2025-05-15T07:34:56-05:00 2024-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Austin Willuweit CFO 6057559130 2025-05-14 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-05-14 2023 2025-03-06 01:10:19Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 1032945515 0 X www.monument.health X 1973 SD Improving the health of individuals and our communities. 13 7 5112 205 8096987 523096 1792112 14649514 890966958 983049234 19259133 32982133 551711 1023251 912569914 1031704132 112439 1512792 0 0 403587845 416046401 0 0 1070685 539428501 569410797 943128785 986969990 -30558871 44734142 1355082505 1422455024 530194231 525395889 824888274 897059135 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 1 790143262 1512792 975075789 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, 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. 790143262 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 1 552 0 1 5112 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 13 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 50.82 9.18 X X 0 1727313 253482 Brad Archer MD Chief Medical Officer 46.59 8.41 X 876666 0 124753 Jacob Weasel MD Board Member/Employed Physician 40.58 0.00 X 529711 0 77840 Bobbie Schneller MD Board Member/Employed Physician 40.96 0.00 X 369327 0 61981 Michael Statz MD Board Member/Employed Medical Director 40.87 0.00 X 146213 0 2472 Steven Frost MD Board Member 0.58 0.00 X 5500 0 0 Daryl Reinicke Chair 1.27 0.00 X X 0 0 0 Holly Lien Board Member 0.77 0.00 X 0 0 0 Ross Mckie Board Member 1.65 0.00 X 0 0 0 Scott Barbour Board Member 0.69 0.00 X 0 0 0 Tom Rau Board Member 0.77 0.00 X 0 0 0 Col Michelle Schnakenberg Board Member 0.48 0.00 X 0 0 0 Dusty Petersen Board Member 1.04 0.69 X 0 0 0 Mark A Thompson CFO/CBDO From 01/2024 46.59 8.41 X 868581 0 49983 Austin Willuweit VP Finance/ CFO From 01/2024 46.59 8.41 X 340040 0 60239 John Pierce President Rapid City Hospital / Market 55.00 0.00 X 722589 0 113854 Patrick Woodard Chief Healthcare Infor. Officer 46.59 8.41 X 565975 0 65925 Michael Tilles VP Operations-Rapid City Market 55.00 0.00 X 412329 0 48064 Mark Longacre VP Operations-Rapid City Market 55.00 0.00 X 396927 0 58241 Mark Schulte VP Rapid City Market 55.00 0.00 X 364167 0 61453 Tasha Frisinger VP of Nursing 55.00 0.00 X 255367 0 54001 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1617558 0 139352 Charan Mungara MD Physician - Cardiology 40.00 0.00 X 1539230 0 115852 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1491379 0 150985 Siri Knutsen Larson MD Physician - Dermatology 40.00 0.00 X 1423594 0 139132 Kyle Schmidt MD Physician - Neurosurgery 40.00 0.00 X 1391422 0 119835 Nicole Kerkenbush-Former Chief Nursing/Perf Officer 46.59 8.41 X 203850 0 17642 13520425 1727313 1715086 680 1 1 0 Travel Nurse across America LLC 5020 Northshore Drive North Little Rock AR 72118 Contract Labor 56061620 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Professional services 13466513 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 30368 Professional services 11968144 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 10719111 Weatherby Medical Staffing PO Box 972633 Dallas TX 75397 Contract labor 9805091 394 128706 11008979 3511829 14649514 Pharmacy 621400 221292597 215034591 6258006 Laboratory 621500 122882999 122270739 612260 Surgical Services 621110 96584311 96584311 MIS CT Scan 621500 45438130 45438130 Cardiac Services 621110 20510690 20510690 476340507 475113786 1226721 983049234 11079598 11079598 704420 704420 1184447 977928 206519 206519 206519 21198115 0 21198115 21198115 21198115 802780 128706 109590 693190 693190 277407 153865 123542 123542 1031704132 975075789 8096987 33881842 X 1512792 1512792 6030486 1034422 4996064 386385 386385 375283553 308599868 66125422 558263 9215264 7484724 1717062 13478 1525901 1239351 284318 2232 23604812 18745093 4821147 38572 8918934 810228 8096206 12500 1104153 1104153 372915 372915 42029 42029 140778177 106982356 33794811 1010 1142095 28441 1093251 20403 15935897 7502333 8104410 329154 23704685 4475595 19177746 51344 30893540 11300301 19591255 1984 1893445 1335647 547949 9849 1265855 15088 1250767 10490031 10476107 13924 55424054 39664001 15729443 30610 4529201 877092 3652109 Medical Supplies 203517677 203224335 293057 285 Interco Supplies/Servic 65240126 63851042 1389084 All other expenses 4124977 598061 3525915 1001 UBI Tax 33006 33006 986969990 790143262 195756043 1070685 26082675 52052042 31325460 9765128 120275308 133132371 27397609 28753819 13839488 17773530 960879137 467210820 522125485 493668317 241276882 312214814 351347903 356323249 7767722 7223666 13643973 11548088 1355082505 1422455024 84891254 94745939 337498000 329259000 26285258 26285000 81519719 75105950 530194231 525395889 X 803564484 870979020 21323790 26080115 824888274 897059135 1355082505 1422455024 X 44734142 26775654 661065 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 42029 42029 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 2024 dues which were paid in fiscal year 2024 in the amount of $356,420.48, 5.50% 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 2024 dues which were paid in fiscal year 2024 in the amount of $70,080, 32.00% was used for lobbying purposes. In fiscal year 2024 $42,028.73 of dues expense were incurred in regard to lobbying. 1662929 100000 7500 1755429 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1.00000 0 0 13101820 13101820 625670659 236258118 389412541 309048450 224358022 84690428 13058208 6594680 6463528 493668317 Equity Securities and Funds - Domestic 83192443 F Equity Securities and Funds - International 85543005 F Investment in Privately Held Companies 3861279 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Private Equity/Debt 106775403 F Real Estate Funds 3647594 F Absolute Return Assets - Hedge Funds 30303294 F 356323249 Other Long Term Liabilities 21434912 Due from related party 53245689 Lease liability 425349 75105950 X Part V, Line 4: 1. 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 $1,755,429 endowment funds, $684,832 are restricted to be used for grants/scholarships to students in a healthcare program, $612,197 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 45042000 North America - Canada and Mexico, but not the United States 0 0 Investment 1561000 0 0 0 0 0 0 46603000 0 46603000 1 0 1 1 1 0 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 478645 49500 429145 28778 45980 4396 Hospice Ball 109833 5284 104549 1592 12409 16280 155 12 332580 73922 258658 921058 128706 792352 1592 41187 62260 4551 109590 682762 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 11233260 11233260 0.01140 170860787 84387184 86473603 0.08760 182094047 84387184 97706863 0.09900 7122246 7122246 0.00720 102157943 50283568 51874375 0.05260 1070965 1070965 0.00110 110351154 50283568 60067586 0.06090 292445201 134670752 157774449 0.15990 1 25266 25266 0.00000 1 13071 13071 0.00000 2 38337 38337 0.00000 1 80006459 232694636 238525414 -5830778 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 Services 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 fiscal year 2024, Monument Health focused on 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; and Access to Medical Services: Right Care, Right Place. Teams from Rapid City Hospital, Same Day Surgery Center, Monument Health Network, and community representatives collaborated on implementing the Community Health Improvement Plan (CHIP).Cancer Care InitiativesMonument Health made significant strides in cancer prevention, treatment, and survivorship with three key objectives:Improved patient access and expanded services through the Cancer Care Institute Expansion, increased infusion capacity, reestablished Breast Surgery Program, reinstituted survivorship visits, support groups, and education classes post-COVID, and added Integrative & Complementary Medicine Services.Positioned the Cancer Care Institute for the future by reviewing investments in Oncology pharmacy support through alignment with other ambulatory pharmacy service lines and adding Specialty & Clinical Pharmacists. The organization invested in oncology devices & technological advances including CT and Radiation Oncology Machine upgrades.Increased awareness of cancer resources by implementing South Dakota's Comprehensive Cancer Control Program and building relationships with the Monument Health Foundation, Black Hills Road Trip of Hope, Walking Forward, and American Cancer Society.Heart Disease and Stroke AdvancementsMonument Health maintained stable coronary angiography and Percutaneous Coronary Intervention (PCI) volumes while achieving the lowest number of post-PCI deaths in recorded facility history. Their post-PCI In-Hospital Risk Standardized Mortality rates ranked better than the 90th percentile compared to over 1,700 participating sites. For the 12th consecutive year, Monument Health received the American Heart Association Chest Pain Myocardial Infarction (MI) Platinum Achievement Award.All Acute Myocardial Infarction (AMI) performance composites continued to exceed national averages. Despite a 25% increase in AMI patients, primarily due to more Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) patients, mortality rates remained stable. The AMI In-Hospital Risk Standardized Mortality reached the 90th percentile compared to over 700 participating hospitals. The cardiovascular surgery program continued to grow with excellent results.Stroke care advanced with the development of a Comprehensive Stroke Center staffed by two Interventional Neurologists and an expanded Interventional Radiology (IR) team. Education enriched the knowledge of medical staff and patients about early stroke recognition. Emergency Room stroke protocols were updated across the health system to meet Joint Commission guidelines. A new stroke alert process for Large Vessel Occlusion was developed with the Transfer Center and Emergency Departments. A dysphagia performance improvement project continued throughout FY24, with mandatory iLearn dysphagia training implemented. Monument Health received the American Heart Association Get with Guidelines Gold Plus Award for Stroke.Diabetes, Nutrition, Physical Activity, and Weight ManagementMonument Health pursued three objectives to improve diabetes care:Increased community awareness of diabetes prevention and management programs by providing screenings and education at 20 different community health fairs, offering certified trainers for the Monument Health Diabetes Prevention Program and Better Choices Better Health programs, and continuing the annual Diabetes Symposium, which attracted over 150 participants.Improved transition from inpatient to outpatient care by streamlining the outpatient referral process with the inpatient Case Management Team, implementing system-wide RN Diabetes rounding, expanding the inpatient Endocrinology team with greater outreach, and partnering with nursing triage services for post-discharge support.Improved patient access for Primary Care and Diagnostic Procedures through ongoing outreach clinics and streamlined Dietetic Services.Mental Health and Substance Abuse ResourcesMonument Health implemented six strategies to increase access and awareness of mental health and substance abuse resources:Established clear direction for substance abuse disorder care by developing consistent care guidelines and aligning programming with national standards to offer a broader spectrum of outpatient services for adults.Developed strategies to mitigate labor challenges by implementing new services to retain staff, clarifying roles for APPs to maximize their use, and developing telemedicine capabilities to expand patient access.Improved therapeutic programming for inpatients through standardized therapeutic objectives and clarified operational reporting structures for therapeutic teams.Defined effective patient flow strategies with standardized guidelines for both inpatient and outpatient services, improved care delivery for geriatric psychiatric patients, and optimized operational setup of outpatient clinics.Defined a strategy for health equity through partnerships with Indian Health Services and Oyate and development of population health research strategies.Met community needs through optimized provider scheduling tools, improved Medicaid funding initiatives, and evaluation of care delivery and billing practices.Access to Medical Services: Right Care, Right PlaceMonument Health increased access to care through several key project activities: Increased visit volume through optimized templates and greater provider availability Improved scheduling accuracy to route patients to correct providers and reduced rescheduling needs Enhanced patient retention through referral capture, resulting in additional visits and downstream revenue Expanded patient acquisition through digital options and conveniences like online scheduling Increased staff efficiency through standardized workflows and cross-coverage within the Patient Contact Center Improved provider satisfaction with streamlined workflows and simplified referral processes Maintained focus on Primary Care recruitmentThe Care Access Workplan included four main components:Integrated Team efforts to efficiently use patient and clinician time, assign patients to appropriate care levels quickly, improve communication, and support roles based on licensure.Nurse Triage to prioritize care based on clinical assessment and Schmidt and Thompson protocols, enhance patient experience, and support provider efficiencies.Scheduling Templates with accurate templates and locations, appropriate security, and alignment to provider in-clinic time.Referrals with proactive management of ordered services and close-the-loop follow-up procedures to promote continuity of care.Through these comprehensive efforts across all five priority areas, Monument Health demonstrated its commitment to addressing the most pressing health needs of its communities. 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 FY24 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 FY24 implementation plan are: Access to Health Services, Diabetes, Heart disease and stroke, Injury and violence, Mental health, Potentially disabling conditions, Sexually transmitted diseases, Substance abuse and Tobacco use. 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) Donated to Black Hills Road Trip of HopeNutrition, 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 Staff supported Love Inc.'s banquet and baked numerous goods that sold for over $10,000 to donate to local churches and food banks 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/financial-assistance/ Part V, Lines 16a-c Same Day Surgery Center The Financial Assistance Policy, Application form, and plain language summary are available at https://www.samedaysurgerycenter.org/index.php?page=financial-assistance 5 1 - Monument Health Home Care-Hospice House 224 Elk St Rapid Ctiy SD 57701 End of Life Care 2 - Monument Health Dialysis Center 132 Yankee St Spearfish SD 57783 Dialysis Center 3 - Monument Health Home Care-Spearfish 1440 North Main Street Spearfish SD 57783 Home Care 4 - Monument Health Medical Clinic 122 7th Ave Wall SD 57790 Clinic 5 - Monument Health Dialysis Center 955 East North St Rapid Ctiy SD 57701 Dialysis 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, 7b and 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) 82000 0 Community development South Dakota Ellsworth Development Authority PO Box 477 Rapid City SD 57709 271166754 Other Exempt Entity 10250 0 Community development American Heart Association Inc 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 10000 0 Donation United Way of the Black Hills 621 6th St Suite100 Rapid City SD 57701 460259754 501(c)(3) 5250 0 Donation Pennington County Treasurer 300 Kansas City St Rapid City SD 57701 466000381 Government 750000 0 Crisis Stabilization Unit SD State University Foundation 815 Medary Ave Brookings SD 57006 460273801 501(c)(3) 500000 0 Donation Wellspring Inc DBA Wellfully 22 Waterloo St Rapid City SD 57701 460414463 501(c)(3) 52000 0 Donation Leadership South Dakota PO Box 675 Platte SD 57369 820880122 501(c)(3) 30000 0 Donation SD Governor's Office of Economic Development 711 E Wells Ave Pierre SD 57501 466000364 Government 15000 0 Donation Black Hills State University Foundation 1200 University St Unit 9506 Spearfish SD 57799 237428348 501(c)(3) 12500 0 Donation SD Community Foundation PO Box 296 Pierre SD 57501 460398115 501(c)(3) 10000 0 Donation Feeding South Dakota 4701 N Westport Ave Sioux Falls SD 57107 363293534 501(c)(3) 8292 0 Donation City of Box Elder 420 Villa Dr Box Elder SD 57719 460281490 Government 7500 0 Donation State of South Dakota HOSA - Future Health Professionals 1400 W 22nd St Sioux Falls SD 57105 466000364 Government 7500 0 Donation SD Chamber of Commerce & Industry PO Box 190-222 E Capitol 17 Pierre SD 57501 460141180 501(c)(6) 7000 0 Community development Suncatcher Therapeutic Riding Academy Inc PO Box 3975 Rapid City SD 57709 460461253 501(c)(3) 5500 0 Donation 13 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 1158268 0 369600 0 199445 0 224622 0 28860 0 1980795 0 176555 Joseph Tuma MD Physician - Cardiology 1521792 0 32500 0 63266 0 106070 0 33282 0 1756910 0 63266 0 Charan Mungara MD Physician - Cardiology 1509130 0 30100 0 0 0 90480 0 25372 0 1655082 0 0 0 Bhaskar Purushottam MD Physician - Cardiology 1378438 0 32500 0 80441 0 110982 0 40002 0 1642363 0 80441 0 Siri Knutsen Larson MD Physician - Dermatology 1380838 0 3200 0 39556 0 97415 0 41717 0 1562726 0 39556 0 Kyle Schmidt MD Physician - Neurosurgery 1362172 0 29250 0 0 0 80969 0 38865 0 1511256 0 0 0 Brad Archer MD Chief Medical Officer 643589 0 148000 0 85077 0 98862 0 25891 0 1001419 0 71687 0 Mark A Thompson CFO/CBDO From 01/2024 593215 0 116600 0 158766 0 25504 0 24478 0 918563 0 150096 0 John Pierce President Rapid City Hospital / Mark 534122 0 124700 0 63767 0 80265 0 33589 0 836443 0 40877 0 Patrick Woodard Chief Healthcare Infor. Officer 426049 0 65528 0 74398 0 57376 0 8549 0 631900 0 0 0 Jacob Weasel MD Board Member/Employed Physician 494084 0 21000 0 14627 0 44918 0 32922 0 607551 0 14627 0 Michael Tilles VP Operations-Rapid City Market 322696 0 59400 0 30233 0 31321 0 16743 0 460393 0 14887 0 Mark Longacre VP Operations-Rapid City Market 307694 0 57900 0 31333 0 29494 0 28747 0 455168 0 15177 0 Bobbie Schneller MD Board Member/Employed Physician 337876 0 15000 0 16451 0 33109 0 28872 0 431308 0 16451 0 Mark Schulte VP Rapid City Market 283862 0 54200 0 26105 0 27611 0 33842 0 425620 0 10981 0 Austin Willuweit VP Finance/ CFO From 01/2024 264550 0 50700 0 24790 0 27071 0 33168 0 400279 0 10653 0 Tasha Frisinger VP of Nursing 223034 0 20390 0 11943 0 23136 0 30865 0 309368 0 0 0 Nicole Kerkenbush-Former Chief Nursing/Perf Officer 169529 0 0 0 34321 0 15612 0 2030 0 221492 0 27979 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 209,620 Brad Archer MD 84,592 Patrick Woodard 44,176 Austin Willuweit 13,920 Nicole Kerkenbush 6,342 Barbara Hespen 15,471 John Pierce 59,744 Michael Tilles 17,541 Mark Longacre 15,908 Mark Schulte 14,888 Tasha Frisinger 11,760 Joseph Tuma MD 88,355 Charan Mungara MD 77,280 Bhaskar Purushottam MD 93,580 Siri Knutsen Larson MD 83,145 Kyle Schmidt MD 67,060 Bobbie Schneller MD 21,227 Jacob Weasel MD 31,200 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 176,555 Brad Archer MD 71,687 Mark Thompson 150,096 Austin Willuweit 10,653 Nicole Kerkenbush 27,979 John Pierce 40,877 Michael Tilles 14,887 Mark Longacre 15,177 Mark Schulte 10,981 Joseph Tuma MD 63,266 Bhaskar Purushottam MD 80,441 Siri Knutsen Larson MD 39,556 Bobbie Schneller 16,451 Jacob Weasel MD 14,627 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 48662122 241560080 1807893 185230960 54521227 2019 0 1 1 1 B 16177836 139921863 1143985 85179027 53598850 2023 0 0 1 1 A 0 1 1 0 1 0 0.00700 0.01220 0.01920 0 0 1 B 0 0 0 0 0.00440 0.00000 0.00440 0 0 0 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 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 $1,479,027. Amy Kress Family member of Mark Thompson 73431 Employee compensation 0 Becky Sharp Family member of Mark Thompson 133814 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 62199 Employee compensation 0 Kody Sharp Family member of Mark Thompson 42260 Employee compensation 0 Alyssa Brunner Family member of Director 74681 Employee compensation 0 Form 990, Part III, line 3 The Hospital ceased operations of a rehabilitation facility and made the decision to discontinue certain outpatient dialysis services. 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 Dusty Petersen. The relationship exists because Dusty Peterson is on the board of Monument Health Inc, which employes Paulette Davidson. 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 labor: Program service expenses 83,346,836. Management and general expenses 174,032. Fundraising expenses 1,010. Total expenses 83,521,878. Professional Fees: Program service expenses 124,562. Management and general expenses 4,086,015. Fundraising expenses 0. Total expenses 4,210,577. Purchased Service: Program service expenses 23,510,958. Management and general expenses 29,534,764. Fundraising expenses 0. Total expenses 53,045,722. Form 990, Part XI, line 9: Released From Restriction -2,171,242. Reverse Auxiliary Net Income -20,376. Record Accum. Pension Liability 2,790,812. Transfers 167,106. Reverse Medical Staff Net Income -105,235. 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 131278174 20428059 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 2416400 1764779 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 511146 1798292 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 2100000 FMV Medical & Dental Building P 671639 FMV Same Day Surgery Center L 5498512 FMV