2022-05-12T15:39:12-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Mark Thompson CFO 6057559130 2022-05-12 1 Mark Thompson 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 952721693 0 X www.monument.health X 1973 SD Monument Health Rapid City Regional is dedicated to improving the health of individuals and our communities. 15 7 5082 0 17624604 801093 20214905 34190586 770763546 890597533 7482081 26215401 599780 837469 799060312 951840989 218000 362500 0 0 319122843 361967981 0 0 851358 447960832 537602447 767301675 899932928 31758637 51908061 1290053350 1522340119 529146030 598496243 760907320 923843876 X Our vision at Monument Health Rapid City Regional is to be one team, to listen, to be inclusive, and to show we care. Monument Health Rapid City Regional is dedicated to improving the health of individuals and our communities. 0 0 524800675 362500 579261958 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 47928936 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 145554314 RCH Surgical Services - provide in and out-patient surgical services to acute care patients. 27728080 100286665 RCH Pharmacy - provide pharmaceuticals in support of acute care hospital patients. 27728080 100286665 633876232 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 1 490 0 1 5082 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 15 7 0 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 1.25 0.00 X 0 0 0 Deidre Budahl Board Member 2.38 0.00 X 0 0 0 Jay White DO Board Member 0.83 0.00 X 48665 0 0 Tom Rau Board Member 1.96 0.00 X 0 0 0 Ross Mckie Board Member 2.38 0.00 X 0 0 0 Scott Barbour Board Member 1.12 0.00 X 0 0 0 Sandra Burns Board Member 0.98 0.00 X 0 0 0 Col Robert Corby Board Member 1.08 0.00 X 0 0 0 Srinivas Gangineni MD Board Member/Employed Physician 41.15 0.00 X 651146 0 76580 Alex Schabauer MD Board Member/Employed Physician 42.52 0.00 X 771412 0 99536 Michael Statz MD Board Member/Employed Physician 41.06 0.00 X 150896 0 0 Jacob Weasel MD Board Member/Employed PhysIcian 41.21 0.00 X 538948 0 69851 Jack Lynass Chairman 1.09 0.00 X X 0 0 0 Paulette R Davidson President & CEO 49.24 10.76 X X 0 1194256 204200 Dusty Pinske Board Member 2.15 0.02 X 0 0 0 Mark A Thompson CFO/Treasurer 45.13 9.87 X 567052 0 94448 Teresa Burroff General Counsel/Secretary 45.13 9.87 X 491229 0 58138 Brad Archer MD Chief Medical Officer 45.13 9.87 X 684327 0 101882 Nicole Kerkenbush Chief Performance Officer 45.13 9.87 X 385368 0 38086 Stephanie Lahr MD CIO/CMIO 45.13 9.87 X 495146 0 80097 Michael Tilles President Home Plus 55.00 0.00 X 359256 0 44648 Mark Longacre President Monument Health Orthopedic 55.00 0.00 X 370754 0 52649 John Pierce President Rapid City Market 55.00 0.00 X 502720 0 85442 Michael Latour System Director of Musculoskeletal care 55.00 0.00 X 194483 0 38119 Michelle Stephens VP Ops-Rapid City Market Until 12/2020 55.00 0.00 X 232345 0 44011 Douglas Koch VP Rapid City Market 55.00 0.00 X 380573 0 63236 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1260362 0 104404 John Karl Heilman III MD Physician - Cardiology 40.00 0.00 X 1028020 0 41272 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1144990 0 116187 Rodney SamuelsonMD Physician - Neurosurgery 40.00 0.00 X 1109383 0 86259 Paul Miller MD Physician - Orthopedic Surgeon 40.00 0.00 X 1320863 0 40956 Mary Masten Former General Counsel, Emeritus 16.47 3.59 X 103179 0 12951 Tresha Moreland Former VP Human Resources Operation 0.00 0.00 X 256546 0 931 Thomas Worsley President Spearfish Market 0.00 55.00 X 0 405444 55124 13047663 1599700 1609007 599 1 1 0 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 42655714 Medefis 10826 Old Mill Rd 101 Omaha NE 68105 CONTRACT LABOR 14261790 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 PROFESSIONAL SERVICES 12860647 Morrison Management Specialists Inc PO BOX 102289 Atlanta GA 30368 Professional Services 8388647 Weatherby Locums PO BOX 972633 Dallas TX 75397 Contract Labor 7878618 361 64239 30591923 3534424 34190586 Cardiac Services 622110 221898544 221898544 In Patient Pharmacy 446110 187567526 187567526 Surgical Services 622110 165929161 165929161 Laboratory 621500 165213883 164301688 912195 MIS CT Scan 621500 102099608 102099608 47888811 31205869 16682942 890597533 9442784 9442784 9533 9533 1319831 734949 584882 584882 584882 16763084 0 16763084 16763084 16763084 235613 64239 41970 193643 193643 133262 103785 29477 29477 UBI from Partnerships 900099 29467 29467 29467 951840989 873031873 17624604 26993926 X 362500 362500 8146993 2307166 5839827 465027 465027 326389045 264265014 61593434 530597 2691271 2145275 541733 4263 3975945 3169319 800329 6297 20299700 15886476 4377148 36076 800818 800818 469569 469569 180436 180436 101921393 59719302 42202091 1529345 160911 1317977 50457 16974257 11343126 5424756 206375 18659890 3454512 15205378 27222668 14160338 13057770 4560 1483042 1017344 460469 5229 565866 69035 496831 8326141 7923263 402878 48719350 29640534 19075043 3773 3010153 716183 2293970 Medical Supplies 192345445 192311072 30762 3611 Interco Supplies and Se 113349289 24610072 88739217 All other expenses 1931813 149763 1781930 120 UBI Tax 112972 112972 899932928 633876232 265205338 851358 139068036 41772129 12279791 21488897 0 100402394 123891844 18320680 24269941 14405214 15020965 803370686 321807992 480832960 481562694 233027103 334835929 288421589 475666040 3295583 2541789 0 1289891 1290053350 1522340119 145480668 187968814 273917128 354900207 25251406 109748234 30375816 529146030 598496243 X 737027735 895510202 23879585 28333674 760907320 923843876 1290053350 1522340119 X 51908061 93385307 17643188 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 180436 180436 0 Part II-B, Line 1: Annual dues are paid to the South Dakota Association of Healthcare Organizations. A portion of the dues are applicable to lobbying activities. For calendar year 2021 dues, which were paid in fiscal year 2021, in the amount of $328,118.80, 43.144% 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 2021 dues, which were paid in fiscal year 2021, in the amount of $67,033, 25.56% 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 2021 dues, which were paid in fiscal year 2021, in the amount of $11,256, 31.00% was used for lobbying purposes. In fiscal year 2021, $18,250 of consulting expense was incurred in regard to lobbying. 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 0.00000 1.00000 0.00000 0 0 10310660 10310660 526016521 157131612 368884909 10186635 5067786 5118849 245647863 159608594 86039269 11209007 11209007 481562694 Private Equity/Debt 137550116 F Real Estate Funds 5313245 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Investment in Privately Held Companies 3394577 F Equity Securities and Funds - Domestic 229496056 F Equity Securities and Funds - International 29158762 F Fixed Income - Bond Funds & Corp Bonds - Domestic 27753053 F 475666040 Other Long Term Liabilities 14937811 Accrued Pension Liability 9524889 Due from related party 5913116 30375816 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 23157072 North America 0 0 Investment 1829749 0 0 0 0 0 0 24986821 0 24986821 1 0 0 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. Part IV, Line 4: The organization invests in partnerships that hold direct or indirect interests in passive foreign investment companies. The investment partnerships have properly filed Form 8621, or the underlying investments did not generate any unrelated business income. Under these facts, it is not necessary for the organization to file an additional Form 8621. Part IV, Line 5: The organization has an ownership interest in a foreign partnership. However, the organization is below the ownership percentage that would trigger the filing of the Form 8865 and also does not meet the dollar threshold for transfers during the year. Therefore, no Form 8865 has been filed. CCI GOLF 52760 15000 37760 8000 Tough Enough to Wear Pink 80669 49239 31430 5570 5 161286 161286 28400 294715 64239 230476 41970 41970 188506 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 8207191 8207191 0.00910 75079566 55503420 19576146 0.02180 83286757 55503420 27783337 0.03090 24 6608079 2362 6605717 0.00730 3 6007556 4494877 1512679 0.00170 20662543 993235 19669308 0.02190 1683291 1391601 291690 0.00030 3 594067 594067 0.00070 30 35555536 6882075 28673461 0.03190 30 118842293 62385495 56456798 0.06280 1 14946 14946 0.00000 1 3562 3562 0.00000 1 37195 37195 0.00000 1 6533 6533 0.00000 1 900 900 0.00000 5 63136 63136 0.00000 1 81270680 0 200523855 208177827 -7653972 X 1 1 2 Medical & Dental Building Office Building 0.71450 0.28550 3 The Imaging Center LLC Medical Imaging 0.50000 0.50000 4 Same Day Surgery Center Specialty and Ambulatory Srvcs 0.40000 0.60000 5 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 18 1 1 0 1 X See Section C, Line 7d X X 1 18 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 18 1 1 0 1 X See Section C, Line 7d X X 1 18 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 134 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 134 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: http://www.samedaysurgerycenter.org/community-health-needs-assessment/ Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 11: During FY21, Monument Health focused on the following four priority areas identified through the most recent Community Health Needs Assessment: Cancer, Heart Disease and Stroke, Diabetes and Mental Health. Work 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.Cancer -Began construction on the expansion of the Cancer Care Institute in March 2021. The new location 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. -Expanded patient services including Breast Survivorship Visits, Advanced Radiation Brachy Treatments, and implementation of the first phase of the Genetics Navigator Platform for cancer screenings. -Adopted 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. -Implemented telehealth and tele-video visits to support cancer patients throughout the COVID-19 pandemic. -Participated in the American Society fo Clinical Oncology survey for COVID-19 in Oncology Registry, which collects information about patterns of symptoms and severity of COVID-19 infection, how COVID-19 influences the delivery of cancer care, and how patient cancer and COVID-19 outcomes are affected. -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, which had to be virtual this year due to COVID-19. This event highlights current heart and stroke topics, advancements in cardiac medicine, lifestyle management and new physicians and Advanced Practice Providers to the community. -Improved the Stroke metric of tissue plasminogen activator door-to-needle time and increased occurrences of Alteplase administration. -Recruited four additional providers for Heart and Vascular Care and Neurology Care. -Provided heart and vascular outreach clinics in Spearfish, Chadron, Alliance, Belle Fourche, Newcastle, Custer, and Hot Springs. -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 South Dakota State University Extension Office and SD Foundation for Medical Care. -Pursued Medicare Diabetes Prevention Program supplier status with goal of implementing program mid-2022. Implemented LACES program to improve transition from inpatient to outpatient care. Program focuses on Low Blood Glucose, A1C, Consults, Education and Survival Skills for patients. -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 explored 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. Mental Health -Partnered with Avera E-care for Psychiatrist and Social Worker or Nurse services by phone and video. -Increased mental health needs assessment coverage in the ED for patient evaluation and therapeutic work. -Continued collaboration with Pennington County Care Campus and provided representation on their Advisory Board. -Held on-site and televisits from Protection & Advocacy for Individuals with Mental Illness Program to provide education on available services. -Offered Alcoholics Anonymous meeting availability to patients within our facilities via streaming due to COVID-19. -Conducted group sessions for the Red Road to Wellbriety addiction program, which aligned with the Tribal Practices and Cultural Beliefs Teen Group. Sessions were held via tele-health due to COVID-19. -Implemented Trauma Informed Care and provided toolkits for Emergency Department and Medical Staff. Caregivers are continuously trained through orientation, monthly meetings, and annual competency. -Expanded the availability of counselors located in our primary care facilities across the Monument Health system. -Recruited additional Psychiatrists and Psychologists. -Continued use of systemwide standard processes for mental health screening of patients identified at risk utilizing the Columbia scale. Same Day Surgery Center Part V, Section B, Line 11: During FY21, Same Day Surgery Center focused on the following two priority areas identified through the most recent CHNA: Cancer and Diabetes. Teams comprised of representatives from Rapid City Hospital, Same Day Surgery Center, Monument Health Network, and the community to work on the priority areas selected for each facility's Health Improvement Plan.Cancer-Implement Lifestyle Medicine to assist individuals and families to adopt and sustain health behaviors that affect health and quality of life.-Participate in wellness fairs, in collaboration with Dermatology and Mammography, to provide education on cancer screening opportunities.-Improve patient education materials and offerings.-Partner with the Susan G. Komen Foundation for education and awareness.Diabetes-Utilize a system-wide approach to education and documentation in the electronic medical record.-Provide education and equipment to patients.-Integrate pharmacists in medication management for diabetes patients.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. 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, including on the facility website, in waiting rooms, and in the admissions office. The policy in its entirety is also available upon request.The financial assistance policy application form was translated into the primary language spoken by limited English proficient 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 2 - Monument Health Rapid City Hospice House 224 Elk St Rapid Ctiy SD 57701 End of Life Care 3 - Monument Health Dermatology 2805 Fifth St Rapid Ctiy SD 57701 Clinic 4 - Monument Health Dialysis Center 132 Yankee St Spearfish SD 57783 Dialysis Center 5 - Monument Health Home Care-Spearfish 1440 North Main Street Spearfish SD 57783 End of Life Care 6 - Monument Health Medical Clinic 112 7th Ave Wall SD 57790 Clinic 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: The organization's community benefit report can be found on its website 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 heath 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 Mitchell Technical College Foundation 1800 E Spruce St Mitchell SD 57301 460452950 501(c)(3) 45000 2021 pledge payment Elevate Rapid City PO BOX 747 Rapid City SD 57701 460118545 501(c)(3) 60000 Diamond level pledge & military advisory sponsorship South Dakota Governor's Office of Economic Development 711 E Wells Ave Pierre SD 57501 466000364 Government 30000 2020 & 2021 sponsorship of governors pheasant hunt Yellow Jacket Foundation 1200 University Unit 9411 Spearfish SD 57799 510151319 501(c)(3) 10000 Sponsorship Black Hills Trails PO BOX 661 Sturgis SD 57785 900966680 501(c)(3) 12500 Sponsorship of sturgis trail system Leadership South Dakota PO BOX 91533 Sioux Falls SD 57109 820880122 501(c)(3) 10000 2020-20201 silver sponsorship fee Pennington County Treasurer 300 Kansas City Street Rapid City SD 57701 466000381 Government 195000 2021 care campus sponsorship 7 0 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. 1 1 0 0 0 0 0 1 0 Paulette R Davidson President & CEO 0 973611 0 201145 0 19500 0 177630 0 26570 0 1398456 0 0 Joseph Tuma MD Physician - Cardiology 1157862 0 53358 0 49142 0 78680 0 25724 0 1364766 0 49142 0 Paul Miller MD Physician - Orthopedic Surgeon 1299663 0 21200 0 0 0 9330 0 31626 0 1361819 0 0 0 Bhaskar Purushottam MD Physician - Cardiology 1056321 0 53358 0 35311 0 87868 0 28319 0 1261177 0 35311 0 Rodney SamuelsonMD Physician - Neurosurgery 1061274 0 21200 0 26909 0 64279 0 21980 0 1195642 0 26909 0 John Karl Heilman III MD Physician - Cardiology 974662 0 53358 0 0 0 13578 0 27694 0 1069292 0 0 0 Alex Schabauer MD Board Member/Employed Physician 657791 0 53358 0 60263 0 74098 0 25438 0 870948 0 60263 0 Brad Archer MD Chief Medical Officer 558270 0 116251 0 9806 0 77388 0 24494 0 786209 0 0 0 Srinivas Gangineni MD Board Member/Employed Physician 557955 0 84463 0 8728 0 37259 0 39321 0 727726 0 8728 0 Mark A Thompson CFO/Treasurer 453646 0 93906 0 19500 0 66956 0 27492 0 661500 0 0 0 Jacob Weasel MD Board Member/Employed PhysIcian 509748 0 29200 0 0 0 39892 0 29959 0 608799 0 0 0 John Pierce President Rapid City Market 402797 0 55848 0 44075 0 53127 0 32315 0 588162 0 24575 0 Stephanie Lahr MD CIO/CMIO 390288 0 85358 0 19500 0 47882 0 32216 0 575244 0 0 0 Teresa Burroff General Counsel/Secretary 391448 0 80281 0 19500 0 45944 0 12195 0 549368 0 0 0 Thomas Worsley President Spearfish Market 0 342086 0 47754 0 15604 0 24936 0 30189 0 460569 0 0 Douglas Koch VP Rapid City Market 324253 0 46820 0 9500 0 29842 0 33394 0 443809 0 0 0 Nicole Kerkenbush Chief Performance Officer 310785 0 55083 0 19500 0 34615 0 3471 0 423454 0 0 0 Mark Longacre President Monument Health Orthopedic 320566 0 35633 0 14555 0 23298 0 29352 0 423404 0 0 0 Michael Tilles President Home Plus 302926 0 42567 0 13763 0 23190 0 21458 0 403904 0 0 0 Michelle Stephens VP Ops-Rapid City Market Until 12/20 223495 0 0 0 8850 0 16268 0 27743 0 276356 0 0 0 Tresha Moreland Former VP Human Resources Operation 43121 0 3600 0 209825 0 582 0 349 0 257477 0 0 0 Michael Latour System Director of Musculoskeletal c 193283 0 1200 0 0 0 14393 0 23725 0 232601 0 0 0 Michael Statz MD Board Member/Employed Physician 64903 0 10243 0 75750 0 0 0 0 0 150896 0 0 0 Mary Masten Former General Counsel, Emeritus 103179 0 0 0 0 0 0 0 12951 0 116130 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, Lines 4a-b Tresha Moreland received a severance payment of $209,825. 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 column c on Schedule J: PAULETTE DAVIDSON 168,300 JOSEPH TUMA, MD 65,102 BHASKAR PURUSHOTTAN, MD 78,538 RODNEY SAMUELSON 54,949 ALEX SCHABAUER 60,520 BRAD ARCHER, MD 68,646 SRINIVAS GANGINENI, MD 27,725 MARK THOMPSON 46,396 JACOB WEASEL, MD 31,150 JOHN PIERCE 35,252 STEPHANIE LAHR, MD 38,552 TERESA BURROFF 36,812 THOMAS WORSLEY 15,606 DOUGLAS KOCH 21,100 NICOLE KERKENBUSH 25,500 MARK LONGACRE 14,556 MICHAEL TILLES 14,058 MICHELE STEPHEN 8,850 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. JOHN PIERCE 24,575 JOSEPH TUMA, MD 49,142 BHASKAR PURUSHOTTAM, MD 35,311 RODNEY SAMUELSON, MD 26,909 ALEX SCHABAUER, MD 60,263 SRINIVAS GANGINENI, MD 8,728 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 11045000 241560039 1807893 185230918 54521227 2019 0 1 1 1 B 138447584 1143985 83704749 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 $3,071,916. 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 $4,748.65. Gregg Radtke Family member of Director Sandra Burns 50155 Employee compensation 0 Shelby Lynass Family member of Director Jack Lynass 74099 Employee compensation 0 AMY KRESS Family member of Mark Thompson 73567 Employee compensation 0 BECKY SHARP Family member of Mark Thompson 126074 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 47648 Employee compensation 0 KODY SHARP Family member of Mark Thompson 93450 Employee compensation 0 Form 990, Part VI, Section A, line 1 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 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 finance and legal 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 59,657,111. Management and general expenses 38,560,490. Fundraising expenses 0. Total expenses 98,217,601. Professional fees: Program service expenses 62,191. Management and general expenses 3,641,601. Fundraising expenses 0. Total expenses 3,703,792. Form 990, Part XI, line 9: Adj to the Funded Status of the Pension Plan 16,665,372. Medical Staff Net Income -11,089. Partner Distributions & Non-Controlling Int 1,766,306. Auxiliary Net Income 75,091. Released From Restriction -818,138. Transfers -34,354. 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 86997987 268030103 Monument Health Rapid City Hospital Inc Black Hills Medical Office Building 353 Fairmont Blvd Rapid City SD 57701 411992146 Medical Office Building SD 597467 3005340 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 3103645 1909023 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 171820 2168604 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 2410211 FMV