2024-05-14T12:59:19-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Austin Willuweit CFO 6057559130 2024-05-13 1 Austin Willuweit 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-05-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 914197369 0 X www.monument.health X 1973 SD Monument Health Rapid City Hospital is dedicated to improving the health of individuals and our communities. 14 7 5062 193 9841419 263401 19062879 1792112 886367787 890966958 21422326 19259133 402635 551711 927255627 912569914 438151 112439 0 0 388321658 403587845 0 0 937968 517122502 539428501 905882311 943128785 21373316 -30558871 1405384189 1355082505 567389962 530194231 837994227 824888274 X Our vision at Monument Health Rapid City Hospital is to be one team, to listen, to be inclusive, and to show we care. Monument Health Rapid City Hospital is dedicated to improving the health of individuals and our communities. 0 0 755282080 112439 881228984 Monument Health Rapid City Hospital, Inc. (MHRCH) offers both inpatient and outpatient health services. Its tertiary hospital, Rapid City Hospital (RCH), serves Western South Dakota. The nearest larger hospital is in Sioux Falls, SD, more than 350 miles away. As such, the services provided by MHRCH are truly a healthcare safety net for Western South Dakota. MHRCH is a community-based health care system with a mission to make a difference, every day. MHRCH also provides patient care at the Behavioral Health Center, Orthopedic and Specialty Hospital, Family Medicine Residency Clinic, Heart and Vascular Institute, Hospice House, Rehabilitation Institute, Medical Clinics and Urgent Care locations. The Hospital employs physicians through its residency, cardiology, cardiovascular surgery, medical oncology, psychiatry, neurology, hospitalist, orthopedics and other programs.Monument Health Home Plus, LLC provides home care, hospice, pharmacy, and durable medical equipment services to the communities Monument Health serves. 755282080 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 578 0 1 5062 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 14 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X Austin Willuweit 6057559127 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Paulette R Davidson President & CEO 50.55 9.45 X X 0 1706840 232865 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1612881 0 116463 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1565024 0 129774 Charan Mungara MD Physician - Cardiology 40.00 0.00 X 1560616 0 109131 Siri Knutsen Larson MD Physician - Dermatology 40.00 0.00 X 1311701 0 130301 Ethan Levine MD Physician - Cardiology 40.00 0.00 X 1228479 0 112182 Brad Archer MD Chief Medical Officer 46.33 8.67 X 886440 0 117823 John Pierce President Rapid City Market 55.00 0.00 X 745376 0 108781 Mark A Thompson CFO/Treasurer 46.33 8.67 X 710030 0 102330 Srinivas Gangineni MD Board Member/Employed Physician 40.92 0.00 X 700395 0 86937 Stephanie Lahr MD CIO/CMIO until 3/23 46.33 8.67 X 658966 0 61673 Teresa Burroff Gen. Counsel/Secretary until 11/22 46.33 8.67 X 585595 0 66150 Thomas Worsley President Spearfish Market 0.00 55.00 X 0 582927 64430 Jacob Weasel MD Board Member/Employed Physician 40.92 0.00 X 537616 0 77704 Nicole Kerkenbush - Chief Nursing/Perf Officer Until 06/23 46.33 8.67 X 459144 0 58561 Michael Tilles VP Operations-Rapid City Market 55.00 0.00 X 439729 0 48718 Mark Longacre VP Operations-Rapid City Market 55.00 0.00 X 406756 0 56301 Mark Schulte VP Rapid City Market 55.00 0.00 X 379881 0 62811 Michael Latour System Director of Musculoskeletal Care 55.00 0.00 X 199072 0 37715 Tasha Frisinger VP of Nursing 55.00 0.00 X 164031 0 40189 Michael Statz MD Board Member/Employed Physician 41.21 0.00 X 141718 0 2137 Jay White Board Member 0.98 0.00 X 75548 0 0 Steven Frost MD Board Member 1.12 0.00 X 2000 0 0 Ross Mckie Chair 2.08 0.00 X X 0 0 0 Daryl Reinicke Board Member 1.48 0.00 X 0 0 0 Scott Barbour Board Member 1.21 0.00 X 0 0 0 Dusty Pinske Board Member 1.13 0.75 X 0 0 0 Tom Rau Board Member 1.12 0.00 X 0 0 0 Deidre Budahl Board Member 1.50 0.00 X 0 0 0 Col Michelle Schnakenberg Board Member From 09/22 0.83 0.00 X 0 0 0 14370998 2289767 1822976 598 1 1 0 Medefis 10826 Old Mill Rd 101 Omaha NE 68105 Contract labor 51644887 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 23783393 AYA Healthcare Inc 2550 University Ave West Suite 320N St Paul MN 55114 Medical Staffing 21422614 MJ Harris Construction Services LLC 1 Riverchase Ridge Birmingham AL 35244 Construction 17668810 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Professional services 13857172 397 155524 172997 1463591 1792112 Pharmacy 621400 183999537 175563529 8436008 Laboratory 621500 113446462 113225635 220827 Surgical Services 621110 87252059 87252059 MIS CT Scan 621500 37332071 37332071 Cardiac Services 621110 22048707 22048707 446888122 445703538 1184584 890966958 7711834 7711834 327399 327399 1451103 1240071 211032 211032 211032 11219900 0 11219900 11219900 11219900 480566 155524 243332 237234 237234 247497 144052 103445 103445 912569914 881228984 9841419 19707399 X 112439 112439 8704592 1498010 7206582 376816 376816 358346003 292261460 65548251 536292 11811108 9455134 2338735 17239 1695319 1357152 335693 2474 22654007 17738498 4877509 38000 6628464 277756 6350708 758399 758399 454250 454250 561744 561744 142630927 111411312 31219615 1197537 27922 1153182 16433 18293895 9409926 8615905 268064 22168501 4093758 18060469 14274 29713479 10264773 19446843 1863 2296561 1434574 854322 7665 1123353 32193 1091160 8937131 8937131 52118068 39306727 12788924 22417 2971995 742366 2229629 Medical Supplies 204296024 203986784 308764 476 Interco Supplies/Servic 44029361 42538485 1490876 All other expenses 1184655 18864 1153020 12771 UBI Tax 64157 64157 943128785 755282080 186908737 937968 31726572 26082675 82612122 31325460 133917359 120275308 27611166 27397609 17519116 13839488 935446701 413321216 508040991 522125485 162886141 241276882 425997462 351347903 2541789 7767722 12531471 13643973 1405384189 1355082505 121121966 84891254 345811041 337498000 26285258 26285258 74171697 81519719 567389962 530194231 X 811150365 803564484 26843862 21323790 837994227 824888274 1405384189 1355082505 X -30558871 23034268 -5581350 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 503600 0 0 1 58144 561744 0 Part II-B, Line 1: Annual dues were paid to the South Dakota Association of Healthcare Organizations. A portion of the dues are applicable to lobbying activities. For calendar year 2023 dues, which were paid in fiscal year 2023, in the amount of $327,723, 6.23% was used for lobbying purposes. Annual dues were paid to the American Hospital Association, a portion of which is applicable to lobbying activities. For calendar year 2023 dues, which were paid in fiscal year 2023, in the amount of $68,039, 27.29% was used for lobbying purposes. Annual dues were paid to the American Medical Rehab Providers Association, a portion of which is applicable to lobbying activities. For calendar year 2023 dues, which were paid in fiscal year 2023, in the amount of $11,883, 35.00% was used for lobbying purposes. In fiscal year 2023, $503,600 of contribution expense and $15,000 of consulting expense were incurred in regard to lobbying. The contribution was provided to an organization working toward Medicaid expansion through an initiated ballot measure. 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 0.00000 1.00000 0.00000 0 0 13014138 13014138 571668252 207631385 364036867 287870630 199573925 88296705 62893681 6115906 56777775 522125485 Mortgage-Backed Securities 89241000 F Private Equity/Debt 139567357 F Real Estate Funds 5035241 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Investment in Privately Held Companies 2500143 F Equity Securities and Funds - Domestic 72003931 F 351347903 Other Long Term Liabilities 20810031 Accrued Pension Liability 8175871 Due from related party 38747176 Lease liability 686797 Third party payor settlements 13099844 81519719 X Part V, Line 4: Endowed funds are held in an interest bearing account subject to the terms as specified by the donor and Board of Directors. The earnings on the endowment funds become temporarily restricted funds and therefore are not part of the endowment balance. The earnings are used to support the activities and programs in proportion to the restricted balances. Of the $1,662,929 endowment funds, $692,332 are restricted to be used for grants/scholarships to students in a healthcare program, $512,197 is restricted for use in the pediatrics unit, $100,000 for promotion of a healthy community, $197,400 for cardiac services, $100,000 for hospice patients, $36,000 for plants in public areas and $25,000 for cancer care. Part X, Line 2: References to "Monument Health" apply to all entities controlled by Monument Health, Inc. and its subsidiaries. This includes the reporting entity. Monument Health believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. Monument Health would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investment 55841000 North America - Canada and Mexico, but not the United States 0 0 Investment 2577000 0 0 0 0 0 0 58418000 0 58418000 1 0 1 1 1 0 Part III Accounting Method: Part I, Line 2: The organization does not award grants or assistance outside the United States. The organization has investment activities outside the United States. Schedule F, Part IV: The organization reviews its direct and indirect investments during the tax period for determining required foreign filings. Line 1: The organization makes direct and indirect transfers to foreign corporations and foreign partnerships. The organization would file Form 926 or Form 8865 if the transfers met the requirements for filing. The organization's transfers to foreign corporations did require filing Form 926. The organization's transfers to foreign partnerships did not require filing Form 8865. Lines 3 and 4: The organization has ownership interests in foreign corporations and foreign partnerships. The organization would file Form 5471 or Form 8865 if the ownership met the requirements for filing. The organization's ownership in foreign corporations did not require filing Form 5471. The organization's ownership in foreign partnerships did not require filing Form 8865. Line 5: The organization invests in partnerships that hold direct or indirect interests in passive foreign investment companies (PFICs). The organization would file Form 8621s for underlying investments that generate unrelated business income. The organization would not file Form 8621s where the investment partnerships have properly filed Form 8621s, or where the underlying investments did not generate any unrelated business income. The organization did not require filing Form 8621. Golden Guitar Gala 316650 88573 228077 2247 24500 10348 77282 Northern Hill Hospice Ball 108593 66951 41642 1350 13857 11510 2458 8 209177 209177 99780 634420 155524 478896 3597 38357 21858 179520 243332 235564 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 8707717 8707717 0.00920 82820252 51808596 31011656 0.03290 91527969 51808596 39719373 0.04210 17 5665618 5665618 0.00600 27113836 5191975 21921861 0.02320 1752894 1469568 283326 0.00030 2 1004620 1004620 0.00110 19 35536968 6661543 28875425 0.03060 19 127064937 58470139 68594798 0.07270 1 26060 26060 0.00000 1 297659 297659 0.00030 1 639 639 0.00000 1 103881 103881 0.00010 1 57 57 0.00000 5 428296 428296 0.00040 1 86751664 0 215358327 237688112 -22329785 X 1 1 1 Medical & Dental Building Office Building 0.71450 0.28550 2 The Imaging Center LLC Medical Imaging 0.50000 0.50000 3 Same Day Surgery Center Specialty and Ambulatory Srvcs 0.40000 0.60000 4 Western Providers Inc PHO 0.50000 0.50000 2 1 Monument Health Rapid City Hospital 353 Fairmont Blvd Rapid City SD 57701 www.monument.health 10558 X X X X X 1 Specialty Hosp; 8 PB clinics; 1 behavioral health facility 2 Same Day Surgery Center 651 Cathedral Drive Rapid City SD 57701 www.samedaysurgerycenter.org 10581 X Monument Health Rapid City Hospital Inc 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X See Section C, Line 7d X X 1 21 1 See Section C, Line 7d 0 1 X 250.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X See Section C, Line 16a-c X See Section C, Line 16a-c X See Section C, Line 16a-c X X X X X X X 1 X 0 X X X X 1 X 0 0 Same Day Surgery Center 2 0 0 1 X X X X X X X X X 21 1 1 0 1 X See Section C, Line 7d X X 1 21 1 See Section C, Line 7d 0 1 X 250.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X See Section C, Line 16a-c X See Section C, Line 16a-c X See Section C, Line 16a-c X X X X X X X 1 X 0 X X X X 0 X X 0 0 Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 5: As part of the community health needs assessment, an online key informant survey was conducted that solicited input from individuals who have a broad interest in the health of the community. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall.Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. A total of 118 community stakeholders comprised of physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders completed the key informant survey for the Monument Health service area. Same Day Surgery Center Part V, Section B, Line 5: As part of the community health needs assessment, an online key informant survey was conducted that solicited input from individuals who have a broad interest in the health of the community. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. A total of 118 community stakeholders comprised of physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders completed the key informant survey for the Monument health service area. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 6a: The Community Health Needs Assessment was undertaken by Monument Health, including: Monument Health Rapid City Hospital, Same Day Surgery Center, and Monument Health Network (Monument Health Spearfish Hospital, Monument Health Sturgis Hospital, Monument Health Lead-Deadwood Hospital, and Monument Health Custer Hospital). Under a management contract with Monument Health, Hans P. Peterson Memorial Hospital in Philip, SD, also collaborated on the project. Hans P. Peterson Memorial Hospital provided funding for their portion of the assessment. Same Day Surgery Center Part V, Section B, Line 6a: The Community Health Needs Assessment was undertaken by Monument Health, including: Monument Health Rapid City Hospital, Same Day Surgery Center, Monument Health Network (Monument Health Spearfish Hospital, Monument Health Sturgis Hospital, Monument Health Lead-Deadwood Hospital, and Monument Health Custer Hospital). Under a management contract with Monument Health, Hans P. Peterson Memorial Hospital in Philip, SD, also collaborated on the project. Hans P. Peterson Memorial Hospital provided funding for their portion of the assessment. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 7d: https://monument.health/about-us/community-health-needs-assessment/ Same Day Surgery Center Part V, Section B, Line 7d: https://www.samedaysurgerycenter.org/community-health-needs-assessment/ Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 11: During FY23, Monument Health focused on the following five priority areas identified through the most recent Community Health Needs Assessment (CHNA):-Cancer-Heart Disease and Stroke-Diabetes, Nutrition, Physical Activity and Weight-Mental Health and Substance Abuse-Access to Medical Services: Right Care, Right PlaceTeams comprised of representatives from Rapid City Hospital, Same Day Surgery Center, Monument Health Network, and the community worked on the priority areas selected for each facility's Community Health Improvement Plan (CHIP).CancerGoal: Explore, develop, and support opportunities that will positively impact the health of our communities related to cancer prevention, treatment and survivorship. Objective 1: Improved patient access & expanded services:-Cancer Care Institute Expansion was completed in July 2022-Increased infusion capacity-Reestablished Breast Surgery Program-Reinstituted survivorship visits, support groups, and education classes post-COVID-Added Integrative & Complimentary Medicine ServicesObjective 2: Positioned the Cancer Care Institute for the future:-Continued to review and evaluate investments in Oncology pharmacy support via: o Alignment w/other ambulatory pharmacy service lines o Adding Specialty & Clinical Pharmacists-Invested in oncology devices & technological advances: o CT and Radiation Oncology Machine upgradesObjective 3: Increased awareness of cancer resources:-Implemented SD's 2021-2025 Comprehensive Cancer Control Program-Building relationships/Access Other Resources o Monument Health Foundation o Black Hills Road Trip of Hope o Walking Forward o American Cancer SocietyHeart Disease and StrokeGoal: Explore, develop, and support opportunities that will positively impact the health of our communities related to heart disease and stroke. Cardiology Updates:-Coronary Angiography and PCI volumes are stable-2022 had the lowest number of post PCI deaths in recorded Monument Health history-Monument Health Post PCI In-Hospital Risk Standardized Mortality is better than the 90th percentile as compared to more than 1700 participating sites-Monument Health has now received the American Heart Association Chest Pain MI Platinum Achievement Award for 12 consecutive years-All AMI performance composites continue to be better than national average-The number of AMI patients cared for in 2022 is up about 25% over previous years, mostly due to an increase in NSTEMI patients-The number of AMI deaths in 2022 remained stable despite the 25% increase in patient load-Monument Health AMI In-Hospital Risk Standardized Mortality is at the 90th percentile as compared to more than 700 participating hospitals-Ongoing CV Surgery growth, program development with excellent resultsStroke Updates:-Developed Comprehensive Stroke Center with 2 Interventional Neurologists and expanded IR team-Education: enriched the knowledge of medical staff and patients about the benefits of recognizing stroke signs and signals early-Change to Emergency Room stroke protocols across health system to meet Joint Commission guidelines in January 2022-New stroke alert process for Large Vessel Occlusion developed working with the Transfer Center and Emergency Departments-Dysphagia Performance Improvement project initiated in May 2022 and continued throughout FY23, including multidisciplinary committee: CNP, RN, PT/OT and Speech. Jan 2023 the iLearn dysphagia training was made mandatory.-Monument Health received the American Heart Association Get with Guidelines Gold Plus Award for Stroke.Diabetes, Nutrition, Physical Activity and WeightGoal: Explore, develop, and support opportunities that will positively impact the health of our communities related to diabetes.Objective 1: Increased community awareness of diabetes prevention and management programs that promote healthy lifestyles:-Provided screenings and education at community health fairs at 20 different events-Provided certified trainers for the Monument Health Diabetes Prevention Program and Better Choices Better Health programs-Continued annual Diabetes Symposium o Successful symposium completed in November 2022 with 150+ participantsObjective 2: Improve transition from inpatient to outpatient care:-Streamlining outpatient referral process with inpatient Case Management Team-System-wide RN Diabetes rounding-Inpatient Endocrinology team growth and greater outreach-Partnered with nursing triage services to provide post-discharge supportObjective 3: Improve patient access for Primary Care and Diagnostic Procedures:-Ongoing outreach clinics-Streamlined Dietetic ServicesMental Health and Substance AbuseGoal: Increase access and awareness of mental health and substance abuse resources and education.Strategy 1: Establish a clear direction for substance abuse disorder care at Monument Health-Develop care guidelines for the care we deliver to substance abuse patients and ensure consistency and safety-Align programming with national standards to offer a broader spectrum of options for adults of outpatient servicesStrategy 2: Develop robust strategies to mitigate labor challenges, both in the inpatient and outpatient settings-Determine new services and enhance current efforts to retain staff-Clarify roles and responsibilities for APPs and maximize their use-Develop a telemedicine strategy to expand internal abilities to see patientsStrategy 3: Improve therapeutic programming for inpatients of Monument Health-Develop standard therapeutic programming objectives-Clarify operational reporting structures and processes for therapeutic teamsStrategy 4: Define effective patient flow strategies-Develop standardized patient flow guidelines, both inpatient and outpatient-Improve delivery of care to geriatric psychiatric inpatients and outpatients-Evaluate and optimize operational setup of outpatient clinic, including the physical spaceStrategy 5: Define a strategy for health equity with behavioral health patients at Monument Health-Partner with Indian Health Services and Oyate to better serve the community-Develop a population health research strategy, including development of a report on which to base the equity workStrategy 6: Meet community need through enhancement of patient access and financial opportunities-Optimize provider scheduling tools to allow for more nimble, responsive scheduling-Create and implement a plan to focus on improving Medicaid funding-Determine what care is being delivered now and not billed as well as what billable care should be delivered but isn'tAccess to Medical Services: Right Care, Right PlaceGoal: Increase access to care and improve existing services to meet current and future demands.Key Project Activities:-Increased visit volume through optimized templates and greater provider availability-Increased scheduling accuracy to route patients to correct provider and reduced rescheduling needs-Increased patient retention through referral capture (where applicable), resulting in additional visits as well as downstream ancillary revenue-Increased patient acquisition through digital options/convenience (e.g., online scheduling)-Increased staff efficiency through standardized and optimized workflows-Staff cross-coverage within Patient Contact Center-Provider satisfaction with streamlined workflows and simplified processes for referrals and close-the-loop-Focus on Primary Care recruitmentCare Access Workplan:Integrated Team:-Efficiently use patient & clinician time-Assign patient to appropriate level of care quickly-Improve patient experience and communication-Clarify and support roles based on licensureNurse Triage:-Prioritize patient care based on clinical assessment and Schmidt and Thompson protocols-Improve patient experience and communication-Support provider practice efficienciesScheduling Templates: Accurate scheduling templates and locationsAccurate scheduling securityAlignment to provider in-clinic timeScheduling:-Streamlined scheduling processes across locations-Reflection of intended scheduling processes and openingsReferrals:-Proactive management of ordered services-Close the loop follow-up procedures to promote continuity of care Same Day Surgery Center Part V, Section B, Line 11: Same Day Surgery Center will address the following two priority areas identified through the most recent CHNA: Cancer and Nutrition, Physical Activity and Weight. Cancer is a continuation of a need identified in the prior CHNA.In acknowledging the wide range of priority health issues revealed through the FY23 CHNA process, Same Day Surgery Center determined it could only focus on those which it deemed most pressing, most under-addressed, and within the ability to influence. The areas identified during the CHNA process that will not be directly addressed through the FY23 implementation plan are: Access to Health Services, Diabetes, Heart disease and stroke, Mental health, and Substance abuse. These needs are being addressed by other organizations in the community, are outside of our core area of expertise, or require resources that are not available at this time.Teams comprised of representatives from Rapid City Hospital, Same Day Surgery, Monument Health Network, and the community worked on the priority areas selected for each facility's Community Health Improvement Plan (CHIP).Cancer-Supported Tough Enough to Wear Pink, transferred funds to MH Foundation (department of MHRCH) to address needs of community cancer patients.-Provided screenings and education at community health fairs/events-Improved patient education materials, offerings, and practices to focus on the importance of cancer prevention and early detection to reduce cancer incidence in our region-Participated in cancer fundraisers and awareness walk(s)Nutrition, Physical Activity and Weight-Provided screenings and education at community health fairs/events-Participated in food drives and distribution for food-insecure populations-Encouraged physical activity through community activities Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 13h: Must reside within 200 mile radius of the location where the service was received.Presumptive eligibility may be used. Same Day Surgery Center Part V, Section B, Line 13h: Must reside within 200 mile radius of the location where the service was received.Presumptive eligibility may be used. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 16j: A summary of the hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, in waiting rooms, and in the admissions office. The policy in its entirety is also available upon request.The FAP application form was translated into the primary language spoken by LEP populations. This is posted on the website listed for line 16a. Same Day Surgery Center Part V, Section B, Line 16j: A summary of the hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, in waiting rooms, and in the admissions office. The policy in its entirety is also available upon request.The FAP application form was translated into the primary language spoken by LEP populations. This is posted on the website listed for line 16a. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Same Day Surgery Center Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Lines 16a-c Monument Health Rapid City Hospital The Financial Assistance Policy, Application form, and plain language summary are available at https://monument.health/patient-visitor-guide/financial-assistance/ Part V, Lines 16a-c Same Day Surgery Center The Financial Assistance Policy, Application form, and plain language summary are available at http://www.samedaysurgerycenter.org/financial-assistance/ 6 1 - Monument Health Home Care 224 Elk St Rapid Ctiy SD 57701 Home Care 1 - Monument Health Rapid City Hospice House 224 Elk St Rapid Ctiy SD 57701 End of Life Care 3 - Monument Health Home Care-Spearfish 1440 North Main Street Spearfish SD 57783 Home Care 4 - Monument Health Medical Clinic 112 7th Ave Wall SD 57790 Clinic 5 - Monument Health Dialysis Center 132 Yankee St Spearfish SD 57783 Dialysis Center 6 - Monument Health Rehabilitation Center 1050 Fairmont Blvd Rapid Ctiy SD 57701 Rehabilitation Center Part I, Line 3c: References to "Monument Health" apply to all entities controlled by Monument Health, Inc. and its subsidiaries. This includes the reporting entity.Financial assistance debt reduction write-offs for free or discounted care are based on an income matrix utilizing the current Federal Poverty Level (FPL) income guidelines after satisfying applicable co-pay requirements. The income matrix may be updated annually as the FPL income guidelines are released.Presumptive eligibility may be used if all other financial assistance avenues are exhausted. Part I, Line 6a: Monument Health Rapid City Hospital is included in the community benefit report prepared by Monument Health. This report is available at the facilities and can be found at:https://monument.health/about-us/mission-vision-values/ Part I, Line 7: Ratio of patient care cost to charges is used for the calculation of cost of services provided for lines 7a and 7b. A cost accounting system was used to calculate amounts on line 7g. Actual costs are used for the calculation of costs of services provided for lines 7e, 7h, and 7i. Part II, Community Building Activities: Monument Health provides numerous community benefit health events and screenings throughout the Black Hills Region. Monument Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Monument Health provides in-kind support and employee volunteers to help support community health events and activities. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 15 and 16. Part III, Line 8: The Medicare surplus or deficit is derived from the actual payments received from the Medicare program for services provided to patients with Medicare coverage. The payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our communities. Part III, Line 9b: The collection policy requires invoking of the financial assistance policy (FAP) at any time a patient expresses financial difficulty in meeting their debt obligation. Upon invoking the FAP, all collection activity is suspended. If the patient is approved for charity, then the account is closed out of the collection process and classified as charity. If a patient expresses financial concern but fails to complete the application process, additional notification is sent to the patient prior to re-instituting collection activity. We are following the 501(r) Final Regulations timelines for notifications and collections. Part VI, Line 2: We gather additional data on needed services from patient surveys, advisory councils and patient and family advisory councils. Part VI, Line 3: Financial Assistance Program brochures explaining the policy, a copy of the policy and Financial Assistance applications are available at each point of entry. Signs alerting patients to the availability of Financial Assistance are prominently displayed and a plain language summary describing the Financial Assistance program accompanies one billing statement for hospital services sent to the patient. The Financial Assistance policy, plain language summary and Financial Assistance application are provided free upon request and are also available on the hospital website at www.monument.health. Monument Health contracts with Midland Medical Group (an unrelated entity) to meet with uninsured patients to assist them with finding a funding source or applying for financial assistance; and our self-pay outsource partner also communicates any funding and financial assistance opportunities with our patients. Part VI, Line 4: Monument Health and its affiliates provide health care services to the 360,000 people who live in the Black Hills of South Dakota and the surrounding region, as well as thousands of visitors each year. Monument Health serves a 38-county region comprised of western South Dakota, southeastern Montana, northeastern Wyoming, southwestern North Dakota and northwestern Nebraska. Part VI, Line 5: Monument Health collaborates with agencies and community-wide coalitions to address prioritized health needs within the communities we serve. Monument Health addresses its community's health needs by: 1) Community members serve on governing boards, advisory councils and family member councils; 2) developing new programs and initiatives to address identified health needs: and 3) promoting an understanding of these health needs among other community organizations and within the public itself. Monument Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Monument Health provides in-kind support and employee volunteers to help support community health events and activities. Part VI, Line 6: Monument Health is committed to partnering with the communities it serves to meet the needs of each respective community. Monument Health, Inc. is the parent organization of Monument Health Rapid City Hospital, Inc., Monument Health Network, Inc., and Monument Health Physicians, Inc. These corporations work together to meet the health care needs of the region. 1 Elevate Rapid City PO Box 747 Rapid City SD 57701 460118545 501(c)(6) 50000 0 Pledge payment South Dakota Ellsworth Development Authority PO Box 747 Rapid City SD 57701 460118545 10000 0 Sponsorship City of Box Elder 420 Villa Drive Box Elder SD 57719 460281490 Government 10000 0 Sponsorship American Heart Association Inc 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 10000 0 Sponsorship Center for American Indian Research and Native Studies PO BOX 448 Martin SD 57551 141966086 501(c)(3) 12409 0 Sponsorship Helpline Center Inc 1000 N West Ave 310 Sioux Falls SD 57104 237424387 501(c)(3) 5500 0 Sponsorship Boys & Girls Club of the Black Hills PO BOX 677 Hill City SD 57745 460332124 501(c)(3) 5280 0 Event Sponsorship Central States Fair Inc 800 San Francisco St Rapid City SD 57701 460238981 501(c)(5) 9250 0 Sponsorship 5 3 Part I, Line 2: The governing board and management of the receiving organization develop programs which enhance the charitable mission of the organization. Disbursement of grant or contribution funds for these programs are made in accordance with the established procedures within the organization and are subject to the conditions established by the organization's governing board and management. These procedures are developed to ensure that distributed funds are adequately monitored for appropriate usage. 0 1 0 0 0 0 0 1 0 Paulette R Davidson President & CEO 0 1048570 0 468970 0 189300 0 203572 0 29293 0 1939705 0 168800 Joseph Tuma MD Physician - Cardiology 1493422 0 65000 0 54459 0 85913 0 30550 0 1729344 0 54459 0 Bhaskar Purushottam MD Physician - Cardiology 1443111 0 65000 0 56913 0 90524 0 39250 0 1694798 0 56913 0 Charan Mungara MD Physician - Cardiology 1464913 0 28905 0 66798 0 82200 0 26931 0 1669747 0 0 0 Siri Knutsen Larson MD Physician - Dermatology 1296901 0 14800 0 0 0 89629 0 40673 0 1442003 0 0 0 Ethan Levine MD Physician - Cardiology 1143479 0 85000 0 0 0 80032 0 32150 0 1340661 0 0 0 Brad Archer MD Chief Medical Officer 613416 0 196723 0 76301 0 93920 0 23904 0 1004264 0 64571 0 John Pierce President Rapid City Market 493781 0 161925 0 89670 0 71692 0 37089 0 854157 0 69170 0 Mark A Thompson CFO/Treasurer 485887 0 155035 0 69108 0 70813 0 31517 0 812360 0 48608 0 Srinivas Gangineni MD Board Member/Employed Physician 632999 0 35486 0 31910 0 52551 0 34386 0 787332 0 31910 0 Stephanie Lahr MD CIO/CMIO until 3/23 408520 0 147796 0 102650 0 44928 0 16745 0 720639 0 82150 0 Teresa Burroff Gen. Counsel/Secretary until 11/22 386929 0 132493 0 66173 0 39331 0 26819 0 651745 0 45673 0 Thomas Worsley President Spearfish Market 0 410537 0 134382 0 38008 0 34802 0 29628 0 647357 0 17508 Jacob Weasel MD Board Member/Employed Physician 510496 0 27120 0 0 0 44050 0 33654 0 615320 0 0 0 Nicole Kerkenbush - Chief Nursing/Perf Officer Until 06/23 326336 0 103759 0 29049 0 55761 0 2800 0 517705 0 22921 0 Michael Tilles VP Operations-Rapid City Market 310677 0 88210 0 40842 0 31886 0 16832 0 488447 0 28984 0 Mark Longacre VP Operations-Rapid City Market 297271 0 78067 0 31418 0 27568 0 28732 0 463056 0 16050 0 Mark Schulte VP Rapid City Market 274090 0 73076 0 32715 0 28894 0 33917 0 442692 0 18331 0 Michael Latour System Director of Musculoskeletal C 184380 0 14692 0 0 0 12293 0 25422 0 236787 0 0 0 Tasha Frisinger VP of Nursing 139931 0 1000 0 23100 0 8607 0 31582 0 204220 0 0 0 Part I, Line 3 The Executive Committee, which is a committee of the Monument Health (parent) Board, reviews and approves base salary and total compensation ranges for all executives within the Monument Health System. Part I, Line 4b Monument Health provides a supplemental nonqualified retirement plan and a flexible benefit plan that can include deferred compensation for its executives and physicians. The following individuals had amounts deferred into the account as reported in Schedule J, Column C: Paulette Davidson $190,512 Brad Archer MD $81,209 Mark Thompson $52,744 Stephanie Lahr $31,868 Teresa Burroff $26,447 Nicole Kerkenbush $42,892 Mark Longacre $15,368 John Pierce $56,000 Michael Tilles $19,666 Mark Schulte $14,388 Joseph Tuma MD $73,944 Charan Mungara MD $70,000 Siri Knutsen Larson $76,918 Ethan Levine $67,494 Srinivas Gangineni MD $37,498 Jacob Weasel MD $31,648 The following individuals had supplemental non-qualified retirement plan amounts included in Schedule J, column B(iii) that were previously reported as deferred compensation on Form 990. These amounts are identified in Schedule J, Column F: Paulette Davidson $168,800 Brad Archer MD $64,571 Mark Thompson $48,608 Stephanie Lahr $82,150 Teresa Burroff $45,673 Nicole Kerkenbush $22,291 John Pierce $69,170 Michael Tilles $28,984 Mark Longacre $16,050 Mark Schulte $18,331 Joseph Tuma MD $54,459 Bhaskar Purushottam MD $56,913 Srinivas Gangineni MD $31,910 Part I, Line 7 Executives and Other Employees of System Entities will be eligible to receive annual incentive awards that are competitive with the incentives offered by the organizations in the System's Peer group(s) in accordance with the terms of the Monument Health, Inc. Annual Incentive Plan for Selected Executives and Other Employees (Incentive Plan). In accordance with this plan, the parent Board's Executive Committee will review and approve all incentive compensation performance measures and all awards, if any. The committee ensures that the total compensation, including incentive awards, is reasonable. A SD Health & Educational Facilities Authority 460315509 83755VE26 2017-09-07 238488122 Refund Series 2010 and 2011 Bond; Hospital buildings and equipment 0 0 0 B SD Health & Educational Facilities Authority 460315509 83755VM76 2020-10-27 138442836 See Part VI 0 0 0 A 45983122 241560080 1807893 185230960 54521227 2019 0 1 1 1 B 13022836 139921863 1143985 85179027 53598850 2023 0 0 1 1 A 0 1 1 0 1 0 0.00460 0.00960 0.01420 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: SD Health & Educational Facilities Authority Date the Rebate Computation was Performed: 09/07/2022 Form 990, Schedule K, Part I, Line B Description of Purpose: Hospital Buildings Constructing and Renovating & Equipment, Refund Series 2015 Bonds and Termination of Interest Rate Swap relating to refunded bond. Schedule K, Part II, Line 3, Bond A The issue price on Part I, column (e) is different than the amount on Part II, line 3 due to interest earned during the construction phase on the proceeds of $3,071,958. Schedule K, Part II, Line 3, Bond B THE ISSUE PRICE ON PART I, COLUMN (E) IS DIFFERENT THAN THE AMOUNT ON PART II, LINE 3 DUE TO INTEREST EARNED DURING THE CONSTRUCTION PHASE ON THE PROCEEDS OF $1,479,027. Amy Kress Family member of Mark Thompson 70315 Employee compensation 0 Becky Sharp Family member of Mark Thompson 145968 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 55661 Employee compensation 0 Kody Sharp Family member of Mark Thompson 104872 Employee compensation 0 Form 990, Part VI, Section A, line 1a The membership of the Executive Committee of the Corporation shall consist of the following: Chair of the Board of Directors, Vice Chair of the Board of Directors, two other Board members appointed by the Chair, and the Corporation's President. The Chair of the Board of Directors shall serve as the Chair of the Executive Committee. Directors on the Executive Committee shall serve during the term of office they hold which places them on the Executive Committee, or, for the two Chair-appointed members, for a term of one (1) year or until their successors are appointed. The Executive Committee, when the Board of Directors is not in session, shall have and may exercise all of the authority of the Board of Directors, except to the extent, if any, that such authority shall be limited by a motion or resolution of the Board of Directors or that is authority reserved to the Member. It is intended that the powers of the Executive Committee to act for the whole Board be confined to such urgent matters as reasonably should not be deferred until the next regularly-scheduled meeting of the full Board. Form 990, Part VI, Section A, line 2 Paulette Davidson has a business relationship with Thomas Worsley. The relationship exists because Paulette Davidson is the CEO of the supporting organization that exercises reserve powers over the supported organization, Monument Health Network. Form 990, Part VI, Section A, line 6 Monument Health, Inc. is the sole member of Monument Health Rapid City Hospital, Inc. Form 990, Part VI, Section A, line 7a The organization's sole member and supporting organization, Monument Health, Inc., appoints the members of Monument Health Rapid City Hospital's governing body. The bylaws require that at least one member of Monument Health Rapid City Hospital's board also serves as a voting member of the sole member's board to better assure the sole member's continued responsiveness to Monument Health Rapid City Hospital. Form 990, Part VI, Section A, line 7b Monument Health, Inc. provides compliance, governance, financial, and planning support to its Supported Organizations to best assure the functions and services of the Supported Organizations are coordinated and supported in a manner that furthers the shared charitable mission of the Supported Organizations and MHI, as a whole. Monument Health, Inc. has final authority in significant business decisions affecting Supported Organizations. Form 990, Part VI, Section B, line 11b The 990 is prepared and reviewed by an independent accounting firm. It is then reviewed internally by management. The Form 990 is further reviewed, prior to filing, by the organization's board of directors through a portal to the organization's internal information system, to which each board member has access. Educational sessions have been provided to board members on how to access the portal. Form 990, Part VI, Section B, line 12c As part of the annual disclosure of potential conflicts process, all board members, officers, and management are required to complete an annual disclosure statement on financial interests and conflicting interests. At Board and Board Committee meetings, the meeting agenda includes an initial item "Conflicts of Interest" where the Chair asks members if they have any conflicting interests or financial interests related to an agenda item. If a conflicting or financial interest is disclosed, it is noted in the minutes and there is discussion or determination of whether the disclosure requires the board or committee member to be excused from discussion or action on that agenda item. Board or committee members whose disclosure is found to be a conflict may be invited to speak on the matter by the Chair, but are not permitted to vote on the matter and may be required to leave the meeting during discussion, after they have made any comments invited by the Chair. Failure to comply with the Conflict of Interest policy constitutes grounds for removal from office or membership on the Board or Board Committee and, in the case of all employees, termination of employment. Form 990, Part VI, Section B, line 15a The Executive Committee of Monument Health, Inc (MHI; parent) annually engages an independent third party compensation firm to conduct a review of all executives, Vice President level and above, to determine an appropriate compensation range in which their compensation would be established. The independent compensation consultant provided peer group market comparative data for base salary, total cash compensation, benefits and total compensation for executives. The CEO or her designee determines the actual base salary of the executives within the committee-approved base salary range based on experience and performance, providing the total compensation is within the targeted market percentile, e.g. 50th percentile. Each year, the independent consultant meets with Committee members and presents data upon which the Committee determines all elements of compensation for the member's CEO (base salary, total cash compensation, benefits and total compensation) and reaffirms the organization's executive compensation philosophy, which includes the targeted market percentile for all other executives. Actual compensation is paid by Monument Health Rapid City Hospital and charged to Monument Health, Inc. Form 990, Part VI, Section C, line 19 The Articles of Incorporation of the organization are filed in the office of the Secretary of State of South Dakota and are available to the public from the Office of the Secretary of State. Other documents (Bylaws, conflict of interest policy and financial statements) are not posted for the public but are available or described in other public documents or sites such as offering statements in bond issues or municipal securities rulemaking board's electronic municipal market access (EMMA) data port. Form 990, Part IX, line 11g Contract and purchased services: Program service expenses 111,411,312. Management and general expenses 31,219,615. Fundraising expenses 0. Total expenses 142,630,927. Form 990, Part XI, line 9: Released From Restriction -4,893,227. Reverse Auxiliary Net Income -11,904. Record Accum. Pension Liability for FY20 -395,150. Transfers -129,568. Reverse Medical Staff Net Income -151,501. Form 990, Part X, Line 20: The issue price of the bonds includes the filing organization's share of the entire bond issue, which was issued to Monument Health, Inc. on behalf of the Monument Health Obligated Group. The Monument Health Obligated Group consists of Monument Health, Inc., Monument Health Rapid City Hospital, Inc., Monument Health Network, Inc. and Monument Health Physicians, Inc. In accordance with the IRS instructions, information related to the tax exempt bond reporting is being reported on the Monument Health Rapid City Hospital, Inc. tax return. Monument Health Home Plus LLC 2925 Regional Way PO Box 6000 Rapid City SD 57701 364841157 Healthcare Services SD 114434439 15833375 Monument Health Rapid City Hospital Inc Monument Health Inc 353 Fairmont Blvd Rapid City SD 57701 201487506 Healthcare SD 501(c)(3) Line 12c, III-FI N/A 0 Monument Health Network Inc 353 Fairmont Blvd Rapid City SD 57701 460360899 Healthcare SD 501(c)(3) Line 3 Monument Health Inc 0 Monument Health Physicians Inc 353 Fairmont Blvd Rapid City SD 57701 460372454 Healthcare SD 501(c)(3) PF Monument Health Inc 0 Same Day Surgery Center 651 Cathedral Drive Rapid City SD 57701 411889892 Medical Services SD Monument Health Rapid City Hospital Inc RELATED 1864951 1426940 0 1 0.40000 Medical & Dental Building 2805 S 5th St Rapid City SD 57701 460339629 Medical Office Bldg SD Monument Health Rapid City Hospital Inc Investment 459731 1975920 0 1 0.71450 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 Same Day Surgery Center F 2222000 FMV Medical & Dental Building P 342965 FMV