REGIONAL WEST HEALTH SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
REGIONAL WEST HEALTH SERVICES (EIN 36-3314157)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201343199349303914
Schema version
2012v2.3
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

FieldValueIRS element (for citing)
Timestamp2013-11-15T10:05:55-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CONTRYMAN ASSOCIATES PC CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 2246AddressLine1
CitySCOTTSBLUFFCity
StateNEState
ZIP Code69363ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363314157EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1REGIONAL WEST HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlREGINameControl

US Address USAddress

FieldValueIRS element (for citing)
Address Line14021 AVENUE BAddressLine1
CitySCOTTSBLUFFCity
StateNEState
ZIP Code69361ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID GRIFFITHSName
TitleTREASURERTitle
Date Signed2013-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAN W CHARRON CPA CMAName
Phone3086357705Phone
Date Prepared2013-11-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID GRIFFITHS TREASURERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14021 AVENUE BAddressLine1
CitySCOTTSBLUFFCity
StateNEState
ZIP Code69361ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13600490GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.RWHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Activity Or Mission DescriptionHEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees115TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7220112ProgramServiceRevenuePriorYear
Program Service Revenue CY8057022ProgramServiceRevenueCY
Investment Income Prior Year4227901InvestmentIncomePriorYear
Investment Income Current Year5219840InvestmentIncomeCurrentYear
Other Revenue Prior Year10383OtherRevenuePriorYear
Other Revenue Current Year5065OtherRevenueCurrentYear
Total Revenue Prior Year11458396TotalRevenuePriorYear
Total Revenue Current Year13281927TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7752241SalariesEtcPriorYear
Salaries Etc Current Year8873429SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2808816OtherExpensePriorYear
Other Expenses Current Year1381521OtherExpensesCurrentYear
Total Expenses Prior Year10561057TotalExpensesPriorYear
Total Expenses Current Year10254950TotalExpensesCurrentYear
Revenues Less Expenses Prior Year897339RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3026977RevenuesLessExpensesCY
Total Assets BOY17003586TotalAssetsBOY
Total Assets EOY19628359TotalAssetsEOY
Total Liabilities BOY1856534TotalLiabilitiesBOY
Total Liabilities EOY1679304TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15147052NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY17949055NetAssetsOrFundBalancesEOY
Mission DescriptionHEALTH CARE SERVICES FOR THE PEOPLE OF WESTERN NEBRASKA AND EASTERN WYOMING.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense10247884Expense
DescriptionREGIONAL WEST HEALTH SERVICES 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.Description
Total Program Service Expense10247884TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109638NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees115NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDAVID GRIFFITHSNamePerson
Telephone Number3086301111TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14021 AVENUE BAddressLine1
CitySCOTTSBLUFFCity
StateNEState
ZIP Code69361ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

Average Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationTitleTitleOfficerOfficerKey EmployeeKeyEmployeeFormerFormer
JEFFREY HOLLOWAY MD
1.00X062945730929
TODD S SORENSEN MD
50.00X534071142286585PRESIDENTX
JON MORGAN MD
1.00X046413812139
DAVID HOLDT MD
1.00X032608531929
DAVID GRIFFITHS
50.00X259340044081TREASURERX
TOM HOLYOKE
1.00X0359540
MARK HARTMAN MD
1.00X0330000
GLEN FORNEY MD
1.00X023120
MARK GILLAM
1.00X020410
HOD KOSMAN
1.00X011840CHAIRMANX
DONALD M GENTRY MD
1.00X000
JANE HUNTER EDD
1.00X000
JIM TRUMBULL
1.00X000
DENNIS HADDEN
1.00X000
REV LAUREN EKDAHL
1.00X000
DORA OLIVARES
1.00X000
JIM DARNELL
1.00X000
JULIE MARSHALL
1.00X000
LEE GLENN
1.00X000
JENNIFER BROOKER
40.0045100029960SECRETARYX
STUART FULKS
50.00260725028427VP OF MARKETX
PAUL HOFMEISTER
50.00238036061009GENERAL COUNX
LISA BEWLEY
50.00186904033465VP OF INFO SX
STEVE HODGES
50.00178703041518VP OF HUMANX
LISA M STEELE
75490041392SECRETARYX
FieldValueIRS element (for citing)
Total Reportable Comp From Org1778369TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1495593TotalReportableCompFrmRltdOrgs
Total Other Compensation441434TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionCONSULTING REVENUEDescription
Total Revenue Column8057022TotalRevenueColumn
Related Or Exempt Function Income8057022RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue8057022TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5143403TotalRevenueColumn
Exclusion$5,143,403ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities395000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities318563Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities76437Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column76437TotalRevenueColumn
Related Or Exempt Function Income76437RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Total Revenue Column5065TotalRevenueColumn
Related Or Exempt Function Income5065RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue5065TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13281927TotalRevenueColumn
Related Or Exempt Function Income8138524RelatedOrExemptFunctionIncome
Exclusion$5,143,403ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total534071Total
Program Services534071ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6286504Total
Program Services6286504ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total210925Total
Program Services210925ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1408029Total
Program Services1408029ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total433900Total
Program Services433900ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2335Total
Program Services2335ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total901Total
Management And General901ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5901Total
Program Services5901ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total6165Total
Management And General6165ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total441Total
Program Services441ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total53084Total
Program Services53084ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1595Total
Program Services1595ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PHYSICIAN RECRUITMENT13073861307386
TELEPHONE16331633
OTHER PURCHASED SERVICES10621062
LICENSES AND FEES655655

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total363Total
Program Services363ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10254950Total
Program Services10247884ProgramServices
Management And General7066ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1719131BOY
EOY446479EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6391BOY
EOY10825EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2134873BOY
EOY2085242EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2456447BOY
EOY2589069EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY9421230BOY
EOY13775593EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY52941BOY
EOY-1EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1212573BOY
EOY721152EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY17003586BOY
EOY19628359EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY89568BOY
EOY74315EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1766966BOY
EOY1604989EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1856534BOY
EOY1679304EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15147052BOY
EOY17949055EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15147052BOY
EOY17949055EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17003586BOY
EOY19628359EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses3026977ReconcilationRevenueExpenses
Reconciliation Unrealized Invest75026ReconciliationUnrealizedInvest
Reconcilation Other Changes-300000ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Written IRS DeterminationXWrittenIRSDetermination
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1REGIONAL WEST MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
EIN470385129EIN
Type Of Organization3TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$300,000Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts300000SumOfAmounts

Schedule D IRS990ScheduleD

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENT IN MED CTR OF THE ROCKIES10412815C
INVESTMENT IN REGIONAL CARE INC3362778C
FieldValueIRS element (for citing)
Total Of Book Value Securities13775593TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED EXPENSES$888,251
SELF FUNDED HEALTH PLAN PAYABLE$716,738
FieldValueIRS element (for citing)
Total Of Amounts1604989TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsTitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
JEFFREY HOLLOWAY MD
499708128939810298311098660386
TODD S SORENSEN MD
14221422PRESIDENT460892731798570288362065659250
JON MORGAN MD
4353062801981311200939476277
DAVID HOLDT MD
27231350975279731011918358014
DAVID GRIFFITHS
TREASURER2490591028143248833303421
STUART FULKS
VP OF MARKETING13708612363927731696289152102489
PAUL HOFMEISTER
GENERAL COUNSEL2241911384560191818299045
LISA BEWLEY
VP OF INFO SYSTEMS177056984832698767220369
STEVE HODGES
VP OF HUMAN RESOURCE1686661003740767751220221
LISA M STEELE
SECRETARY7549040930462116882

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTSIdentifier
Return ReferenceSCHEDULE J, PAGE 1, PART I, LINE 4ReturnReference
ExplanationTODD S SORENSEN, MD 0 159,162 0 DAVID GRIFFITHS 0 25,367 0 STUART FULKS 8,891 16,218 0 PAUL HOFMEISTER 0 36,531 0 LISA BEWLEY 0 19,483 0 STEVE HODGES 0 20,017 0Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BFROM WAS PRESENTED TO AND REVIEWED BY THE BOARD IN THE MONTH PRIOR TO THE FILING DEADLINE.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CANNUAL 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.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS AND POLICY STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY BEING POSTED ON THE ORGANIZATION'S WEBSITE.
RECONCILIATION OF CHANGES - OTHERFORM 990, PART XI, LINE 9TRANSFERS FROM AFFILIATES 0 TRANSFERS TO AFFILIATES 0
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 9TRANSFERS TO AFFILIATES 300,000

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