2021-05-12T13:22:11-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Mark Thompson CFO 6057559130 2021-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-11 2019 2022-09-23 18:48:47Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 803220212 0 X www.monument.health X 1973 SD Monument Health is dedicated to improving the health of individuals and our communities. 14 8 4704 292 13657135 531281 2376782 20214905 780413572 770763546 25367998 7482081 414940 599780 808573292 799060312 0 218000 0 0 291320600 319122843 0 0 1048047 467433326 447960832 758753926 767301675 49819366 31758637 1161098499 1290053350 407173139 529146030 753925360 760907320 X Our vision at Monument Health is to be one team, to listen, to be inclusive, and to show we care. Monument Health is dedicated to improving the health of individuals and our communities. Values: Trust, Respect, Compassion, Community, Excellence 0 0 316200727 218000 502703533 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. 29607803 35442788 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. 120333598 125271401 RCH Surgical Services - provide in and out-patient surgical services to acute care patients. 81412091 93860753 RCH Pharmacy - provide pharmaceuticals in support of acute care hospital patients. 81412091 93860753 547554219 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 1 457 0 1 4704 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 14 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 CA X X Mark Thompson 6057559127 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Paulette R Davidson President & CEO 49.31 10.69 X X 0 1717978 215619 James Takara MD Physician - Cardiac Surgery 40.00 0.00 X 1199974 0 98775 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1079910 0 110111 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1089259 0 98197 Paul Miller MD Physician - Orthopedic Surgery 34.00 6.00 X 1117468 200342 38501 Mark A Thompson CFO/Treasurer 45.20 9.80 X 964572 0 106253 John Karl Heilman III MD Physician - Cardiology 40.00 0.00 X 997484 0 40941 Alex Schabauer MD Board Member/Employed Physician 41.12 0.00 X 939063 0 90853 Stephanie Lahr MD CIO/CMIO 45.20 9.80 X 741039 0 87788 Teresa Burroff General Counsel/Secretary 45.20 9.80 X 759037 0 55468 Brad Archer MD Chief Medical Officer 45.20 9.80 X 697242 0 108789 John Pierce President Rapid City Market 55.00 0.00 X 604283 0 96015 Srinivas Gangineni MD Board Member/Employed Physician 40.62 0.00 X 508973 0 76583 Thomas Worsley President Spearfish Market 0.00 55.00 X 0 501133 59450 Michael Tilles President Home Plus 55.00 0.00 X 432324 0 54067 Douglas Koch VP Rapid City Market 55.00 0.00 X 403769 0 64421 Nicole Kerkenbush Chief Performance Officer 45.20 9.80 X 424129 0 38813 Mark Longacre President Monument Health Orthopedic 50.60 4.40 X 336648 30955 58231 Andrea Baier MD Board Member/Employed Physician 41.38 0.00 X 333467 0 56500 Tresha Moreland VP Human Resources Operation 45.20 9.80 X 353829 0 34907 Michelle Stephens VP Operations-Rapid City Market 55.00 0.00 X 231546 0 48637 Michael Latour System Director of Musculoskeletal care 43.45 11.55 X 168017 44777 37897 Laura C Wightman Chief Nursing Officer Until 04/2019 45.20 9.80 X 191509 0 10361 Michael Statz MD Board Member/Employed Physician 40.87 0.00 X 190321 0 0 Mary Masten General Counsel, Emeritus 16.44 3.56 X 118255 0 15818 Jack Lynass Chairman 1.11 0.00 X X 0 0 0 Deidre Budahl Board Member 1.14 0.00 X 0 0 0 Sandra Burns Board Member 0.90 0.00 X 0 0 0 Col Robert Corby Board Member 0.54 0.00 X 0 0 0 Ross Mckie Board Member 1.24 0.00 X 0 0 0 Kelly Manning MD Board Member 0.58 0.00 X 0 0 0 Daryl Reinicke Board Member 0.77 0.00 X 0 0 0 Tom Rau Board Member 1.11 0.00 X 0 0 0 Lia Green Board Member 2.08 0.01 X 0 0 0 13882118 2495185 1702995 408 1 1 0 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 69395993 Medefis 10826 Old Mill Rd 101 Omaha NE 68105 CONTRACT LABOR 15530296 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 PROFESSIONAL SERVICES 12324030 Weatherby Locums PO BOX 972633 Dallas TX 75397 Contract Labor 9630987 Morrison Management Specialists Inc PO BOX 102289 Atlanta GA 30368 Professional Services 8028695 329 126264 17113550 2975091 20214905 In Patient Pharmacy 446110 168227939 168227939 Cardiac Services 622110 163124119 163124119 Surgical Services 622110 163048328 163048328 Laboratory 621500 135841384 133354277 2487107 MIS CT Scan 621500 86085726 86085726 54436050 43379403 11056647 770763546 10182294 10182294 461273 461273 1079362 734949 344413 344413 344413 3161486 -3161486 -3161486 -3161486 229229 126264 145923 83306 83306 176222 117542 58680 58680 UBI from Partnerships 900099 113381 113381 113381 799060312 757278472 13657135 7909800 X 218000 218000 9598496 2245598 7352898 223039 223039 284898891 233266368 50962834 669689 5554258 4442627 1099010 12621 267140 213675 52858 607 18581019 14288147 4244472 48400 415306 415306 459631 459631 77429 77429 84645854 59292213 25350216 3425 993226 122759 825636 44831 14717355 9322215 5219305 175835 15876496 2518856 13317188 40452 23845756 7379128 16465466 1162 1967391 1268717 689648 9026 341048 36037 305011 4444885 4444885 42502122 29492797 12971606 37719 2470855 749362 1721493 Medical Supplies 159524545 159371044 149230 4271 Interco Supplies and Se 93266584 18293165 74973419 All other expenses 2315189 365587 1949593 9 UBI Tax 97160 97160 767301675 547554219 218699409 1048047 20575182 139068036 6596505 12279791 91316552 100402394 17333404 18320680 11259472 14405214 755750299 274917339 427826924 480832960 264562046 233027103 318224096 288421589 3404318 3295583 1161098499 1290053350 53511322 145480668 283109330 273917128 70552487 109748234 407173139 529146030 X 731470655 737027735 22454705 23879585 753925360 760907320 1161098499 1290053350 X 31758637 -13110239 -11666438 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 77429 77429 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 2020 dues, which were paid in fiscal year 2020, in the amount of $209,981.70, 23.06% 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 2020 dues, which were paid in fiscal year 2020, in the amount of $67,033, 23.32% 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 2020 dues, which were paid in fiscal year 2020, in the amount of $11,256, 30.00% was used for lobbying purposes. In fiscal year 2020, $10,000 of consulting expense was incurred in regard to lobbying. 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1.00000 0 0 10310660 10310660 465098685 132527961 332570724 225466922 137903199 87563723 54874032 4486179 50387853 480832960 Private Equity/Debt 55788624 F Real Estate Funds 6844852 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Investment in Privately Held Companies 8187404 F Equity Securities and Funds - Domestic 35116890 F Equity Securities and Funds - International 67252723 F Fixed Income - Bond Funds & Corp Bonds - Domestic 56779419 F Absolute Return Assets - Hedge Funds 15451446 F 288421589 Payable Under Interest Rate Swap 6988211 Other Long Term Liabilities 18712030 Accrued Pension Liability 35651578 Due from related party 48396415 109748234 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 39965167 0 0 0 0 0 0 39965167 0 39965167 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. Duck Race 62404 48838 13566 42854 Tough Enough to Wear Pink 77426 77426 46454 5 215663 215663 56615 355493 126264 229229 145923 145923 83306 1 1 X 1 X 1 X 1 1 0 1 1 9215916 9215916 0.01200 62713829 48931085 13782744 0.01800 71929745 48931085 22998660 0.03000 17 3661 11708021 11708021 0.01530 1 5804519 3736535 2067984 0.00270 16904961 2216603 14688358 0.01910 1734179 1772149 0 0.00000 3 19252 578804 578804 0.00080 21 22913 36730484 7725287 29043167 0.03790 21 22913 108660229 56656372 52041827 0.06790 2 2220 2220 0.00000 1 9520 9520 0.00000 1 4627 4627 0.00000 1 65214 65214 0.00010 1 7518 7518 0.00000 6 89099 89099 0.00010 1 77515257 0 181347428 184078957 -2731529 X 1 1 1 Black Hills Medical Office BD LLC Office Building 0.67930 0.32070 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 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 200.000000000000 250.000000000000 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 200.000000000000 250.000000000000 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 FY20, Monument Health focused on the following four priority areas identified through the most recent CHNA: Cancer, Heart Disease and Stroke, Diabetes and Mental Health. 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 Health Improvement Plan (CHIP).Cancer:-Purchased the cancer risk assessment screening tool/survey and navigation platform which is the first step in the development of a genetics program. -Completed the American Club of Therapeutic Radiologists (ASTRO) Accreditation Program for Excellence (Accreditation Program for Excellence - APEx). This accreditation demonstrates that the Cancer Care Institute has the systems, personnel, policies and procedures needed to meet APEx standards for high-quality patient care.-Added access to new education and research to the Cancer Care Institute public website, including new patient education from the Mayo Clinic Care Network.-Completed significant planning for the expansion of the Cancer Care Institute with construction planned to begin in April 2021. The new location will more than double the space of the existing facility to expand radiation and medical oncology, integrate infusion services, and add comprehensive brachytherapy services and integrated services. -Supported community events for Susan G Komen and Breast Cancer Awareness Month. -Utilized the Mayo Clinic Care Network to collaborate on individual patient cancer care to provide patients with care close to home. Heart Disease and Stroke:-Provided blood pressure screenings and education at community events, including the Black Hills Stock Show. Stroke program coordinator spoke at the Stock Show on stroke signs, symptoms, and risk factors.-Marketing such as billboards and Facebook announcements on recognizing the signs and symptoms of stroke and heart disease throughout the year. Particular emphasis was placed in February during Heart Month and in May during Stroke Awareness month. -Hosted and participated in events to increase awareness of Heart Disease and Stroke such as the Annual Heart Ball, annual Heart Walk, and February Freeze run/walk.-Provided education to area providers through the annual Cardiac Symposium, which had to be virtual this year due to COVID-19.-Implemented Lifestyle Medicine as a new service line and launched a new Lipid Management Clinic. -Recruited additional providers for Heart and Vascular Care and Neurology Care.-Improved the Stroke metric of tissue plasminogen activator (tPA) door-to-needle time. -Expanded Heart and Vascular outreach to additional communities in Nebraska, Wyoming and South Dakota. -Implemented a new Calcium Scoring Screening process in partnership with National Heart Health. -Partnered with South Dakota Banker's Association to offer Comprehensive Heart & Vascular Screens for their members.-Hosted an ongoing monthly stroke support group. -Utilized the Mayo Clinic Care Network to collaborate on care for cardiology and stroke patients, to provide patients with care close to home. Diabetes:-Provided screenings and education at community events, including the Black Hills Stock Show. -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 SDSU Extension/SD Foundation for Medical Care.-Supported local events for Diabetes programs, such as the Diabetes Inc. Taste of Caring event.-Expanded Rapid City inpatient endocrinology on-site support. -Providers and educators/dieticians provided telephonic and televideo visits during COVID-19 and explored options to continue post-pandemic.-Ongoing outreach clinics in all service areas at least monthly.Mental Health:-Partnered with Call to Freedom to provide information on Human Trafficking. -Collaborated with Pennington County Care Campus and provided representation on their Advisory Board. -Arranged on-site and televisits from Protection & Advocacy for Individuals with Mental Illness (PAIMI) Program to provide education on available services.-Expanded AA meeting availability to patients within our facilities to include adult AA, teen AA, Al-Anon and Red Road to Wellbriety. -Implemented lifestyle medicine through dietary changes within the facility and recreation therapy programs. -Supported the local Wellfully program events. -Expanded the availability of counselors located in our primary care facilities. -Recruited additional Psychiatrists. -Implemented standard process for mental health screening of patients identified at risk utilizing the Columbia scale. Same Day Surgery Center Part V, Section B, Line 11: During FY20, 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 (CHIP).Cancer-Implement Lifestyle Medicine to assist individuals and families to adopt and sustain health behaviors that affect health and quality of life.-Participate in area 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 events.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, 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/ 7 1 - Monument Health Home Hospice House 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 717 Meade Street 100 Rapid Ctiy SD 57701 Clinic 4 - Monument Health Dialysis Center 132 Yankee St Spearfish SD 57783 Dialysis Center 5 - Monument Health HomeHospice-Spearfish 1440 North Main Street Spearfish SD 57783 End of Life Care 6 - Monument Health Medical Clinic 112 7th Ave Wall SD 57790 Clinic 7 - Monument Health Pine Ridge Med Clinic East Highway 18 Pine Ridge SD 57702 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 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. The result is a deficit with costs exceeding the reimbursements.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) 95000 2019 ENDOWMENT & SCHOLARSHIPS AND 2020 Pledge ELEVATE RAPID CITY PO BOX 747 Rapid City SD 57701 460118545 501(c)(3) 60000 2019 PLEDGE TEAMMATES MENTORING PROGRAM 6801 O STREET Lincoln NE 68510 832455583 501(c)(3) 25000 MENTORING EXPANSION SOUTH DAKOTA GOVERNOR'S OFFICE OF ECONOMIC DEVELOPMENT 711 E WELLS AVE Pierre SD 57501 466000364 Government 15000 SPONSORSHIP OF ECONOMIC DEVELOPMENT EVENTS YELLOW JACKET FOUNDATION 1200 UNIVERSITY UNIT 9411 Spearfish SD 57799 510151319 501(c)(3) 10000 SPONSORSHIP SUSAN G KOMEN GREAT PLAINS 8707 WEST CENTER ROAD Omaha SD 68124 260056671 501(c)(3) 7000 SPONSORSHIP UNITED WAY OF THE BLACK HILLS 621 6TH STREET SUITE 100 Rapid City SD 57701 460259754 501(c)(3) 6000 SPONSORSHIP 7 Part I, Line 2: The governing board and management of the receiving organization develop programs which enhance the charitable mission of the organization. Disbursement of grant or contribution funds for these programs are made in accordance with the established procedures within the organization and are subject to the conditions established by the organization's governing board and management. These procedures are developed to ensure that distributed funds are adequately monitored for appropriate usage. 0 1 0 0 0 0 0 1 0 Paulette R Davidson President & CEO 0 810916 0 647275 0 259787 0 189139 0 26480 0 1933597 0 240787 James Takara MD Physician - Cardiac Surgery 1160619 0 4000 0 35355 0 69402 0 30212 0 1299588 0 35355 0 Bhaskar Purushottam MD Physician - Cardiology 1030101 0 49809 0 0 0 80176 0 29935 0 1190021 0 0 0 Joseph Tuma MD Physician - Cardiology 996278 0 49809 0 43172 0 72666 0 30823 0 1192748 0 43172 0 Paul Miller MD Physician - Orthopedic Surgery 1097468 200342 20000 0 0 0 9239 0 26940 2322 1153647 202664 0 0 Mark A Thompson CFO/Treasurer 407368 0 349754 0 207450 0 80227 0 26027 0 1070826 0 188450 0 John Karl Heilman III MD Physician - Cardiology 947675 0 49809 0 0 0 13941 0 27000 0 1038425 0 0 0 Alex Schabauer MD Board Member/Employed Physician 845230 0 49809 0 44024 0 62729 0 28124 0 1029916 0 44024 0 Stephanie Lahr MD CIO/CMIO 357499 0 245900 0 137640 0 58603 0 29185 0 828827 0 118640 0 Teresa Burroff General Counsel/Secretary 355187 0 256523 0 147327 0 55392 0 76 0 814505 0 128327 0 Brad Archer MD Chief Medical Officer 470056 0 211750 0 15436 0 81128 0 27661 0 806031 0 0 0 John Pierce President Rapid City Market 338675 0 120313 0 145295 0 65340 0 30675 0 700298 0 126295 0 Srinivas Gangineni MD Board Member/Employed Physician 467083 0 41890 0 0 0 35749 0 40834 0 585556 0 0 0 Thomas Worsley President Spearfish Market 0 297022 0 105188 0 98923 0 32039 0 27411 0 560583 0 83623 Michael Tilles President Home Plus 258567 0 91163 0 82594 0 28717 0 25350 0 486391 0 69334 0 Douglas Koch VP Rapid City Market 288144 0 103125 0 12500 0 33400 0 31021 0 468190 0 0 0 Nicole Kerkenbush Chief Performance Officer 257330 0 84563 0 82236 0 36533 0 2280 0 462942 0 63236 0 Mark Longacre President Monument Health Orthopedic 245485 30955 77138 0 14025 0 22426 6875 25676 3254 384750 41084 0 0 Andrea Baier MD Board Member/Employed Physician 313467 0 20000 0 0 0 23164 0 33336 0 389967 0 0 0 Tresha Moreland VP Human Resources Operation 227155 0 62948 0 63726 0 26014 0 8893 0 388736 0 52282 0 Michelle Stephens VP Operations-Rapid City Market 177488 0 44031 0 10027 0 21486 0 27151 0 280183 0 0 0 Michael Latour System Director of Musculoskeletal c 158048 25102 0 0 9969 19675 16702 0 18811 2384 203530 47161 9969 19675 Laura C Wightman Chief Nursing Officer Until 04/2019 107742 0 0 0 83767 0 7597 0 2764 0 201870 0 83767 0 Michael Statz MD Board Member/Employed Physician 62500 0 13258 0 114563 0 0 0 0 0 190321 0 0 0 Mary Masten General Counsel, Emeritus 62713 0 0 0 55542 0 0 0 15818 0 134073 0 55542 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 column c on Schedule J: TERESA BURROFF 46,435 PAULETTE DAVIDSON 179,900 STEPHANIE LAHR, MD 49,364 TRESHA MORELAND 17,057 JOHN PIERCE 46,626 MARK THOMPSON 57,686 MICHAEL TILLES 19,760 LAURA WIGHTMAN 6,758 SRI GANGINENI, MD 26,219 BHASKAR PURUSHOTTAM, MD 70,937 JAMES TAKARA, MD 55,461 JOSEPH TUMA, MD 58,725 BRAD ARCHER, MD 72,727 NICOLE KERKENBUSH 27,600 DOUG KOCH 25,000 ANDREA BAIER, MD 13,925 ALEX SCHABAUER, MD 48,788 MICHELLE STEPHENS 14,150 The following individuals had supplemental non-qualified retirement plan amounts included in schedule J, column B(iii) that were previously reported as deferred compensation on Form 990. These amounts are identified in Schedule J, column f. PAULETTE DAVIDSON 240,787 TERESA BURROFF 128,327 NICOLE KERKENBUSH 63,236 STEPHANIE LAHR, MD 118,640 TRESHA MORELAND 52,282 LAURA WIGHTMAN 83,767 JOHN PIERCE 126,295 MARK THOMPSON 188,450 MICHAEL TILLES 69,334 MICHAEL LATOUR 29,644 JAMES TAKARA,MD 35,355 JOSEPH TUMA,MD 43,172 ALEX SCHABAUER, MD 44,024 MARY MASTEN 55,542 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 2015-01-27 67210000 Refund Series 2008 bonds issued 8/14/08 0 0 0 B SD Health & Educational Facilities Authority 460315509 83755VE26 2017-09-07 238488122 Refund Series 2010 and 2011 Bonds; Hospital buildings and equipment 0 0 0 A 16755000 67210000 250000 66960000 2015 1 0 1 1 B 7110000 241560039 1807893 185230918 54521227 2019 0 1 1 1 A 0 0 0 0 0.00000 0.00030 0.00030 0 0 1 B 0 1 1 0 1 0 0.00460 0.00960 0.01420 0 0 1 A 0 0 1 0 1 1 US Bank NA 9.200000000000 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 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 $3,071,916. Gregg Radtke Family member of Director Sandra Burns 45618 Employee compensation 0 Shelby Lynass Family member of Director Jack Lynass 66956 Employee compensation 0 Erika Radtke Family member of Director Sandra Burns 69161 Employee compensation 0 Nadine Radtke Family member of Director Sandra Burns 18974 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 22330 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 2 Paulette Davidson has a business relationship with the following individuals due to being the CEO of the supporting organization that exercises reserve powers over the supported organizations that employ each of these key employees: Teresa Burroff; Stephanie Lahr MD; Tresha Moreland; Mary Masten; Brad Archer MD; Nicole Kerkenbush; John Pierce; Michael Tilles; Mark Thompson; Laura Wightman; Douglas Koch; Mark Longacre; Michelle Stephens; Michael Latour; Thomas Worsley; and employed Board Members: Sri Gangineni MD; Alex Schabauer MD; Andrea Baier MD; Michael Statz MD. 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 (the System). 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) engaged 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. In May 2017, the independent consultant met with Committee members and presented 2017 data upon which the Committee determined all elements of compensation for the member's CEO (base salary, total cash compensation, benefits and total compensation) and reaffirmed the organization's executive compensation philosophy, which includes the targeted market percentile for all other executives. 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 59,174,533. Management and general expenses 25,082,859. Fundraising expenses 3,225. Total expenses 84,260,617. Professional fees: Program service expenses 117,680. Management and general expenses 267,357. Fundraising expenses 200. Total expenses 385,237. Form 990, Part XI, line 9: Adj to the Funded Status of the Pension Plan -10,545,579. Medical Staff Net Income -61,255. Temporarily Restricted Net Asset Changes -1,241,401. Auxiliary Net Income 44,560. Transfers with related organizations 137,237. 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. Monument Health Home Plus LLC 2925 Regional Way PO Box 6000 Rapid City SD 57701 364841157 Healthcare Services SD 73218777 188026726 Monument Health Rapid City Hospital Inc BLACK HILLS MEDICAL OFFICE BUILDING 353 FAIRMONT BLVD Rapid City SD 57701 411992146 Medical Office Building SD 170192 43717 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) Line 10 Monument Health Inc 0 MEDICAL & DENTAL BUILDING 2805 S 5th St Rapid City SD 57701 460339629 Medical Office Bldg SD Monument Health Rapid City Hospital Inc Investment -53740 792398 0 1 0.71450 Black Hills Medical Office BD LLC 353 Fairmont Blvd Rapid City SD 57701 411992146 Medical Office Bldg SD Monument Health Rapid City Hospital Inc Investment 263287 0 0 0.67930 Same Day Surgery Center 651 Cathedral Drive Rapid City SD 57701 411889892 Medical Services SD Monument Health Rapid City Hospital Inc RELATED 1254844 1825018 0 1 0.40000 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 Same day Surgery Center F 1060000 FMV Form 990, Schedule R, Parts I and III Effective March 27, 2020, MHRCH acquired 100% ownership in Black Hills Medical Office BD, LLC. Activity through March 26, 2020 is included in Part III of Schedule R, and activity from March 27, 2020 to yearend is included in Part I of Schedule R.