 1 X 0 X X X X 1 X 0 0 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 EFFECITVELY 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. 2 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 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 $292,930. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL DID NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES DURING THE YEAR. PART III, LINE 2: THE BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS IS STATED IN TERMS OF UNREALIZABLE REVENUE, RATHER THAN AT THE ACTUAL COSTS ASSOCIATED WITH THE BAD DEBT. A COST TO CHARGE RATIO IS APPLIED TO THE BAD DEBT EXPENSE TO ESTIMATE THE COST OF THE BAD DEBT. A SIMILAR METHOD IS USED TO DETERMINE THE COSTS OF THE CHARITY CARE FOR THE ORGANIZATION. PART III, LINE 3: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE/CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE RWGC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. THE HOSPITAL 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. 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 AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: APPROXIMATELY 52% 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 2018. 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 POSIBLE 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 THIS YEAR INCLUDED CHIROPRACTIC CARE ON-SITE AND BEHAVIORAL HEALTH COUNSELING SERVICES ON-SITE. WE ARE LOOKING TO ADD A PAIN MANAGEMENT SPECIALIST THROUGH TELEMEDICINE NEXT YEAR. 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. NEXT YEAR 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. X 1 1 0 1 0 0 0 0 0 0 0 JOHN MENTGEN CHAIRMAN/CEO 0 509882 0 0 0 9273 0 70118 0 46325 0 635598 0 0 PAUL HOFMEISTER VICE PRESIDENT 0 319314 0 0 0 10191 0 20264 0 28376 0 378145 0 0 MIKE ICKOWSKI TREASURER/CFO 0 305004 0 15000 0 9380 0 58410 0 17694 0 405488 0 0 WILLIAM GILES BOARD MEMBER 171216 0 0 0 933 0 6971 0 28127 0 207247 0 0 0 LAURIE SOPER APRN 238283 0 0 0 0 0 6951 0 1751 0 246985 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. MICHAEL ICKOWSKI, CFO, WAS THE ONLY EMPLOYEE WHO RECEIVED THIS BENEFIT. PART I, LINE 3 THE CEO, CFO, AND BOARD VICE PRESIDENT ARE COMPENSATED BY REGIONAL WEST HEALTH SERVICES, A RELATED ORGANIZATION. METHODS USED TO ESTABLISH COMPENSATION FOR THESE INDIVIDUALS INCLUDE THE FOLLOWING: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 59,118 MICHAEL ICKOWSKI 47,410 PAUL HOFMEISTER 9,265 FORM 990, PART III, LINE 2 DURING 2018, REGIONAL WEST GARDEN COUNTY ADDED TWO NEW ANCILLARY SERVICES TO THE CRITICAL ACCESS HOSPITAL: CHIROPRACTIC CARE AND BEHAVIORAL HEALTH COUNSELING SERVICES, BOTH ON-SITE. 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 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, 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 1,143,696. MANAGEMENT AND GENERAL EXPENSES 36,991. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,180,687. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 281,267. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 281,267. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 115,936. MANAGEMENT AND GENERAL EXPENSES 2,550. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 118,486. FORM 990, 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 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 PHYSICIANS CLINIC 4021 AVENUE B SCOTTSBLUFF NE 69361 363314159 DR. CLINICS 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 4201 AVENUE B SCOTTSBLUFF NE 69361 470760050 TPA NE N/A C 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 REGIONAL WEST HEALTH SERVICES & AFFILIATE R 1262457 CASH