2020-05-15T09:25:28-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Mark Thompson CFO 6057559130 2020-05-14 1 Kim Hunwardsen CPA P00484560 6122536500 2020-05-14 216.147.181.49 2020-05-14 09:28:00 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2020-09-23 17:36:50Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 809375030 0 X www.monument.health X 1973 SD Monument Health is dedicated to improving the health of individuals and our communities. 14 8 4903 308 11664775 1079753 2375680 2376782 704972214 780413572 37860710 25367998 236746 414940 745445350 808573292 0 0 0 0 287244751 291320600 0 0 1043771 411789680 467433326 699034431 758753926 46410919 49819366 1131251656 1161098499 408174755 407173139 723076901 753925360 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 1 0 478801732 537707420 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. 31272192 29607803 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. 24853107 120333598 RCH Surgical Services - provide in and out-patient surgical services to acute care patients. 22417006 81412091 RCH Pharmacy - provide pharmaceuticals in support of acute care hospital patients. 22417006 81412091 557344037 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 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 584 0 1 4903 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 X Jack Lynass Chairman 0.75 0.00 X X 0 0 0 Andrea Baier MD Board Member/Employed Physician 40.74 0.00 X 323371 0 55927 Deidre Budajhl Board Member 0.95 0.00 X 0 0 0 Sandra Burns Board Member 0.38 0.00 X 0 0 0 Timothy Frost MD Board Member 0.48 0.00 X 2500 0 0 Srinivas Gangineni MD Board Member/Employed Physician 40.62 0.00 X 542373 0 79862 Lia Green Board Member 2.58 0.02 X 0 0 0 Rich Kinzley Board Member 0.16 0.00 X 0 0 0 Kelly Manning MD Board Member 0.48 0.00 X 0 0 0 Robert Mudge Board Member 0.16 0.00 X 0 0 0 Tom Rau Board Member 0.51 0.00 X 0 0 0 Alex Schabauer MD Board Member/Employed Physician 40.97 0.00 X 810383 0 88788 Michael Statz MD Board Member/Employed Physician 40.71 0.00 X 178060 0 0 Brent Phillips President & CEO Until 07/2018 48.43 11.57 X X 0 510692 108854 Paulette R Davidson President & CEO 48.43 11.57 X X 0 949112 99787 Mark A Thompson CFO/Treasurer 44.39 10.61 X 618307 0 90672 Teresa Burroff General Counsel/Secretary 44.39 10.61 X 526037 0 46994 Brad Archer MD Chief Medical Officer 44.39 10.61 X 610756 0 85102 Tresha Moreland VP Human Resources Operations 44.39 10.61 X 290407 0 33887 Nicole Kerkenbush Chief Performance Officer 44.39 10.61 X 289126 0 33392 Stephanie Lahr MD CIO/CMIO 44.39 10.61 X 514675 0 82542 Mary Masten General Counsel, Emeritus 44.39 10.61 X 286202 0 35070 Laura C Wightman Chief Nursing Officer Until 04/2019 44.39 10.61 X 373183 0 47623 John Pierce President Rapid City Market 55.00 0.00 X 388593 0 69325 Douglas Koch VP Rapid City Market 55.00 0.00 X 260753 0 34375 Michael Tilles President Home Plus 55.00 0.00 X 355563 0 52489 Michael Latour System Director of Musculoskeletal Care 30.00 25.00 X 99137 85263 34113 Mark Longacre President - Monument Health Ortho Specialty Hosp 23.30 31.70 X 0 339032 44091 John Karl Heilman III MD Physician - Cardiology 40.00 0.00 X 944409 0 38966 James Takara MD Physician - Cardiac Surgery 40.00 0.00 X 1020709 0 90367 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1022878 0 116840 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1118542 0 95629 Roger Knutsen MD Physician - Dermatology 40.00 0.00 X 967816 0 24544 Thomas Worsley President Spearfish Market 0.00 55.00 X 0 385312 57515 11543780 2269411 1546754 342 1 1 0 Layton Gustafson 9090 South Sandy Parkway Sandy UT 84070 Construction 79417227 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Contract Labor 8969674 Medefis 10826 Old Mill Rd 101 Omaha NE 68105 Temporary Medical Staff Coverage 8652491 Weatherby Locums PO BOX 972633 Dallas TX 75397 Contract Labor 6832362 Morrison Management Specialists Inc PO BOX 102289 Atlanta GA 30368 Professional Services 6189918 306 167429 20058 305026 1884269 2376782 In Patient Pharmacy 446110 159844777 159844777 Surgical Services 622110 136382527 136382527 Cardiac Services 622110 134759916 134759916 Laboratory 621500 132243504 132243504 MIS CT Scan 621500 71797074 71797074 145385774 133878969 11506805 780413572 8672911 8672911 1664089 1664089 590318 441574 148744 148744 148744 15030998 0 15030998 15030998 15030998 199822 167429 150610 49212 49212 268568 209554 59014 59014 UBI from Partnerships 900099 157970 157970 157970 808573292 768965781 11664775 25565954 8973635 1944774 7028861 388771 388771 257829280 221666004 35430784 732492 2179838 1647800 526746 5292 5334059 4032163 1288947 12949 16615017 12444315 4129649 41053 509311 152 509159 427850 12771 415079 56693 56693 69465212 39031624 30430673 2915 909382 84367 787901 37114 13660051 6739763 6763953 156335 14289019 3012029 11236538 40452 23270239 8116697 15152095 1447 2087914 1280951 798522 8441 414527 57152 357375 4267580 7479 4260101 36271681 10457157 25809832 4692 2994303 881996 2112307 Medical Supplies 140589772 140589183 0 589 Interco. Serv. & Suppl. 81113431 30053794 51059637 Bad Debt Expense 74631947 74631947 All other expenses 2474414 263148 2211266 758753926 557344037 200366118 1043771 8012424 20575182 2658134 6596505 83644994 91316552 17282863 17333404 9662027 11259472 666269366 238442442 333165133 427826924 588826079 264562046 64271229 318224096 3580906 3404318 20147867 0 1131251656 1161098499 62300320 53511322 292151374 283109330 53723061 70552487 408174755 407173139 X 700627981 731470655 20785991 20791776 1662929 1662929 723076901 753925360 1131251656 1161098499 X 49819366 -10809071 -8161836 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 56693 56693 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 2019 dues, which were paid in fiscal year 2019, in the amount of $215,307.70, 10.87% 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 2019 dues, which were paid in fiscal year 2019, in the amount of $65,081, 22.73% 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 2019 dues, which were paid in fiscal year 2019, in the amount of $10,926, 32.00% was used for lobbying purposes. In fiscal year 2019, $15,000 of consulting expense was incurred in regard to lobbying. 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1662929 1.00000 0 0 8346017 8346017 320668418 117843197 202825221 10186635 3861648 6324987 200459721 116737597 83722124 126608575 126608575 427826924 Private Equity/Debt 33809276 F Real Estate Funds 10958098 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Investment in Privately Held Companies 23645070 F Equity Securities and Funds - Domestic 30952983 F Equity Securities and Funds - International 99347659 F Fixed Income - Bond Funds & Corp Bonds - Domestic 61820823 F Absolute Return Assets - Hedge Funds 14689956 F 318224096 Payable Under Interest Rate Swap 6223434 Other Long Term Liabilities 16905786 Accrued Pension Liability 36853032 Due from related party 10570235 70552487 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 0 0 Investment 18870000 0 0 0 0 0 0 18870000 0 18870000 1 0 0 1 1 0 Part I, Line 2: The organization does not award grants or assistance outside the United States. The organization has investment activities outside the United States. 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 97877 84864 13013 46500 Tough Enough to Wear Pink 82565 82565 52500 5 186809 186809 51610 367251 167429 199822 150610 150610 49212 1 1 X 1 X 1 X 1 1 0 1 1 9332814 9332814 0.01360 56626504 39502896 17123608 0.02500 65959318 39502896 26456422 0.03860 15 3549 3524919 3524919 0.00520 2 255 5876356 3891955 1984401 0.00290 16119605 4586401 11533204 0.01690 1860992 1474116 386876 0.00060 6 500 409038 409038 0.00060 23 4304 27790910 9952472 17838438 0.02620 23 4304 93750228 49455368 44294860 0.06480 2 8457 8457 0.00000 1 3600 3600 0.00000 1 400 2371 2371 0.00000 1 8184 8184 0.00000 2 19461 19461 0.00000 7 400 42073 42073 0.00000 1 74631947 0 181690225 176572321 5117904 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 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 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, 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. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 7d: https://monument.health/about-us/community-health-needs-assessment/ Same Day Surgery Center Part V, Section B, Line 7d: https://monument.health/about-us/community-health-needs-assessment/ Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 11: During FY19, Monument Health focused on the following three priority areas identified through the most recent CHNA: Access to Healthcare Services, Mental Health, and Wellness (Physical Activity, Nutrition, and Weight). 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).Access to Health Services-Piloted 24/7 call center for primary care patients from Flormann Street Clinic in Rapid City - will grow to serve additional Monument Health locations.-Implemented physician work standards across the system in July 2018 to increase access to care.-System diabetes work to standardize care and improve access.-Primary Case Management program developed that serves Rapid City, Spearfish, Lead/Deadwood, Sturgis, Custer, Hot Springs, and Hill City.-Awarded funding from SD Department of Health to send out reminder letters to more than 14,000 patients that showed they were due or overdue for their breast, cervical, and/or colorectal cancer screenings.Wellness (Physical Activity, Nutrition, Weight)-Worked on expanding access to Monument Health Diabetes Prevention Program. In FY19 a Master Trainer became certified to train new instructors for the program.-Implemented the CATCH (Coordinated Approach to Child Health) evidence-based curriculum in 5 Spearfish locations, 4 Rapid City locations, and 1 Blackhawk location.-Held three KidShape 2.0 workshops in FY19-Increased access to the Better Choices, Better Health program by providing workshop locations at Monument Health and nine leaders from within the system. -Continued partnership with Live Well Black Hills and Healthy Hometown (SM) powered by Wellmark working in the Rapid City, Spearfish, Custer, and Lead/Deadwood communities.Mental Health-Zero Suicide initiative - began implementation in FY18 with initial focus on hospital emergency departments and inpatient behavioral health.-Hosted a community meeting to discuss suicide prevention attended by more than 50 people representing a variety of community organizations.-Opened 8 additional adult inpatient beds at the Behavioral Health Center.-Partnered with Avera Health to provide E-care Telepsychiatry in the Rapid City Hospital Emergency Department with goal to expand to other Monument Health hospitals.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. Same Day Surgery Center Part V, Section B, Line 11: During FY19, 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 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/ Part V, Line 11, Implementation Strategy - Same Day Surgery Center Description of failure:Type of failure: 501(r)(3) - The most current CHNA Implementation Strategy for Same Day Surgery Center was not posted to the website on or before November 15, 2019.Cause of the failure: Due to staff turnover. Facility or facilities where the failure occurred: The failure occurred at Same Day Surgery Center.The date(s) of the failure and its discovery: March 30, 2020Description of the correction of the failure:Method of correction: The Implementation Strategy was posted to the website.Date of correction: April 13, 2020Description of the practices or procedures put into placeThe Implementation Strategy was posted on the website at: https://monument.health/about-us/community-health-needs-assessment/ 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 I, Ln 7 Col(f): The bad debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column, is $74,631,947. 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 bad debt reported on line 2 is at charges as reported on the financial statements. Part III, Line 4: The footnote to the Organization's financial statements can be found on page ten of the attached audited financial statements. Part III, Line 8: 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 380,000 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 1 0 0 0 0 0 1 0 Andrea Baier MD Board Member/Employed Physician 303371 0 20000 0 0 0 23529 0 32398 0 379298 0 0 0 Srinivas Gangineni MD Board Member/Employed Physician 486684 0 55689 0 0 0 36211 0 43651 0 622235 0 0 0 Alex Schabauer MD Board Member/Employed Physician 701929 0 53920 0 54534 0 61171 0 27617 0 899171 0 54534 0 Michael Statz MD Board Member/Employed Physician 178060 0 0 0 0 0 0 0 0 0 178060 0 0 0 Brent Phillips President & CEO Until 07/2018 0 510692 0 0 0 0 0 90834 0 18020 0 619546 0 0 Paulette R Davidson President & CEO 0 540024 0 409088 0 0 0 71640 0 28146 0 1048898 0 0 Mark A Thompson CFO/Treasurer 399842 0 105656 0 112809 0 65580 0 25091 0 708978 0 112809 0 Teresa Burroff General Counsel/Secretary 346644 0 179393 0 0 0 46918 0 76 0 573031 0 0 0 Brad Archer MD Chief Medical Officer 424818 0 185938 0 0 0 57303 0 27799 0 695858 0 0 0 Tresha Moreland VP Human Resources Operations 223087 0 67320 0 0 0 25307 0 8580 0 324294 0 0 0 Nicole Kerkenbush Chief Performance Officer 199126 0 90000 0 0 0 30957 0 2435 0 322518 0 0 0 Stephanie Lahr MD CIO/CMIO 359425 0 155250 0 0 0 47519 0 35023 0 597217 0 0 0 Mary Masten General Counsel, Emeritus 286202 0 0 0 0 0 13750 0 21320 0 321272 0 0 0 Laura C Wightman Chief Nursing Officer Until 04/2019 271820 0 101363 0 0 0 28983 0 18640 0 420806 0 0 0 John Pierce President Rapid City Market 290689 0 79248 0 18656 0 38681 0 30643 0 457917 0 18656 0 Douglas Koch VP Rapid City Market 185421 0 30000 0 45332 0 20472 0 13903 0 295128 0 0 0 Michael Tilles President Home Plus 258063 0 97500 0 0 0 27977 0 24512 0 408052 0 0 0 Michael Latour System Director of Musculoskeletal C 99137 85263 0 0 0 0 0 13575 11001 9537 110138 108375 0 0 Mark Longacre President - Monument Health Ortho Sp 0 271079 0 48125 0 19828 0 28875 0 15216 0 383123 0 0 John Karl Heilman III MD Physician - Cardiology 890489 0 53920 0 0 0 12922 0 26044 0 983375 0 0 0 James Takara MD Physician - Cardiac Surgery 983248 0 0 0 37461 0 59653 0 31553 0 1111915 0 37461 0 Bhaskar Purushottam MD Physician - Cardiology 968958 0 53920 0 0 0 80937 0 35903 0 1139718 0 0 0 Joseph Tuma MD Physician - Cardiology 1021307 0 53920 0 43315 0 69728 0 30504 0 1218774 0 43315 0 Roger Knutsen MD Physician - Dermatology 965016 0 2800 0 0 0 8250 0 16294 0 992360 0 0 0 Thomas Worsley President Spearfish Market 0 300322 0 84990 0 0 0 32000 0 25516 0 442828 0 0 Part I, Line 3 The Executive Committee, which is a committee of the Monument Health (parent) Board, reviews and approves base salary and total compensation ranges for all executives within the Monument Health System. Part I, Line 4b Monument Health provides a supplemental nonqualified retirement plan and a flexible benefit plan that can include deferred compensation for its executives. The following individuals had amounts deferred into the account as reported in column c on Schedule J: Teresa Burroff 38,441 Paulette Davidson 62,930 Stephanie Lahr, MD 38,813 Tresha Moreland 16,830 Brent Phillips 82,008 John Pierce 24,159 Mark Thompson 45,281 Michael Tilles 19,500 Laura Wightman 20,273 Sri, Gangineni, MD 27,269 Bhaskar Purushottam, MD 72,227 James Takara, MD 46,731 Joseph Tuma, MD 56,806 Brad Archer, MD 49,053 Nicole Kerkenbush 22,500 Doug Koch 12,500 Andrea Baier 14,823 Alex Schabauer, MD 48,249 Thomas Worsley 23,290 Mark Longacre 20,625 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 18,656 Mark Thompson 112,809 James Takara, MD 37,461 Joseph Tuma, MD 43,315 Alex Schabauer, MD 54,534 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. 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 13245000 67210000 250000 66960000 2015 1 0 1 1 B 3345000 240199216 1807893 183870096 54521227 2019 0 1 0 1 A 0 0 0 0 0.00020 0.00030 0.00050 0 0 1 B 0 1 1 0 1 0 0.00690 0.00860 0.01550 0 0 1 A 0 0 0 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 $1,711,094. Gregg Radtke Family member of Director Sandra Burns 43801 Employee compensation 0 Erika L Radtke Family member of Director Sandra Burns 66476 Employee compensation 0 Shelby Lynass Family member of Director Jack Lynass 60150 Employee compensation 0 Pamela Kim Phillips MD Family member of Prior CEO 166351 Employee compensation 0 Nadine Radtke Family member of Director Sandra Burns 51994 Employee compensation 0 Form 990, Page 1, Section C, Name of Organization Monument Health Rapid City Hospital, Inc. was known as Rapid City Regional Health, Inc. during fiscal year ended June 30, 2019. The organization changed its name in January, 2020, and filed the name change with the IRS prior to filing of this return. Form 990, Part III, line 2 On January 6, 2019, Monument Health Rapid City Hospital opened a new facility, the Monument Health Orthopedic and Specialty Hospital (MHOSH). MHOSH is a department of, and a remote location of, Monument Health Rapid City Hospital. It is located approximately 4.5 miles from Monument Health Rapid City Hospital's Main Campus and its address is 1635 Caregiver Circle in Rapid City, SD. MHOSH provides four surgery suites and ten inpatient rooms, with surgical procedures primarily focusing on orthopedics, neurosurgery and podiatry. It offers several related outpatient services (orthopedic surgery, neurosurgery, physiatry, primary care sports medicine, sports medicine, regenerative medicine, podiatry, pain management, wound care and weight management); therapy services (physical, speech and occupational therapy); and sports performance services. 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 Brent Phillips has a business relationship with the following individuals due to being the CEO (Until 07/2018) of the supporting organization that exercises reserve powers over the supported organizations that employ each of these key employees: Teresa Burroff; Stephanie Lahr MD; Mary Masten; Tresha Moreland; Brad Archer MD; Nicole Kerkenbush; John Pierce; Michael Tilles; Mark Thompson; Laura Wightman; Doughlas Koch; Mark Longacre; and employed Board Members: Sri Gangineni MD; Alex Schabauer MD; Andrea Baier MD. 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; Mary Masten; Tresha Moreland; Brad Archer MD; Nicole Kerkenbush; John Pierce; Michael Tilles; Mark Thompson; Laura Wightman; Doughlas Koch; Mark Longacre; and employed Board Members: Sri Gangineni MD; Alex Schabauer MD; Andrea Baier 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 VII Mark Longacre, President of Monument Health Orthopedic and Specialty Hospital, worked continuously for Monument Health throughout the fiscal year. The Hospital was operated in Monument Health Physicians for a portion of the year. In February, the Board of Directors made the decision to transfer the Hospital operations to Monument Health Rapid City Hospital, his hours have been allocated accordingly. Form 990, Part XI, line 9: Adj to the Funded Status of the Pension Plan -4,246,910. Medical Staff Net Income -47,887. Temporarily Restricted Net Asset Changes -3,415,535. Auxiliary Net Income -5,292. Transfers with related organizations -446,212. 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 63240780 13310649 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 -68734 1047865 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 -6684 1497696 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 312960 1795562 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 1120000 Cash Schedule R, Part I Monument Health Home Plus, LLC has submitted its name change documentation to the IRS but has not yet received notification from the IRS that the name change has been processed. Therefore, IRS record show the name of the organization as Regional Health Home Plus, LLC.