2023-05-15T07:45:12-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Mark Thompson CFO 6057559130 2023-05-12 1 Mark Thompson 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-12 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 928759825 0 X www.monument.health X 1973 SD Monument Health Rapid City Hospital is dedicated to improving the health of individuals and our communities. 15 11 5028 188 9323299 501544 34190586 19062879 890597533 886367787 26215401 21422326 837469 402635 951840989 927255627 362500 438151 0 0 361967981 388321658 0 0 919741 537602447 517122502 899932928 905882311 51908061 21373316 1522340119 1405384189 598496243 567389962 923843876 837994227 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 603521953 438151 717984751 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. The hospital provides comprehensive care, including Level II Trauma Care. MHRCH also includes Monument Health Orthopedic and Specialty Hospital (MHOSH). MHOSH focuses on orthopedics, neurosurgery and podiatry, as well as related outpatient services, related therapy services and sports performance services.MHRCH is also the single member of Monument Health Home Plus, LLC. 48555742 64011397 Monument Health Home Plus, LLC Specialty Pharmacy offers high-cost, high-touch medication therapy for patients with complex diseases. These include cancer, multiple sclerosis, Crohn's disease, hepatitis C, psoriasis, rheumatoid arthritis and rare genetic conditions. The medications often require special storage, handling, and/or administration. 32791735 56613535 RCH Surgical Services - provide in and out-patient surgical services to acute care patients. 27728080 38497242 RCH Pharmacy - provide pharmaceuticals in support of acute care hospital patients. 27728080 38497242 712597510 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 1 586 0 1 5028 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 15 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X Mark Thompson 6057559127 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Daryl Reinicke Board Member 1.17 0.00 X 0 0 0 Steven Frost MD Board Member 0.93 0.00 X 4000 0 0 Col Robert Corby Board Member 0.58 0.00 X 0 0 0 Sandra Burns Board Member 0.77 0.00 X 0 0 0 Scott Barbour Board Member 0.96 0.00 X 0 0 0 Dusty Pinske Board Member 0.77 0.65 X 0 0 0 Tom Rau Board Member 0.64 0.00 X 0 0 0 Deidre Budahl Board Member 1.54 0.00 X 0 0 0 Ross Mckie Chair 1.27 0.00 X X 0 0 0 Srinivas Gangineni MD Board Member/Employed Physician 40.77 0.00 X 748853 0 79579 Michael Statz MD Board Member/Employed Physician 40.96 0.00 X 151507 0 1907 Jacob Weasel MD Board Member/Employed Physician 40.84 0.00 X 556000 0 69664 Paulette R Davidson President & CEO 50.00 10.00 X X 0 1310683 218349 Mark A Thompson CFO/Treasurer 45.83 9.17 X 612762 0 94486 Teresa Burroff General Counsel/Secretary 45.83 9.17 X 528067 0 38034 Brad Archer MD Chief Medical Officer 45.83 9.17 X 828920 0 111567 Nicole Kerkenbush Chief Nursing/Performance Officer 45.83 9.17 X 387341 0 16652 Stephanie Lahr MD CIO/CMIO 45.83 9.17 X 567864 0 48323 Michael Tilles President Home Plus 55.00 0.00 X 362949 0 44030 Mark Longacre VP Operations-Rapid City Market 55.00 0.00 X 392382 0 41433 John Pierce President Rapid City Market 55.00 0.00 X 544526 0 89630 Douglas Koch term 71321 VP Rapid City Market 45.83 9.17 X 251107 0 27249 Michael Latour System Director of Musculoskeletal Care 55.00 0.00 X 201162 0 33721 Trina Allen VP Human Resources 45.83 9.17 X 272576 0 12165 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1439829 0 100548 Charan Mungara MD Physician - Cardiology 40.00 0.00 X 1283381 0 107273 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1470888 0 110787 Robert Santa-Cruz MD Physician - Urology 40.00 0.00 X 1240988 0 76610 Kalyan Vunnamadala MD Physician - Cardiology 40.00 0.00 X 1269071 0 115895 Thomas Worsley President Spearfish Market 0.00 55.00 X 0 438480 35100 13114173 1749163 1473002 536 1 1 0 Medefis 10826 Old Mill Rd 101 Omaha NE 68105 Contract labor 26060604 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Professional services 14476721 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 13673961 AYA Healthcare Inc 2550 University Ave West Suite 320N St Paul MN 55114 Medical Staffing 11191418 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 30368 Professional services 8894028 353 41168 16986426 2035285 19062879 In Patient Pharmacy 446110 174568082 174568082 Surgical Services 622110 116068366 116068366 Cardiac Services 622110 94006813 94006813 MIS CT Scan 621500 71393396 71393396 Laboratory 621500 56190141 54254294 1935847 374140989 366753537 7387452 886367787 7692481 7692481 17554 17554 1422747 1291765 130982 130982 130982 13712291 0 13712291 13712291 13712291 305120 41168 95904 209216 209216 178966 116529 62437 62437 927255627 877106925 9323299 21762524 X 438151 438151 8895454 2088720 6806734 382240 382240 347447504 282574997 64412263 460244 9696378 7748018 1935850 12510 120412 96217 24040 155 21779670 17140863 4603935 34872 6344004 331172 6011902 930 502012 502012 464100 464100 209090 209090 147367120 113307015 34059266 839 1255410 33802 1162119 59489 19098779 10079435 8768523 250821 20731112 3783881 16875781 71450 29051160 9885718 19163467 1975 2324645 1445667 870352 8626 849021 65938 783083 9764778 9764778 49139009 30253404 18868222 17383 3636552 715104 2921448 Medical Supplies 222575217 222286313 288457 447 All other expenses 2341685 176077 2165608 Interco Supplies/Servic 1425696 1425696 UBI Tax 43112 43112 905882311 712597510 192365060 919741 41772129 31726572 21488897 82612122 123891844 133917359 24269941 27611166 15020965 17519116 873864688 365823697 481562694 508040991 334835929 162886141 475666040 425997462 2541789 2541789 1289891 12531471 1522340119 1405384189 187968814 121121966 354900207 372096299 25251406 30375816 74171697 598496243 567389962 X 895510202 811150365 28333674 26843862 923843876 837994227 1522340119 1405384189 X 21373316 -93066456 -14156509 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 59090 59090 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 2022 dues, which were paid in fiscal year 2022, in the amount of $285,549, 7.80% 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 2022 dues, which were paid in fiscal year 2022, in the amount of $68,039, 26.47% 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 2022 dues, which were paid in fiscal year 2022, in the amount of $11,537, 33.00% was used for lobbying purposes. In fiscal year 2022, $15,000 of consulting expense was incurred in regard to lobbying. 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 0 0 12056726 12056726 539192460 179800025 359392435 268924359 180421869 88502490 53691143 5601803 48089340 508040991 Private Equity/Debt 30850553 F Real Estate Funds 5739159 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Investment in Privately Held Companies 3811505 F Equity Securities and Funds - Domestic 166297725 F Equity Securities and Funds - International 74333459 F Fixed Income - Bond Funds & Corp Bonds - Domestic 26774256 F Absolute Return Assets - Hedge Funds 75190574 F 425997462 Other Long Term Liabilities 16297559 Accrued Pension Liability 13260419 Due from related party 44613719 74171697 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 21688713 North America - Canada and Mexico, but not the United States 0 0 Investment 2536426 0 0 0 0 0 0 24225139 0 24225139 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/ did not require filing Form 926. The organization's transfers to foreign partnerships did 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. Tough Enoung to Wear Pink 69139 41168 27971 5668 Northern Hill Hospice Ball 62183 62183 1367 9090 750 4651 8 210931 210931 72731 342253 41168 301085 1367 9090 750 83050 94257 206828 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 7682430 7682430 0.00850 83185739 53949848 29235891 0.03230 90868169 53949848 36918321 0.04080 23 3119 8624018 8624018 0.00950 3 6486605 4642895 1843710 0.00200 24268188 3521252 20746936 0.02290 1621048 1395198 225850 0.00020 4 615157 615157 0.00070 30 3119 41615016 9559345 32055671 0.03530 30 3119 132483185 63509193 68973992 0.07610 1 20200 20200 0.00000 1 3731 3731 0.00000 1 82101 82101 0.00010 1 23221 23221 0.00000 2 10033 10033 0.00000 1 25753 25753 0.00000 7 165039 165039 0.00010 1 62512018 0 212694862 235688968 -22994106 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://monument.health/about-us/community-health-needs-assessment/ Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 11: Monument Health identified the following five priority areas during its FY22 CHNA process: Cancer, Heart Disease and Stroke, Diabetes, Mental Health, and Access to Medical Service. The first four needs are continuations of needs identified in the prior CHNA. Due to timing of the new implementation strategy, the facility focused on the needs identified in the prior implementation strategy.During FY22, Monument Health focused on the following four priority areas identified through the FY19 Community Health Needs Assessment (CHNA): Cancer Heart Disease and Stroke Diabetes Mental HealthWork was also dedicated to COVID-19 initiatives across the health system. Teams 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).Cancer Continued construction on the expansion of the Cancer Care Institute with estimated completion of July 2023. The new space will more than double the space of the existing facility to expand radiation and medical oncology, expand infusion services, and add comprehensive brachytherapy services and integrated services. Successful recruitment of two Gynecological Oncologists for additional access to care. Continued Breast Survivorship Visits to provide continued high risk screening platform and cancer genetics counseling. Implemented High-dose-rate brachytherapy (HDR) for prostate cancer patients to improve relapse-free and survival rates. Utilized Genetics Navigator Platform to recommend cancer screenings. Continued use of telehealth and tele-video visits to support cancer patients throughout the COVID-19 pandemic. Implemented complementary and alternative medicine through movement and exercise, and education-nutrition support groups. Improved Oncology Pharmacy support through alignment with ambulatory pharmacy services and addition of specialty and clinical pharmacists. Continued participation in South Dakota 2021-2025 Comprehensive Cancer Plan's goals, priorities and tactics throughout Monument Health. Actively contributed to the program with representation and project leaders. Utilized the Mayo Clinic Care Network to collaborate on individual patient cancer care to provide patients with care close to home. Provided cancer education at community events including Judd Hoos Charity Concert for Cancer, Rush Hocky Fights Cancer, Custer Mammo or Bust Run Walk, Deadwood Days of 76 Rodeo, and the Tough Enough to Wear Pink program throughout Black Hills Stock Show and Rodeo Rapid City.Heart Disease and Stroke Hosted and participated in events to increase awareness of Heart Disease and Stroke including the American Heart Association (AHA) Heart Ball, the AHA Heart Walk and February Freeze run/walk. Provided blood pressure screenings and education at community events, including one of the largest regional events, the Black Hills Stock Show and Rodeo Rapid City. Provided education to area providers through the annual Cardiac Symposium. This event highlights current heart and stroke topics, advancements in cardiac medicine, lifestyle management and new physicians and APPs to the community. Provided heart and vascular outreach clinics in Spearfish, Chadron, Alliance, Belle Fourche, Newcastle, Custer and Hot Springs. Updated processes for Stroke Alert to meet Joint Commission goals for stroke patients. Successfully recruited an Interventional Neurologist to maximize patient care. Utilized the Mayo Clinic Care Network to collaborate on care for cardiology and stroke patients, to provide patients with care close to home.Diabetes Offered virtual options for the Monument Health Diabetes Prevention Program and the Better Choices Better Health program for patients identified by case managers and/or diabetes educators. These programs were offered in partnership with the SDSU Extension Office and SD Foundation for Medical Care. Provided education to area providers through the annual Diabetes Symposium. This event was held virtually this year due to the continued pandemic. Pursued Medicare Diabetes Prevention Program supplier status with goal of implementing program late-2022. Continued use of LACES program to improve transition from inpatient to outpatient care. Program focuses on Low Blood Glucose, A1C, Consults, Education and Survival Skills for patients. Initiated development of Community Health Worker program which will provide opportunity to assess and mitigate SDOH disparities through community referrals. Case managers and clinic champions continued to identify patients on provider panels with HbA1C greater than 8 to provide intensive case management. Supported local events for Diabetes education including Diabetes Inc. and the Black Hills Dialysis Group. Provided telephonic and tele-video visits for patients during COVID-19 and explore options to continue post-pandemic. Held ongoing outreach clinics monthly in the communities of Spearfish, Sturgis, Belle Fourche, Lead/Deadwood, Hot Springs, Hill City, Custer, and Newcastle. Completed diabetes screenings at community events such as the Black Hills Stock Show.Mental Health Expanded the availability of counselors in three primary care facilities. Recruited two outpatient psychiatrists. Provided caregiver mental health support through a part-time risk assessment coordinator/counselor and a full-time support counselor. Collaborated with Pennington County Care Campus for establishment of 16 bed short stay Crisis Stabilization Unit. Continued collaboration with Pennington County Care Campus and provided representation on their Advisory Board. Opened Adolescent Crisis Care in October of 2021 and is supported by Pennington County, Behavior Management Systems, Wellfully and Monument Health. Continued efforts in training of Trauma Informed Care and provided toolkits for Emergency Department and Medical Staff. Caregivers are continuously trained through orientation, monthly meetings, and annual competency. Professional development of caregivers in areas of Trauma Informed Care, Grief Counseling, and sleep deprivation and brain function. Participated in implementation of 988 statewide hotline for suicide support, crisis management, and care. Increased partnership with Great Plains Tribal Chairman Health Board for new programs and training seminars.In acknowledging the wide range of priority health issues revealed through the FY22 CHNA process, Monument Health 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 FY22 implementation plan are: Infant health and family planning; Injury & violence; Nutrition, Physical Activity & Weight; 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. 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 FY22 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 FY22 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.Due to timing of the new implementation strategy, the facility focused on the needs identified in the prior implementation strategy.During FY 2022 Same Day Surgery Center focused on the following two priority areas identified through the FY19 Community Health Needs Assessment (CHNA):CancerDiabetesTeams 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 Supporter of Tough Enough to Wear Pink, large financial contribution to MH Foundation to address needs of community cancer patients. Participated in wellness fairs, in collaboration with Dermatolgy and Mammography, to provide education on cancer screening opportunities. Partnered with the Susan G. Komen Foundation for education and awareness.Diabetes Continued to utilize a system-wide approach to education and documentation in the electronic medical record. Continued to provide education and equipment to patients.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.In addition to addressing these needs, work was also dedicated to COVID-19 initiatives across the health system. 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 End of Life 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 End of Life 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, 7b, and 7g. Actual costs are used for the calculation of costs of services provided for lines 7e, 7f, 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. 0 Elevate Rapid City PO Box 747 Rapid City SD 57701 460118545 501(c)(3) 50000 0 Diamond level pledge Yellow Jacket Foundation 1200 University Unit 9411 Spearfish SD 57799 510151319 501(c)(3) 10000 0 Athletic Sponsorship BH Area Community Foundation 803 St Joseph St Rapid City SD 57701 363608635 501(c)(3) 40000 0 Rapid City Strategic Housing Trust Fund & HRC/MOA Partnership Leadership South Dakota PO BOX 91533 Sioux Falls SD 57109 820880122 501(c)(3) 20000 0 Silver Sponsorship Fee Pennington County Treasurer 300 Kansas City Street Rapid City SD 57701 466000381 Government 250000 0 Crisis Stabilization Unit SD Governor's Office Of Economic Development 711 E Wells Ave Pierre SD 57501 466000364 Government 15000 0 2022 Governor's Hunt Sponsorship South Dakota Ellsworth Development Authority PO Box 747 Rapid City SD 57701 460118545 501(c)(3) 13000 0 2022 Military Support Programming and Ellsworth Air Show City of Box Elder 420 Villa Drive Box Elder SD 57719 460281490 Government 13000 0 2022 Events Sponsorship American Heart Association Inc 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 10000 0 Events Sponsorship Shriners International 4091 Sturgis Road Rapid City SD 57702 460168705 501(c)(10) 6150 0 Sponsorship University of South Dakota 414 East Clark Street Vermillion SD 57069 466000364 Government 6000 0 Sponsorship Black Hills Works Foundation Inc PO Box 2104 Rapid City SD 57709 460363653 501(c)(3) 5001 0 Sponsorship 11 1 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 Bhaskar Purushottam MD Physician - Cardiology 1376349 0 52000 0 42539 0 75428 0 35359 0 1581675 0 42539 0 Joseph Tuma MD Physician - Cardiology 1339379 0 52000 0 48450 0 81260 0 19288 0 1540377 0 48450 0 Paulette R Davidson President & CEO 0 980593 0 310590 0 19500 0 190062 0 28287 0 1529032 0 0 Charan Mungara MD Physician - Cardiology 1259381 0 24000 0 0 0 81600 0 25673 0 1390654 0 0 0 Kalyan Vunnamadala MD Physician - Cardiology 1245071 0 24000 0 0 0 81600 0 34295 0 1384966 0 0 0 Robert Santa-Cruz MD Physician - Urology 1220988 0 20000 0 0 0 75080 0 1530 0 1317598 0 0 0 Brad Archer MD Chief Medical Officer 576035 0 165034 0 87851 0 89578 0 21989 0 940487 0 77085 0 Srinivas Gangineni MD Board Member/Employed Physician 687218 0 33037 0 28598 0 46372 0 33207 0 828432 0 28598 0 Mark A Thompson CFO/Treasurer 461087 0 132175 0 19500 0 66881 0 27605 0 707248 0 0 0 John Pierce President Rapid City Market 399688 0 125338 0 19500 0 57183 0 32447 0 634156 0 0 0 Jacob Weasel MD Board Member/Employed Physician 528000 0 28000 0 0 0 40011 0 29653 0 625664 0 0 0 Stephanie Lahr MD CIO/CMIO 421886 0 126478 0 19500 0 12362 0 35961 0 616187 0 0 0 Teresa Burroff General Counsel/Secretary 394158 0 114409 0 19500 0 12207 0 25828 0 566102 0 0 0 Thomas Worsley President Spearfish Market 0 341486 0 79358 0 17636 0 7347 0 27753 0 473580 0 0 Mark Longacre VP Operations-Rapid City Market 290972 0 53838 0 47572 0 15090 0 26343 0 433815 0 32616 0 Michael Tilles President Home Plus 284451 0 65723 0 12775 0 28750 0 15281 0 406980 0 0 0 Nicole Kerkenbush Chief Nursing/Performance Officer 306411 0 69368 0 11562 0 12193 0 4458 0 403992 0 0 0 Trina Allen VP Human Resources 215576 0 47000 0 10000 0 10522 0 1643 0 284741 0 0 0 Douglas Koch term 71321 VP Rapid City Market 158663 0 62040 0 30404 0 13391 0 13858 0 278356 0 26069 0 Michael Latour System Director of Musculoskeletal C 200662 0 500 0 0 0 11913 0 21808 0 234883 0 0 0 Michael Statz MD Board Member/Employed Physician 138250 0 13257 0 0 0 1907 0 0 0 153414 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 177,700 Brad Archer MD 77,526 Mark Thompson 50,078 Douglas Koch 3,930 Mark Longacre 7,478 John Pierce 42,488 Michael Tilles 17,171 Charan Mungara MD 70,000 Bhaskar Purushottam MD 70,821 Robert Santa-Cruz MD 63,180 Joseph Tuma MD 67,751 Kalyan Vunnamadala MD 70,000 Srinivas Gangineni MD 35,662 Jacob Weasel MD 31,710 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: Bhaskar Purushottam MD 42,539 Joseph Tuma MD 48,450 Srinivas Gangineni MD 28,598 Brad Archer,MD 77,085 Mark Longacre 32,616 Douglas Koch 26,069 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 Bonds; 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 15205000 241560080 1807893 185230960 54521227 2019 0 1 1 1 B 1120000 138457764 1143985 83714929 53598850 0 0 0 0 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 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 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 $14,928. Gregg Radtke Family member of Director Sandra Burns 49280 Employee compensation 0 Amy Kress Family member of Mark Thompson 65625 Employee compensation 0 Becky Sharp Family member of Mark Thompson 130300 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 40956 Employee compensation 0 Kody Sharp Family member of Mark Thompson 96078 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 113,307,015. Management and general expenses 34,059,266. Fundraising expenses 839. Total expenses 147,367,120. Form 990, Part XI, line 9: Auxiliary Net Income 72,099. Released From Restriction -1,039,567. Reverse Auxiliary Net Income -69,306. Record Accum. Pension Liability for FY20 -13,131,165. Transfers 11,430. 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 96194264 16201129 Monument Health Rapid City Hospital Inc Black Hills Medical Office Building 353 Fairmont Blvd Rapid City SD 57701 411992146 Medical Office Building SD 137645 1709166 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 1723319 1811625 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 434718 2039543 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 1780000 FMV MEDICAL & DENTAL BUILDING P 467066 FMV