2024-11-08T13:13:29-06:00 2023-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-01-01 363314159 REGIONAL WEST PHYSICIANS CLINIC REGI 3086302877 4021 AVE B SCOTTSBLUFF NE 69361 JEANNE MCKERRIGAN CFO/TREASURER 3086302877 2024-11-07 1 1 WENDY R COOLEY CPA P01523804 4023302660 2024-11-07 2023 2024-10-15 13:58:12Z MEL MCNEA 4021 AVE B SCOTTSBLUFF NE 69361 58671245 0 X WWW.RWHS.ORG X 1984 NE PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 13 0 327 0 0 0 21659200 21659200 41614428 37008429 -4766 0 4294 3616 63273156 58671245 7192 2733 0 0 39267995 39921689 0 0 0 34931970 30165083 74207157 70089505 -10934001 -11418260 7453213 9380374 6289926 19635347 1163287 -10254973 PROVIDE HEALTH CARE TO THE REGION INCLUDING THE UNDERSERVED. 0 0 63387515 2733 37012045 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. 63387515 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 70 0 1 327 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JEANNE MCKERRIGAN 3086302244 4021 AVENUE B SCOTTSBLUFF NE 69361 ARMANDO MAGANA MD DIRECTOR 40.00 0.00 X 1039890 0 56333 MARK HARTMAN MD CHAIR 40.00 1.00 X X 920218 0 58386 SEROZAN AMROLIWALLA MD DIRECTOR 40.00 0.00 X 836734 0 55333 JEFFREY HOLLOWAY MD PRESIDENT 40.00 3.00 X X 742446 0 63193 BRADLEY HERTZLER MD DIRECTOR 40.00 0.00 X 727866 0 62993 TROY DEAN MD DIRECTOR 40.00 0.00 X 549187 0 61887 DORISA POLK MD DIRECTOR 40.00 2.00 X 463530 0 62193 JOSEPH MARGHEIM MD DIRECTOR 40.00 0.00 X 410129 0 68693 MEL MCNEA CEO/PRESIDENT 1.00 45.00 X X 0 419351 21572 AMANDA VICK DIRECTOR 1.00 42.00 X 0 329424 38657 MICHAEL ICKOWSKI TREASURER/CFO THRU 5/2023 1.00 45.00 X X 0 227368 44990 ELIZABETH CLEMENS DIRECTOR 40.00 0.00 X 136000 0 50430 ALAN TOWNSEND INTERIM CFO/TREASURER 1.00 45.00 X X 184211 0 0 MARY ADAMS DIRECTOR 40.00 0.00 X 124095 0 20715 LISA BECKER SECRETARY 40.00 0.00 X 35030 0 15844 OMAR JIMENEZ MD PHYSICIAN 40.00 0.00 X 1225940 0 63193 ROMMIE HUGHES MD PHYSICIAN 40.00 0.00 X 850615 0 59397 RODNEY MARK SAMUELSON MD PHYSICIAN 40.00 0.00 X 768905 0 47203 JASON LATOWSKY MD PHYSICIAN 40.00 0.00 X 750513 0 62193 KARISSA JOHNSON MD PHYSICIAN 40.00 0.00 X 479327 0 62474 KATHRYN PAINTER MD PHYSICIAN 40.00 0.00 X 446045 0 62193 JOHN BLOMSTEDT MD PHYSICIAN 40.00 0.00 X 790782 0 62044 SAED AWADALLAH MD PHYSICIAN 40.00 0.00 X 741372 0 66760 TIMOTHY FRIEDLEIN MD PHYSICIAN 40.00 0.00 X 736650 0 51433 MICHELLE CHELOHA MD PHYSICIAN 40.00 0.00 X 616664 0 60848 JEFFREY SALISBURY MD PHYSICIAN 40.00 0.00 X 456092 0 65243 JOHN MENTGEN FORMER PRESIDENT/CEO 0.00 0.00 X 0 260392 38551 14032241 1236535 1382751 68 1 1 1 RURAL PARTNERS IN MEDICINE 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 1619552 HSWT LLC 3845 ROCKY RIDGE CT HOOD RIVER OR 97031 MEDICAL SERVICES 651802 VIRTUAL MEDICAL STAFF LLC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 MEDICAL SERVICES 639234 TREASURE STATE UROLOGY LLC 2311 SPRUCE STREET BILLINGS MT 59101 MEDICAL SERVICES 519013 LOCUMTENENS HOLDINGS LLC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 MEDICAL SERVICES 467418 28 21659200 21659200 PHYSICIAN SERVICES 621110 31169171 31169171 CONSULTING SERVICES 621110 5839258 5839258 37008429 PURCHASE DISCOUNTS 621110 3616 3616 3616 58671245 37012045 0 0 X 2733 2733 11449405 11449405 239128 239128 22629385 21690625 938760 665478 640035 25443 3318109 3153891 164218 1620184 1519234 100950 18574199 17779293 794906 6928 6928 590708 568094 22614 298843 5367 293476 1633075 1556565 76510 113715 95404 18311 1608 23 1585 7411 7377 34 130521 130220 301 MEDICAL EXPENSES 4432059 4431569 490 CORPORATE ALLOCATION 4250517 4250517 DUES & LICENSES 125499 111624 13875 70089505 63387515 6701990 0 330230 1733374 6105500 6744798 489141 456549 61285 115514 3802445 3472306 411956 330139 55101 0 7453213 9380374 6152032 11673608 137894 7961739 6289926 19635347 X 1163287 -10254973 1163287 -10254973 7453213 9380374 -11418260 0 X X 0 1 X 1 0 X 35237795 40691016 32538292 21659200 21659200 151785503 41921817 40176927 44741223 41619187 37012045 205471199 77159612 80867943 77279515 63278387 58671245 357256702 0 0 0 357256702 1811 2847 4658 1811 2847 4658 11588 9312 8271 29171 77173011 80880102 77287786 63278387 58671245 357290531 0.99990 0.99990 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5887872 544587 55824 67507 6420776 8807244 182428 -2055429 1046371 5887872 7307997 190018 1350185 40956 8807244 6188204 324798 824828 29833 7307997 4837335 719879 1352989 98684 623315 6188204 0.00000 0.19650 0.80350 0 1 1 233303 171362 61941 3557285 3289087 268198 11857 11857 0 330139 LEASE LIABILITY 89431 AFFILIATE PAYABLE 7872308 7961739 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. RWHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023 AND 2022, RWHS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 1 0 0 0 0 0 0 0 OMAR JIMENEZ MD PHYSICIAN 1225940 0 0 0 0 0 13200 0 49996 0 1289136 0 0 0 ARMANDO MAGANA MD DIRECTOR 1039890 0 0 0 0 0 13200 0 43887 0 1096977 0 0 0 MARK HARTMAN MD CHAIR 920218 0 0 0 0 0 8393 0 50805 0 979416 0 0 0 ROMMIE HUGHES MD PHYSICIAN 850615 0 0 0 0 0 13200 0 47009 0 910824 0 0 0 SEROZAN AMROLIWALLA MD DIRECTOR 836734 0 0 0 0 0 13200 0 42874 0 892808 0 0 0 JOHN BLOMSTEDT MD PHYSICIAN 790782 0 0 0 0 0 13200 0 49633 0 853615 0 0 0 RODNEY MARK SAMUELSON MD PHYSICIAN 768905 0 0 0 0 0 13200 0 34006 0 816111 0 0 0 JASON LATOWSKY MD PHYSICIAN 750513 0 0 0 0 0 13200 0 49805 0 813518 0 0 0 SAED AWADALLAH MD PHYSICIAN 741372 0 0 0 0 0 13200 0 54372 0 808944 0 0 0 JEFFREY HOLLOWAY MD PRESIDENT 742446 0 0 0 0 0 13200 0 50805 0 806451 0 0 0 BRADLEY HERTZLER MD DIRECTOR 727866 0 0 0 0 0 13200 0 50605 0 791671 0 0 0 TIMOTHY FRIEDLEIN MD PHYSICIAN 736650 0 0 0 0 0 13200 0 39030 0 788880 0 0 0 MICHELLE CHELOHA MD PHYSICIAN 616664 0 0 0 0 0 13200 0 48427 0 678291 0 0 0 TROY DEAN MD DIRECTOR 549187 0 0 0 0 0 13200 0 49270 0 611657 0 0 0 KARISSA JOHNSON MD PHYSICIAN 479327 0 0 0 0 0 13200 0 50056 0 542583 0 0 0 DORISA POLK MD DIRECTOR 463530 0 0 0 0 0 13200 0 49766 0 526496 0 0 0 JEFFREY SALISBURY MD PHYSICIAN 456092 0 0 0 0 0 13200 0 52845 0 522137 0 0 0 KATHRYN PAINTER MD PHYSICIAN 446045 0 0 0 0 0 13200 0 49771 0 509016 0 0 0 JOSEPH MARGHEIM MD DIRECTOR 410129 0 0 0 0 0 13200 0 56295 0 479624 0 0 0 MEL MCNEA CEO/PRESIDENT 0 419351 0 0 0 0 0 7477 0 14646 0 441474 0 0 AMANDA VICK DIRECTOR 0 328074 0 0 0 1350 0 38657 0 754 0 368835 0 0 JOHN MENTGEN FORMER PRESIDENT/CEO 0 258367 0 0 0 2025 0 29712 0 9042 0 299146 0 0 MICHAEL ICKOWSKI TREASURER/CFO THRU 5/2023 0 226018 0 0 0 1350 0 44990 0 348 0 272706 0 0 ELIZABETH CLEMENS DIRECTOR 136000 0 0 0 0 0 5807 0 45097 0 186904 0 0 0 ALAN TOWNSEND INTERIM CFO/TREASURER 184211 0 0 0 0 0 0 0 0 0 184211 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: MICHAEL ICKOWSKI 25,275 AMANDA VICK 22,051 JOHN MENTGEN 16,050 SCHEDULE J, PART II: REGIONAL WEST HEALTH SERVICES, A RELATED ORGANIZATION, PAID COMMUNITY HOSPITAL CONSULTING, AN UNRELATED ORGANIZATION, $184,211 FOR SERVICES PROVIDED BY ALAN TOWNSEND IN HIS ROLE AS INTERIM CFO. MICHAELA AMROLIWALLA SPOUSE OF SEROZAN AMROLIWALLA, DIRECTOR 134440 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. EACH OF THE REMAINING NOMINEES SHALL BE SUBJECT TO APPROVAL AND ELECTION BY THE BOARD OF DIRECTORS OF 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 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 811,923. MANAGEMENT AND GENERAL EXPENSES 712,547. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,524,470. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 16,967,370. MANAGEMENT AND GENERAL EXPENSES 1,187. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,968,557. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 81,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,172. 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 0 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 REGIONAL WEST HEALTH SERVICES & AFFILIATE R 847705 CASH