2023-11-14T10:34:03-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 363314159 REGIONAL WEST PHYSICIANS CLINIC REGI 3086302877 4021 AVE B SCOTTSBLUFF NE 69361 ALAN TOWNSEND INTERIM CFO/TREASURER 3086302877 2023-11-14 1 ALAN TOWNSEND 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MEL MCNEA 4021 AVE B SCOTTSBLUFF NE 69361 63279070 0 X WWW.RWHS.ORG X 1984 NE PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 12 0 332 12 -465 0 32538292 21659200 44741223 41614428 0 -4766 8271 4294 77287786 63273156 6682 7192 0 0 43185285 39267995 0 0 0 29698531 34931970 72890498 74207157 4397288 -10934001 19988979 7453213 7891691 6289926 12097288 1163287 PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 0 0 68050458 7192 41619187 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. 68050458 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 1 0 0 0 0 0 0 1 0 1 0 1 59 0 1 332 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ALAN TOWNSEND 3086301111 4021 AVENUE B SCOTTSBLUFF NE 69361 OMAR JIMENEZ MD PHYSICIAN 40.00 0.00 X 1379115 0 59946 MARK HARTMAN MD CHAIR 40.00 1.00 X X 988844 0 57952 ARMANDO MAGANA MD DIRECTOR 40.00 0.00 X 937372 0 61919 ROMMIE HUGHES MD PHYSICIAN 40.00 0.00 X 810316 0 61955 TIMOTHY FRIEDLEIN MD PHYSICIAN 40.00 0.00 X 818154 0 51380 JOHN MENTGEN PRESIDENT/CEO THRU 10/2022 1.00 45.00 X X 0 695971 124554 SAED AWADALLAH MD PHYSICIAN 40.00 0.00 X 713255 0 60522 JASON LATOWSKY MD PHYSICIAN 40.00 0.00 X 708509 0 60955 JEFFREY HOLLOWAY MD PRESIDENT 40.00 3.00 X X 697686 0 61955 BRADLEY HERTZLER MD DIRECTOR 40.00 0.00 X 682641 0 60955 JOHN BLOMSTEDT MD PHYSICIAN 40.00 0.00 X 664092 0 60762 RODNEY MARK SAMUELSON MD PHYSICIAN 40.00 0.00 X 596709 0 34924 DORISA POLK MD DIRECTOR 40.00 2.00 X 552196 0 59594 SEROZAN AMROLIWALLA MD DIRECTOR 40.00 0.00 X 576913 0 31373 TROY DEAN MD DIRECTOR 40.00 0.00 X 497866 0 59964 KATHRYN PAINTER MD PHYSICIAN 40.00 0.00 X 461235 0 60912 KARISSA JOHNSON MD PHYSICIAN 40.00 0.00 X 450722 0 60913 JOSEPH MARGHEIM MD DIRECTOR 40.00 0.00 X 391584 0 60941 MICHAEL ICKOWSKI TREASURER/CFO 1.00 45.00 X X 0 369241 46058 AMANDA VICK INTERIM CEO/PRESIDENT THRU 12/2022 1.00 45.00 X X 0 300625 39951 ELIZABETH CLEMENS DIRECTOR 40.00 0.00 X 121243 0 51618 MARY ADAMS DIRECTOR 40.00 0.00 X 100941 0 20145 KAYLA BARGE SECRETARY 1.00 40.00 X 0 24769 27288 MEL MCNEA CEO/PRESIDENT 1.00 45.00 X X 0 8654 0 12149393 1399260 1276536 69 0 1 0 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 3849063 RURAL PARTNERS IN MEDICINE 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 2242605 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 7 FORT LAUDERDALE FL 33308 MEDICAL SERVICES 1501118 VIRTUAL MEDICAL STAFF LLC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 MEDICAL SERVICES 1101364 HAYES HEALTHCARE 5900 N ANDREWS AVE 900 FORT LAUDERDALE FL 33309 MEDICAL SERVICES 858801 26 21659200 21659200 PHYSICIAN SERVICES 621110 35611752 35611752 CONSULTING SERVICES 621110 5953167 5953167 49509 49509 41614428 4766 -4766 -4766 -4766 683 1148 -465 -465 PURCHASE DISCOUNTS 621110 4759 4759 4759 63273156 41619187 -465 -4766 X 7192 7192 8749223 8749223 135333 135333 24288493 23351338 937155 736233 709695 26538 3902835 3495624 407211 1455878 1407117 48761 89790 89790 17363730 16542847 820883 5999 5999 2352539 2306246 46293 250664 250664 1727555 1651037 76518 96579 96579 1151 465 686 6297 6297 157984 157733 251 389944 387534 2410 CORPORATE ALLOCATION 4460196 981119 3479077 MEDICAL EXPENSES 4454187 4454075 112 BAD DEBT EXPENSE 3219725 3219725 0 MISCELLANEOUS 194202 0 194202 161428 134616 26812 74207157 68050458 6156699 0 10460658 330230 6204857 6105500 483913 489141 160393 61285 3753742 3341786 515534 411956 2163624 55101 19988979 7453213 5113260 6152032 49462 0 2728969 137894 7891691 6289926 X 12097288 1163287 12097288 1163287 19988979 7453213 -10934001 0 X X 0 1 X 1 0 X 32693950 35237795 40691016 32538292 21659200 162820253 42387061 41921817 40176927 44741223 41619187 210846215 75081011 77159612 80867943 77279515 63278387 373666468 0 0 0 373666468 640 1811 2847 5298 640 1811 2847 5298 17764 11588 9312 8271 0 46935 75099415 77173011 80880102 77287786 63278387 373718701 0.99990 0.99960 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8807244 182428 -2055429 1046371 5887872 7307997 190018 1350185 40956 8807244 6188204 324798 824828 29833 7307997 4837335 719879 1352989 98684 623315 6188204 4551048 538883 -191365 61231 4837335 0.00000 0.20420 0.79580 0 1 1 203353 160381 42972 3506636 3169548 337088 43753 11857 31896 411956 LEASE LIABILITY 137894 137894 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: THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740 INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022 AND 2021, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 1 0 0 0 0 0 0 0 OMAR JIMENEZ MD PHYSICIAN 1379115 0 0 0 0 0 11600 0 48346 0 1439061 0 0 0 MARK HARTMAN MD CHAIR 986522 0 0 0 2322 0 7597 0 50355 0 1046796 0 0 0 ARMANDO MAGANA MD DIRECTOR 932181 0 0 0 5191 0 11600 0 50319 0 999291 0 0 0 ROMMIE HUGHES MD PHYSICIAN 807994 0 0 0 2322 0 11600 0 50355 0 872271 0 0 0 TIMOTHY FRIEDLEIN MD PHYSICIAN 814954 0 0 0 3200 0 11600 0 39780 0 869534 0 0 0 JOHN MENTGEN PRESIDENT/CEO THRU 10/2022 0 686629 0 0 0 9342 0 75199 0 49355 0 820525 0 0 SAED AWADALLAH MD PHYSICIAN 712769 0 0 0 486 0 11600 0 48922 0 773777 0 0 0 JASON LATOWSKY MD PHYSICIAN 707969 0 0 0 540 0 11600 0 49355 0 769464 0 0 0 JEFFREY HOLLOWAY MD PRESIDENT 695364 0 0 0 2322 0 11600 0 50355 0 759641 0 0 0 BRADLEY HERTZLER MD DIRECTOR 681831 0 0 0 810 0 11600 0 49355 0 743596 0 0 0 JOHN BLOMSTEDT MD PHYSICIAN 663451 0 0 0 641 0 11600 0 49162 0 724854 0 0 0 RODNEY MARK SAMUELSON MD PHYSICIAN 596709 0 0 0 0 0 9523 0 25401 0 631633 0 0 0 DORISA POLK MD DIRECTOR 551298 0 0 0 898 0 11600 0 47994 0 611790 0 0 0 SEROZAN AMROLIWALLA MD DIRECTOR 576662 0 0 0 251 0 11600 0 19773 0 608286 0 0 0 TROY DEAN MD DIRECTOR 497817 0 0 0 49 0 11600 0 48364 0 557830 0 0 0 KATHRYN PAINTER MD PHYSICIAN 460658 0 0 0 577 0 11600 0 49312 0 522147 0 0 0 KARISSA JOHNSON MD PHYSICIAN 450374 0 0 0 348 0 11600 0 49313 0 511635 0 0 0 JOSEPH MARGHEIM MD DIRECTOR 390849 0 0 0 735 0 11600 0 49341 0 452525 0 0 0 MICHAEL ICKOWSKI TREASURER/CFO 0 358860 0 0 0 10381 0 45300 0 758 0 415299 0 0 AMANDA VICK INTERIM CEO/PRESIDENT THRU 12/2022 0 292250 0 0 0 8375 0 39212 0 739 0 340576 0 0 ELIZABETH CLEMENS DIRECTOR 121115 0 0 0 128 0 5267 0 46351 0 172861 0 0 0 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, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: JOHN MENTGEN 64,199 MICHAEL ICKOWSKI 33,700 AMANDA VICK 27,612 MICHAELA AMROLIWALLA SPOUSE OF SEROZAN AMROLIWALLA, DIRECTOR 135333 WAGES OF EMPLOYEE OF ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, COMPRISED OF THE CHAIRMAN, VICE PRESIDENT OF MEDICINE, VICE PRESIDENT OF SURGERY, QUALITY COMMITTEE CHAIR, FM MEDICAL DOCTOR, IT DIRECTOR, HOSPITALIST AND SURGERY REPRESENTATIVES, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. 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 OF THE FORM 990 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 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 PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 838,512. MANAGEMENT AND GENERAL EXPENSES 820,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,659,395. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 15,704,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,704,335. 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 3708158 CASH