2016-05-16T06:57:09-05:00 2015-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-07-01 460360899 Regional Health Network Inc REGI 6057559130 2925 Regional Way PO Box 6000 Rapid City SD 57701 Mark Thompson CFO 6057559130 2016-05-05 1 Kim Hunwardsen CPA P00484560 6122536500 2016-05-05 2014 2016-08-17 19:52:53Z Brent Phillips 2925 Regional Way PO Box 6000 Rapid City SD 57701 115120421 0 X www.regionalhealth.com X 1981 SD Helping Patients and Communities Live Well 12 8 1076 198 3004817 -558700 249860 274440 98111249 113012198 152544 -141718 44880 48110 98558533 113193030 0 0 0 0 48507925 52989347 0 0 0 40468400 44870278 88976325 97859625 9582208 15333405 59173816 64461705 17753987 7711989 41419829 56749716 X Purpose: Helping Patients and Communities Live WellVision: We aspire to be the best healthcare system in AmericaValues: Courage, Integrity, Compassion, Innovation, Mutual RespectGoals: Patient & Family EXPERIENCE; Culture of Safety & Quality CARE; Physician & Caregiver ENGAGEMENT; Community & Financial STEWARDSHIP 1 0 5765448 23341162 Located in the Northern Black Hills of South Dakota, Spearfish Regional Hospital is a licensed 44-bed hospital, which includes locations at the main hospital campus, an outpatient surgery center campus and outpatient therapy services located in Belle Fourche and Spearfish. Our facility offers extensive patient care services including, 24-hour emergency service, hospitalist services, inpatient and outpatient care, labor and delivery, surgery, home health and hospice services. Spearfish Regional Hospital is a certified Trauma Level III facility. Spearfish Regional Hospital serves a geographic area that extends into Wyoming and Montana. The labor and delivery (Labor Delivery Recovery Postpartum - Obstetrics) and surgical services next closest hospital to offer these services is more than an hour away in Rapid City.Total inpatients served in FY2015 were 1,424 Adults and Pediatric admissions. Spearfish Regional Hospital also had 249 short stay observation patients and 426 nursery admissions. Total emergency department visits were 9,736.During FY2015, Spearfish Regional Hospital Surgery Department performed 2,534 total surgical procedures--715 inpatient procedures and 1,819 outpatient procedures. Inpatient procedures included surgeries in the areas of orthopedics, general, obstetrics/gynecology and other types. The outpatient area performed surgeries in the following categories: orthopedics, general surgery, gynecology, ENT and other types. Spearfish Regional Hospital also performed 31 inpatient endoscopies and 1,875 outpatient endoscopies during FY2015. The increase in surgical and endoscopy volumes is due to the consolidation of Spearfish Regional Surgery Center into Spearfish Regional Hospital effective 7.1.14.Spearfish Regional home care visits were 5,385 and hospice days were 6,311 in FY 15. 3181759 4598055 Custer Regional Senior Care is part of Custer Regional Hospital. Custer Regional Hospital's service area includes the central and southern Black Hills along with eastern Wyoming and northern Nebraska. Our primary care clinics are operated in Hill City (Rural Health Clinic), Custer (Provider Based Clinic) and Hot Springs. The nearest hospital is at least 45 minutes away if conditions are optimal. Rugged terrain, bad weather and an influx of tourists during summer months can make the commute to another facility take more than an hour.Our Long Term Care facility has 76 beds which includes a 16-bed secure Alzheimer's unit. The Assisted Living facility offers 16 private suites. The occupancy rate of the long-term care facility was 94.72 percent and for the assisted living facility it was 85.30 percent. 3102640 2529766 Custer Clinic is a department of Custer Regional Hospital. Custer Regional Hospital and Clinic service area includes the central and southern Black Hills, along with eastern Wyoming and northern Nebraska. Our primary care clinics are operated in Hill City (Rural Health Clinic), Custer (Provider Based Clinic) and Hot Springs. The nearest hospital is at least 45 minutes away if conditions are optimal. Rugged terrain, bad weather and an influx of tourists during summer months can make the commute to another facility take more than an hour.For fiscal year 2015, Custer Regional Hospital had 173 inpatient admissions; 40 Swing Bed admissions; 496 acute care patient days; 444 swing bed patient days; 2964 emergency room visits; 19,853 outpatient registrations; 49,447 lab tests; 8,034 Radiology visits; and 40,774 clinic RVUs. The total uncompensated care was $1,082,662 and 71.69 percent of the inpatient stays were Medicare or Medicaid patients.All patients are treated regardless of ability to pay. Financial assistance is offered to patients that are uninsured or underinsured. Custer Regional Hospital and Clinics provide training sites for medical and nursing students interested in rural and/or family practice medicine. 61149253 79538398 The Regional Health Network, Inc. is a network of small hospitals, nursing homes, and assisted living facilities in western South Dakota. These hospitals and long-term care facilities are located in small rural towns and provide a very necessary rural healthcare safety net. 61149253 79538398 73199100 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1076 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X Mark Thompson 6057559127 2925 Regional Way Rapid City SD 57701 Ross Lamphere Chairman 1.50 0.00 X X 0 0 0 Richard Tysdal Vice Chairman 1.00 0.80 X X 0 0 0 David Thom Secretary 0.80 0.00 X X 0 0 0 Dusty Pinske Treasurer 0.80 0.00 X X 0 0 0 Lee B Bailey MD Director 40.90 0.00 X 319957 0 55036 Peter J Cappa Director 1.70 1.50 X 0 0 0 Christopher Gasbarre DO Director 0.70 40.00 X 0 486885 74056 Robert Haivala Director 0.80 0.00 X 0 842 0 Julie Stone Director 0.80 0.00 X 0 0 0 Clinton Walker Director 0.70 0.00 X 0 0 0 Charles E Hart MD President & CEO (July-February) 8.80 51.20 X X 0 979329 39070 Brent Phillips Independent Contractor (December) 1.30 7.70 X X 0 14687 0 Brent Phillips President & CEO (January-June) 8.80 51.20 X X 0 0 0 Timothy H Sughrue CEO RCRH, RHN & COO RHI (July-March) 9.10 45.90 X X 0 674948 47450 Kyle Richards COO 55.00 0.00 X X 209972 0 37731 Mark A Thompson VP CFO 8.00 47.00 X 0 425445 73711 Joseph C Sluka Jr Executive VP/CAO (July-November) 8.00 47.00 X 0 501367 34812 Mark F Brodin VP Decision Support 8.00 47.00 X 0 201410 37229 Sharmila M Chandran VP Corporate Responsibility 8.00 47.00 X 0 204821 19062 Maureen Henson VP Human Resources 8.00 47.00 X 0 171543 16891 Jennifer D Horton VP PR Marketing 8.00 47.00 X 0 191144 46522 David L Klocke MD Chief Medical Officer 8.00 47.00 X 0 424400 50564 Richard S Latuchie VP Info Technology/ CIO 8.00 47.00 X 0 311312 32002 Mary E Masten VP Legal Services 8.00 47.00 X 0 343091 43130 Veronica Schmidt CEO of Custer Regional Hospital 55.00 0.00 X 150140 0 38641 Sherry Bea Smith CEO of Lead-Deadwood Regional Hospital 55.00 0.00 X 171929 0 33043 Larry Veitz CEO of Spearfish Regional Hospital 55.00 0.00 X 256483 0 44610 Krista Birkelo DO Physician - Emergency & Family Medicine 40.00 0.00 X 283850 0 33639 Christopher Fromm MD Physician - Emergency & Family Medicine 40.00 0.00 X 275760 0 53743 Curtis Liedtke DO Physician - Emergency & Family Medicine 40.00 0.00 X 247341 0 18278 M Donald Potts MD Physician - Emergency & Family Medicine 40.00 0.00 X 347664 0 23985 Thomas Reid Nurse Anesthetist 40.00 0.00 X 175485 0 29385 2438581 4931224 882590 34 0 1 0 Alliance Recruiting Resources Inc PO Box 670416 Dallas TX 752670416 Temporary Physician Staffing Services 1280130 DMS Health Technologies Inc 2101 N University Dr Fargo ND 58102 Mobil MRI Diagnostic Services 321907 AEGIS Therapies Inc PO Box 8103 Fort Smith AR 72902 Patient Therapy Treatments 282871 Athena Health Inc 311 Arsenal St Watertown MA 02472 Computer Software-Practice Management Bi 276643 Medical Doctor Associates INc PO Box 277185 Atlanta GA 303847185 Temporary Physician Staffing Services 258325 11 43897 143410 87133 274440 Acute Care Hospital IP and OP 623000 75750000 75750000 Long Term Care Facilities 623000 10649000 10649000 Home Care Services 621610 5530000 5530000 Physician Clinics 621110 4535000 4535000 Assisted Living Facilities 623000 1988000 1988000 14560198 11555381 3004817 113012198 7500 7500 1739972 1889190 -149218 -149218 -149218 86311 43897 38201 48110 48110 113193030 110007381 3004817 -93608 1323611 347777 975834 40784711 34331856 6452855 1124365 926006 198359 7026681 5787044 1239637 2729979 2226609 503370 44874 44874 990 990 14713 14713 5526137 4253609 1272528 61759 22726 39033 296090 181683 114407 898526 627626 270900 2268634 903678 1364956 213504 174298 39206 210111 167866 42245 8143 525 7618 4214796 2451342 1763454 158073 86538 71535 Intercompany Supplies a 11088630 2464482 8624148 Medical Supplies 8789105 8789105 Bad Debt Expense 5478390 5478390 5597803 3977940 1619863 97859625 73199100 24660525 0 42948 23801 13675818 18648439 1400821 1659813 482432 509299 99732941 58160548 41647673 41572393 288886 255911 62430 1572808 1792049 59173816 64461705 4482708 6243589 13271279 1468400 17753987 7711989 X 40079421 55258991 1240408 1390725 100000 100000 41419829 56749716 59173816 64461705 15333405 -3518 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14713 14713 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 2015 dues, which were paid in fiscal year 2015, in the amount of $82,522.80, 6.739% was used for lobbying purposes. In addition, annual dues were paid to the American Hospital Association, a portion of which is applicable to lobbying activities. For calendar year 2015 dues, which were paid in fiscal year 2015, in the amount of $40,140, 22.8% was used for lobbying purposes. 116730 3779 120509 100000 16730 116730 100000 100000 100000 100000 100000 100000 0.00000 0.96860 0.03140 0 0 8873079 8873079 48971888 26372366 22599522 39729135 30113726 9615409 2158839 1674456 484383 41572393 Due to Related Parties-Investment 1468400 1468400 X Part V, Line 4: Endowed funds are permanently restricted from use and are held in an interest bearing account. The interest earned may be used by the organization at its discretion. Part X, Line 2: References to "Regional Health" apply to all entities controlled or leased by Regional Health, Inc. This includes the reporting entity. Regional Health and subsidiaries are organized as nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Regional Health and subsidiaries are annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). In addition, Regional Health and subsidiaries may be subject to income tax on income that is derived from business activities that are unrelated to its tax exempt purpose. Regional 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. Regional 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. Regional Health's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Hospice Ball 68919 2510 66409 1267 16192 3250 4759 Hospice Golf Tournament 22912 3010 19902 1874 9316 200 2 38377 38377 386 957 130208 43897 86311 3141 25894 3250 5916 38201 48110 1 1 X 1 X 1 X 1 1 0 0 2693035 2693035 0.02920 10313952 9786865 527087 0.00570 13006987 9786865 3220122 0.03490 12 1401 6670 6670 0.00010 4 303 9838 9838 0.00010 16 1704 16508 16508 0.00020 16 1704 13023495 9786865 3236630 0.03510 3 4 1447 1447 0.00000 3 4 1447 1447 1 5478390 44079 28142586 27550300 592286 X 1 1 4 1 Spearfish Regional Hospital 1440 N Main Street Spearfish SD 57783 www.regionalhealth.com 10566 X X X 5 Provider-based clinics A 2 Custer Regional Hospital 1039 Montgomery Street Custer SD 57730 www.regionalhealth.com 47660 X X X X 2 Provider-based clinics A 3 Sturgis Regional Hospital 949 Harmon Street Sturgis SD 57785 www.regionalhealth.com 10567 X X X X A 4 Lead-Deadwood Regional Hospital 61 Charles Street Deadwood SD 57732 www.regionalhealth.com 10535 X X X X 1 Provider-based clinic A Facility Reporting Group - A 0 0 1 X X X X X X X X X 12 1 1 0 1 X www.regionalhealth.com/chna X 1 12 1 www.regionalhealth.com/chna 0 0 1 X 200.000000000000 250.000000000000 X X 1 1 X X X X 1 X http://www.regionalhealth.com/Patients-Visitors/Financial-Assistance/Financ X http://www.regionalhealth.com/Patients-Visitors/Financial-Assistance/Financ X X X X 1 X 0 X X X 1 X 0 1 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Spearfish Regional Hospital, - Facility 2: Custer Regional Hospital, - Facility 3: Sturgis Regional Hospital, - Facility 4: Lead-Deadwood Regional Hospital Facility Reporting Group - A Part V, Section B, line 16b website: http://www.regionalhealth.com/Patients-Visitors/Financial-Assistance/Financ Facility Reporting Group - A Part V, Section B, line 16c website: http://www.regionalhealth.com/Patients-Visitors/Financial-Assistance/Financ Group A-Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 5: As part of the community health needs assessment, a focus group was held on September 24, 2012. The focus group participants were comprised of 13 key informants, including representatives from public health, Indian Health Services, other health professionals, social service providers, and other community leaders. 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. Participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Group A-Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 6a: The Community Health Needs Assessment was undertaken by Regional Health, including: Rapid City Regional Hospital, Same Day Surgery Center, Spearfish Regional Hospital, Spearfish Regional Surgery Center, Sturgis Regional Hospital, Lead-Deadwood Regional Hospital and Custer Regional Hospital. Under a management contract with Regional 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. Group A-Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 11: In review of the needs identified in the CHNA, Spearfish Regional Hospital has identified the areas below that will not be addressed due to prioritization of health needs:1) Maternal, Infant, Child Health: As a provider of maternal, infant and child hospital care in the community, SPRH believes it fulfills its role in this area. It was therefore given a lower priority that excluded this as an area chosen for action.2) Oral Health: SPRH has limited expertise available to address oral health and access to oral health insurance. Other community organizations have infrastructure and programs in place to better meet this need. Limited expertise excluded this as an area chosen for action.3) Nutrition, Physical Activity & Weight Status: It was determined that more pressing health needs exist. Limited resources and lower priority excluded this as an area chosen for action.4) Respiratory Diseases: SPRH believes this priority area falls within the purview of other available community resources, including outpatient clinical settings. Participation with the Good Shepherd Clinic positively impacts the ability for those with chronic respiratory disease to access the health care system.5) Substance Abuse: SPRH believes efforts outlined in its plan for mental health and mental health resources will also have a positive impact on substance abuse. A separate set of specific initiatives in this area is not justified at this time.6) Tobacco Use: SPRH is a tobacco-free facility. The facility provides smoking cessation screening to our patients and refers patients and employees to the South Dakota Quit Line for ongoing support. Lower priority excluded this as an area chosen for action.SPRH continued to execute the implementation strategy during fiscal year 2015. The needs that are being addressed are as follows: 1) access to health services; 2) conditions of aging; 3) diabetes; 4) injury and violence prevention; and 5) mental health and mental disorders. Group A-Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 16i: 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 hospital is in the process of revising the FAP and once complete the revised full policy will be available on the Regional Health website. Group A-Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for medically necessary care. The financial assistance policy does not apply to certain elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on certain elective procedures. Group A-Facility 2 -- Custer Regional Hospital Part V, Section B, line 5: As part of the community health needs assessment, a focus group was held on September 24, 2012. The focus group participants were comprised of 13 key informants, including representatives from public health, Indian Health Services, other health professionals, social service providers, and other community leaders. 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. Participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Group A-Facility 2 -- Custer Regional Hospital Part V, Section B, line 6a: The Community Health Needs Assessment was undertaken by Regional Health, including: Rapid City Regional Hospital, Same Day Surgery Center, Spearfish Regional Hospital, Spearfish Regional Surgery Center, Sturgis Regional Hospital, Lead-Deadwood Regional Hospital and Custer Regional Hospital. Under a management contract with Regional 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. Group A-Facility 2 -- Custer Regional Hospital Part V, Section B, line 11: In review of the needs identified in the CHNA, Custer Regional Hospital has identified the areas below that will not be addressed due to prioritization of health needs:1) Access to Health Services: The specific concern identified here was annual checkups for children ages 0-17. National standards deem a checkup every three years as the standard of care for children older than three years of age. Local medical staff adheres to this standard. CRH was a recipient of a grant in FY 12 providing wellness checkups for kids when finances are a barrier to receiving care. 2) Cancer: CRH partners with the All Women Count program promoting early detection for women who have financial barriers to breast cancer screening. Awareness activities through the American Cancer Society currently exist in the community and surrounding area. The provider for mobile mammography services discontinued services in Western South Dakota in 2012. Efforts continue to replace this service yet won't have impact in the timeline and scope of this implementation plan.3) Conditions of Aging: In the area of Alzheimer's deaths, Custer Regional Senior Care, a related facility, is a licensed skilled nursing facility providing services to the elderly of the community. Services include a special care unit specifically serving residents with Alzheimer's and dementia related diagnoses. The Department of Social Services Adult Services and Aging department provides in-home services and case management to elders in the community with conditions of aging, such as difficulty seeing and hearing, assisting in obtaining adaptive equipment and transportation. 4) Injury & Violence Prevention: There are numerous activities currently provided to the community in the area of injury prevention in which CRH partners and it will continue to be open to additional opportunities for partnerships. CRH currently provides physician education presentations to employee groups surrounding safe logging practices and the Custer High School students on healthy decisions; CRH partners with the Custer School District in providing hands-on, experiential education, namely Freshman Impact, on distracted driving and driving under the influence and the negative consequences associated with those unsafe practices; Custer School District has an active Students Against Destructive Decisions group; firearm and hunter safety courses are currently provided; Custer Rotary Club provides area youth bicycle helmets at a community bike rodeo. 5) Mental Health & Mental Disorders: The Service Area currently has several programs and services in place to assist in addressing mental health issues. Mental health issues are best addressed as a community as a whole and although deemed out of the scope for a Critical Access Hospital, CRH will continue to seek opportunities for partnerships with area entities to assist in addressing this issue in its primary service area. Current programs include the Helpline Center; Front Porch Coalition; Suicide Awareness Education in the schools; Veteran Administration Hospital in Fall River County addresses mental health concerns for military veterans; licensed mental health professionals provide counseling services; Department of Social Services provide case management services. 6) Oral Health: Insurance coverage for dental insurance was considered the barrier to adequate oral health and is currently addressed by a Mobile Dental Program providing no cost dental exams to area youth; local dentists provide in-class oral health education to elementary students and provide free dental screenings to children entering kindergarten.7) Respiratory Diseases: Tobacco Use was not an area of need identified. Chronic respiratory disease and pneumonia/influenza are currently addressed through community flu shot clinics and education of the public and health care personnel on importance of flu shots.8) Substance Abuse: Substance abuse issues are currently addressed with existing area programs and services to include Custer Regional Hospital's existing partnership with the Freshman Impact program previously noted. Other area programs and services include Custer Schools Students Against Destructive Decisions group; Southern Hills Alcohol and Drug Center provides substance abuse related services; Veteran's Administration in Fall River County provides Substance Abuse treatment for military veterans.CRH continued to execute the implementation strategy during fiscal year 2015. The needs that are being addressed are as follows: 1) diabetes; 2) heart disease and stroke; and 3) nutrition, physical activity and weight status. Group A-Facility 2 -- Custer Regional Hospital Part V, Section B, line 16i: 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 hospital is in the process of revising the FAP and once complete the revised full policy will be available on the Regional Health website. Group A-Facility 2 -- Custer Regional Hospital Part V, Section B, line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for certain medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on certain elective procedures. Group A-Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 5: As part of the community health needs assessment, a focus group was held on September 24, 2012. The focus group participants were comprised of 13 key informants, including representatives from public health, Indian Health Services, other health professionals, social service providers, and other community leaders. 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. Participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Group A-Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 6a: The Community Health Needs Assessment was undertaken by Regional Health, including: Rapid City Regional Hospital, Same Day Surgery Center, Spearfish Regional Hospital, Spearfish Regional Surgery Center, Sturgis Regional Hospital, Lead-Deadwood Regional Hospital and Custer Regional Hospital. Under a management contract with Regional 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. Group A-Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 11: In review of the needs identified in the CHNA, Sturgis Regional Hospital has identified the areas below that will not be addressed due to prioritization of health needs:1) Access to Health Services: SRH believes more pressing health needs exist. Lower priority excluded this as an area chosen for action.2) Injury & Violence Prevention: SRH has limited expertise available to address injury and violence prevention. The facility will work in collaboration with community partners as opportunities arise.3) Maternal, Infant, Child Health: SRH does not provide obstetrical services at the facility. There are other available resources in the community that serve this need. Limited expertise excluded this as an area chosen for action. 4) Oral Health: SRH has limited expertise available to address oral health. The facility will work in collaboration with community partners as opportunities arise.5) Respiratory Diseases: SRH believes more pressing health needs exist. Lower priority excluded this as an area chosen for action.6) Substance Abuse: SRH has limited expertise available to address alcohol and other drug issues. Other community organizations have infrastructure and programs in place to better meet this need. Limited expertise excluded this as an area chosen for action.7) Tobacco Use: Lower priority excluded this as an area chosen for action.SRH continued to execute the implementation strategy during fiscal year 2015. The needs that are being addressed are as follows: 1) conditions of aging; 2) diabetes; 3) mental health and mental disorders; and 4) nutrition, physical activity and weight status. Group A-Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 16i: 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 hospital is in the process of revising the FAP and once complete the revised full policy will be available on the Regional Health website. Group A-Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for certain medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on certain elective procedures. Group A-Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 5: As part of the community health needs assessment, a focus group was held on September 24, 2012. The focus group participants were comprised of 13 key informants, including representatives from public health, Indian Health Services, other health professionals, social service providers, and other community leaders. 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. Participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Group A-Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 6a: The Community Health Needs Assessment was undertaken by Regional Health, including: Rapid City Regional Hospital, Same Day Surgery Center, Spearfish Regional Hospital, Spearfish Regional Surgery Center, Sturgis Regional Hospital, Lead-Deadwood Regional Hospital and Custer Regional Hospital. Under a management contract with Regional 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. Group A-Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 11: In review of the needs identified in the CHNA, Lead-Deadwood Regional Hospital has identified the areas below that will not be addressed due to prioritization of health needs:1) Access to Health Services: LDRH believes more pressing health needs exist. Lower priority excluded this as an area chosen for action.2) Conditions of Aging: In the area of Alzheimer's deaths, Golden Ridge Regional Senior Care, a related facility, is a licensed assisted living facility providing services to the elderly of the community. Other organizations provide in-home services and case management to elders in the community with conditions of aging, such as difficulty seeing and hearing, assisting in obtaining adaptive equipment and transportation. 3) Maternal, Infant, Child Health: LDRH does not provide obstetrical services at the facility. There are other available resources in the community that serve this need. Limited expertise excluded this as an area chosen for action. 4) Oral Health: LDRH has limited expertise available to address oral health and access to oral health insurance. Other community organizations have infrastructure and programs in place to better meet this need. Limited expertise excluded this as an area chosen for action.5) Respiratory Diseases: LDRH believes this priority area falls within the purview of other available community resources, including outpatient clinical settings. 6) Substance Abuse: LDRH believes efforts outlined in its plan for mental health and mental health resources will also have a positive impact on substance abuse. A separate set of specific initiatives in this area is not justified at this time.7) Tobacco Use: LDRH is a tobacco-free facility. The facility provides smoking cessation screening to our patients and refers patients and employees to the South Dakota Quit Line for ongoing support. Lower priority excluded this as an area chosen for action.LDRH continued to execute the implementation strategy during fiscal year 2015. The needs that are being addressed are as follows: 1) diabetes; 2) injury and violence prevention; 3) mental health and mental disorders; and 4) nutrition, physical activity and weight status. Group A-Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 16i: 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 hospital is in the process of revising the FAP and once complete the revised full policy will be available on the Regional Health website. Group A-Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for medically necessary care. The financial assistance policy does not apply to certain elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on certain elective procedures. 9 Custer Regional Senior Care 1065 Montgomery Street Custer SD 57730 Skilled Long Term Nursing Home Sturgis Regional Senior Care 949 Harmon Street Sturgis SD 57785 Skilled Long Term Nursing Home Fairmont Grand Regional Senior Care 409 east Fairlane Drive Rapid Ctiy SD 57701 Assisted Living Golden Ridge Regional Senior Care 200 Montana Ave Lead SD 57754 Assisted Living Hot Springs Regional Medical Clinic 130 North 15th St Hot Springs SD 57747 Clinic Massa Berry Regional Medical Clinic 890 Lazelle Street Sturgis SD 57785 Clinic Newcastle Regional Medical Clinic 1121 Washington Blvd Newcastle WY 82701 Clinic Buffalo Regional Medical Clinic 209 Ramsland Street Buffalo SD 57720 Clinic Upton Regional Medical Clinic 717 Pine Street Upton WY 82730 Clinic Part I, Line 3c: References to "Regional Health" apply to all entities controlled or leased by Regional Health, Inc. This includes the reporting entity.Part I, Line 3c: 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 is updated annually as the FPL guidelines are released. 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 and 7i. Part I, Line 7, Column (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 $ 5,478,390. Part II, Community Building Activities: Regional Health provides numerous community benefit health events and screenings throughout the Black Hills Region. Regional Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Regional 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 3: The estimated amount of bad debt attributable to patients eligible under the financial assistance policy is determined through a review of the bad debt records to identify patient accounts that would be eligible for a discount under the financial assistance policy. The organization follows HFMA Statement 15, however the amount reported on Part III, Line 3 reflects amounts not previously determined to be charity care in prior years that were determined in the current year to be charity care amounts. Part III, Line 4: The footnote to the financial statements that describes bad debt expense is located on page nine of the audited financials. Part III, Line 8: The Medicare shortfall 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 shortfall with costs exceeding the reimbursement.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 community. Part III, Line 9b: The collection policy requires invoking of the financial assistance policy 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: The Community Health Needs Assessment was conducted in FY2013 by Regional Health, including: Rapid City Regional Hospital, Same Day Surgery Center, Spearfish Regional Hospital, Spearfish Regional Surgery Center, Sturgis Regional Hospital, Lead-Deadwood Regional Hospital, Custer Regional Hospital, and Hans P. Peterson Memorial Hospital. In July 2012, we contracted with Professional Research Consultants, Inc. (PRC) to conduct the needs assessment. PRC is a nationally recognized health care consulting firm with extensive experience conducting Community Health Needs Assessments in hundreds of communities across the United States since 1994. The assessment incorporated data from both quantitative and qualitative sources. Quantitative data input included primary research (the PRC Community Health Survey, November 2012) and secondary research (vital statistics and other existing health-related data); these quantitative components allowed for trending and comparison to benchmark data at the state and national levels. Qualitative data input included primary research gathered through a Key Informant Focus Group.A variety of existing (secondary) data sources was consulted to complement the research quality of the Community Health Needs Assessment. Data for the service area were obtained from the following sources: * Centers for Disease Control & Prevention* GeoLytics Demographic Estimates & Projections* National Center for Health Statistics* South Dakota Department of Public Health* US Census Bureau* US Department of Health and Human Services* US Department of Justice, Federal Bureau of InvestigationAs part of the needs assessment, a focus group was held on September 24, 2012. The focus group participants were comprised of 13 key informants, including representatives from public health, Indian Health Services, other health professionals, social service providers, and other community leaders. Potential 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. Participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. The needs assessment report was completed in February 2013. After reviewing the findings, the Community Health Needs Assessment Steering Committee met regularly during the month of March, to determine the health needs to be prioritized for action in FY2014-FY2016. Following a detailed presentation of the Community Health Needs Assessment findings by PRC, steering committee members were led through a process of understanding key local data findings (Areas of Opportunity) and ranked identified health issues against the following established, uniform criteria: * Magnitude. The number of persons affected, also taking into account variance from benchmark data and Healthy People targets. * Impact/Seriousness. The degree to which the issue affects or exacerbates other quality of life and health-related issues. * Feasibility. The ability to reasonably impact the issue, given available resources. * Consequences of Inaction. The risk of not addressing the problem at the earliest opportunity. A proposed Implementation Strategy was then written to address the community's health needs. In the months of May and June, 2013, the organization's Board as well as the Board of Regional Health reviewed, discussed and approved the implementation strategies for addressing the community health priorities identified through the Community Health Needs Assessment. Part VI, Line 3: We provide information on all statements, on our website, and at all admission areas; we contract with Midland Medical Group (an unrelated entity) to meet with all 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: Regional Health serves the people of the Black Hills Region. The area is mostly rural in nature with only one city of over 50,000 people. Regional Health is the primary medical services provider for the region. Part VI, Line 5: Regional Health is governed by a community board that provides leadership to the organization to meet the community needs. Regional Health partners with several educational institutions to provide numerous clinical training programs, that if they were not provided by Regional Health, would not exist in our region.Regional Health provides numerous community health education events and screenings throughout the Black Hills Region. Regional Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Regional Health provides in-kind support and employee volunteers to help support community health events and activities and other charitable programs. Part VI, Line 6: Regional Health is committed to partnering with the communities it serves to meet the needs of each respective community. Regional Health, Inc. is the parent organization of Rapid City Regional Hospital, Inc., Regional Health Network, Inc., and Regional 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 Lee B Bailey MD Director 319957 0 0 0 0 0 32320 0 22716 0 374993 0 0 0 Christopher Gasbarre DO Director 0 484660 0 2225 0 0 0 52575 0 21481 0 560941 0 0 Charles E Hart MD President & CEO (July-February) 0 822401 0 152408 0 4520 0 21682 0 17388 0 1018399 0 0 Timothy H Sughrue CEO RCRH, RHN & COO RHI (July-March) 0 584475 0 88650 0 1823 0 24219 0 23231 0 722398 0 0 Kyle Richards COO 198672 0 11300 0 0 0 18897 0 18834 0 247703 0 0 0 Mark A Thompson VP CFO 0 355658 0 63697 0 6090 0 57755 0 15956 0 499156 0 6090 Joseph C Sluka Jr Executive VP/CAO (July-November) 0 395997 0 75194 0 30176 0 14160 0 20652 0 536179 0 20782 Mark F Brodin VP Decision Support 0 180608 0 20802 0 0 0 16102 0 21127 0 238639 0 0 Sharmila M Chandran VP Corporate Responsibility 0 182434 0 22387 0 0 0 14814 0 4248 0 223883 0 0 Maureen Henson VP Human Resources 0 171543 0 0 0 0 0 15826 0 1065 0 188434 0 0 Jennifer D Horton VP PR Marketing 0 161539 0 20248 0 9357 0 23245 0 23277 0 237666 0 9357 David L Klocke MD Chief Medical Officer 0 358521 0 65879 0 0 0 27293 0 23271 0 474964 0 0 Richard S Latuchie VP Info Technology/ CIO 0 279031 0 32281 0 0 0 14822 0 17180 0 343314 0 0 Mary E Masten VP Legal Services 0 308434 0 34657 0 0 0 25714 0 17416 0 386221 0 0 Veronica Schmidt CEO of Custer Regional Hospital 133744 0 16396 0 0 0 15014 0 23627 0 188781 0 0 0 Sherry Bea Smith CEO of Lead-Deadwood Regional Hospit 154085 0 17844 0 0 0 16302 0 16741 0 204972 0 0 0 Larry Veitz CEO of Spearfish Regional Hospital 220274 0 24755 0 11454 0 28597 0 16013 0 301093 0 11454 0 Krista Birkelo DO Physician - Emergency & Family Medic 283850 0 0 0 0 0 26093 0 7546 0 317489 0 0 0 Christopher Fromm MD Physician - Emergency & Family Medic 275400 0 0 0 360 0 32616 0 21127 0 329503 0 0 0 Curtis Liedtke DO Physician - Emergency & Family Medic 246981 0 0 0 360 0 8554 0 9724 0 265619 0 0 0 M Donald Potts MD Physician - Emergency & Family Medic 293436 0 0 0 54228 0 8804 0 15181 0 371649 0 53838 0 Thomas Reid Nurse Anesthetist 175485 0 0 0 0 0 7000 0 22385 0 204870 0 0 0 Part I, Line 3 The compliance and audit committee, which is a committee of the Regional Health (parent) Board, reviews and approves base salary and total compensation ranges for all executives within the Regional Health System. Please see Form 990, part VI, Lines 15a & 15b disclosure on Schedule O. Part I, Line 4b Regional 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: Chandran, Sharmila $8,453 Henson, Maureen $10,660 Horton, Jennifer $12,331 Klocke MD, David $19,202 Thompson, Mark $38,769 Richards, Kyle $12,430 Schmidt, Veronica $9,906 Veitz, Larry $15,077 Bailey MD, Lee $17,969 Gasbarre DO, Christopher $43,896 Birkelo DO, Krista $17,796 Fromm MD, Christopher $19,044 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 Regional Health, Inc. Annual Incentive Plan for Selected Executives and Other Employees (Incentive Plan). In accordance with this plan, the Board's Compliance and Audit Committee of Directors will reviews and approves all incentive compensation performance measures and all awards, if any. Form 990, Part III, line 2 Spearfish Surgery Center became a department of Spearfish Regional Hospital: Regional Health Network owned the Spearfish Regional Surgery Center but in prior years it was operated by Regional Health Physicians, Inc., a related organization. Beginning on July 1, 2014, operation of the Spearfish Regional Surgery Center was transferred to and it became a department of Spearfish Regional Hospital, one of the hospitals owned and operated by Regional Health Network. Form 990, Part IV, Line 24a Bond Issues: The issue price of the bonds includes the filing organization's share of the entire bond issue, which was issued to Rapid City Regional Hospital on behalf of the Obligated Group. The Obligated Group consists of Rapid City Regional Hospital, Regional Health Inc, Regional Health Network Inc, and Regional Health Physicians Inc. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Rapid City Regional Hospital's tax return. Form 990, Part V, Line 1a: All 1099's are issued centrally by Rapid City Regional Hospital, Inc., a related organization. Form 990, Part VI, Section A, line 1 The membership of the Executive Committee of the corporation shall consist of the following: Chairman of the Board of Directors, Vice Chairman of the Board of Directors, Secretary, Treasurer, CEO, and the most recent past Chairman of the Board of Directors unless such person is otherwise a member of the Committee (and only if the person continues to be a member of the Board of Directors). The Chairman of the Board of Directors shall serve as Chairman of the Executive Committee. 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. Form 990, Part VI, Section A, line 1 The organization considers some members of the Board to not be independent because they are actively practicing physicians on its or its related entities' medical staffs or, in one instance, is an employee of the organization. Form 990, Part VI, Section A, line 2 Brent Phillips 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 individuals: Lee Bailey, MD, Christopher Gasbarre, DO, Joseph Sluka Jr., Timothy Sughrue, Mark Thompson, Mark Brodin, Sharmila Chandran, Maureen Henson, Jennifer Horton, David Klocke, MD, Richard Latuchie, Mary Masten, Kyle Richards, Veronica Schmidt, Sherry Bea Smith and Larry Veitz. Form 990, Part VI, Section A, line 6 Regional Health, Inc. is the sole member of Regional Health Network, Inc. Form 990, Part VI, Section A, line 7a Regional Health, Inc., being the sole member of Regional Health Network, Inc., has the ability to appoint or remove all members of Regional Health Network, Inc.'s board. Form 990, Part VI, Section A, line 7b Regional 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 RHI, as a whole (the System). Regional Health, Inc. has final authority in significant business decisions affecting the Supported Organizations. Form 990, Part VI, Section B, line 11 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 each board member on how to access the portal. Form 990, Part VI, Section B, line 12c As a part of the annual disclosure of potential conflicts process, all board members, officers, and management receive a copy of the conflict of interest policy and sign an acknowledgement they have read and understand it. Additionally, they are each required to complete a disclosure statement. Annually, a summary list of all conflicts disclosed by board members is prepared and provided to the full board so board members are aware of the conflicts/interests of other board members and are able to point out conflicts if an individual member with a conflict forgets. Additionally, the agenda for each board meeting and each board committee meeting includes an initial agenda item "Conflicts of Interest" where board members are asked if they have any conflicts related to the other items on the agenda. All employees are covered by the conflict of interest policy but completion of the annual disclosure statement is limited to board and board committee members, management, and certain physicians. When a proposed transaction involves a board member, the transaction is reviewed by the compliance and audit committee. At meetings, board members who have a conflict of interest may be invited to speak on the matter by the chairman, but are not permitted to vote on the matter and are required to leave the meeting during discussion, after they have made any comments invited by the chair. Failure to comply with this policy constitutes ground for removal from office or membership and in the case of all employees, termination of employment. Form 990, Part VI, Section B, line 15b The Compliance and Audit committee of the sole member's board, a committee that includes only board members deemed "independent", determines all elements of compensation for the member's CEO (base salary, total cash compensation, benefits and total compensation). For other executive staff, the committee determines the appropriate base salary, cash compensation and total compensation ranges. The CEO of the member or his designee determines the actual base salary of the other executives within the committee-approved base salary range based on performance, while the committee authorizes any incentive compensation awarded to executives and any additional benefits offered to executives. The committee retains an independent compensation consultant, Sullivan & Cotter, to provide peer group market comparative data for base salary, total cash compensation, benefits and total compensation for executives. Sullivan & Cotter most recently completed a market assessment, and the committee approved compensation elements and ranges based thereon, in April and June of 2015. 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 at the Secretary of State's website. 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. Regional Health Inc 353 Fairmont Blvd Rapid City SD 57701 201487506 Healthcare SD 501(c)(3) Line 11c, III-FI N/A 0 Rapid City Regional Hospital Inc 353 Fairmont Blvd Rapid City SD 57701 460319070 Healthcare SD 501(c)(3) Line 3 Regional Health Inc 1 Regional Health Physicians Inc 353 Fairmont Blvd Rapid City SD 57701 460372454 Healthcare SD 501(c)(3) Line 3 Regional Health Inc 1 Medical & Dental Building 2805 S 5th St Rapid City SD 57701 460339629 Medical Office Bldg SD N/A Black Hills Medical Office BD LLC 353 Fairmont Blvd Rapid City SD 57701 411992146 Medical Office Bldg SD N/A 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 Regional Health Physicians Inc J 477674 Cost Rapid City Regional Hospital Inc M 6162818 Cost Rapid City Regional Hospital Inc Q 2080354 Cost