2026-05-14T15:47:05-05:00 2025-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2024-07-01 460319070 Monument Health Rapid City Hospital Inc MONU 6057559130 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Austin Willuweit CFO 6057559130 2026-05-14 1 1 Kim Hunwardsen CPA P00484560 6122536500 2026-05-14 2024 2025-03-06 01:10:19Z Paulette Davidson 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 1095522101 0 X www.monument.health X 1973 SD Improving the health of individuals and our communities. 15 9 5235 203 13167808 58854 14649514 3489255 983049234 1062272909 32982133 25105708 1023251 971219 1031704132 1091839091 1512792 440813 0 0 416046401 441967799 0 0 1547752 569410797 617412214 986969990 1059820826 44734142 32018265 1422455024 1484513220 525395889 532428914 897059135 952084306 X Our vision at Monument Health Rapid City Hospital is to be one team, to listen, to be inclusive, and to show we care. Monument Health Rapid City Hospital is dedicated to improving the health of individuals and our communities. 0 0 864199254 440813 1049106576 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. MHRCH is a community-based health care system with a mission to make a difference, every day. MHRCH also provides patient care at the Behavioral Health Center, Orthopedic and Specialty Hospital, Family Medicine Residency Clinic, Heart and Vascular Institute, Hospice House, Medical Clinics and Urgent Care locations. The Hospital employs physicians through its residency, cardiology, cardiovascular surgery, medical oncology, psychiatry, neurology, hospitalist, orthopedics and other programs.Monument Health Home Plus, LLC provides home care, hospice, pharmacy, and durable medical equipment services to the communities Monument Health serves. 864199254 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 0 0 1 611 0 1 5235 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 15 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X Austin Willuweit 6057559127 353 Fairmont Blvd PO Box 6000 Rapid City SD 577096000 Paulette R Davidson President & CEO 51.30 8.70 X X 0 1932107 267590 Brad Archer MD Chief Medical Officer 47.11 7.89 X 972031 0 134035 Bobbie Schneller DO Board Member/Employed Physician 40.89 0.00 X 401285 0 64301 Steven Frost MD Board Member 0.89 0.00 X 3000 0 0 Daryl Reinicke Chair 1.94 0.00 X X 0 0 0 Holly Lien Board Member 0.81 0.00 X 0 0 0 Ross Mckie Vice Chair 1.57 0.00 X X 0 0 0 Scott Barbour Board Member 1.27 0.00 X 0 0 0 Tom Rau Board Member 0.81 0.00 X 0 0 0 Donna Wright Board Member 0.72 0.00 X 0 0 0 Dusty Petersen Board Member 0.89 0.00 X 0 0 0 Michael Huot MD Board Member 0.98 0.00 X 14180 0 0 Lance Roberts Board Member 0.98 0.00 X 0 0 0 Don Warne MD Board Member 0.61 0.00 X 36000 0 0 Stephanie Forsythe Board Member Until 02/2025 0.26 0.00 X 0 0 0 Jacob Weasel MD Board Member/Employed Physician 40.00 0.43 X 494488 0 72250 Mark A Thompson Chief Bus Dev Officer Until 12/2024 47.02 7.98 X 505374 0 49245 Austin Willuweit Chief Financial Officer 47.02 7.98 X 528595 0 84168 John Pierce President Rapid City Hospital and Market 55.00 0.00 X 822063 0 121912 Michael Tilles VP Operations-Rapid City Market 55.00 0.00 X 453907 0 48897 Mark Longacre until 53124 VP Operations-Rapid City Market 55.00 0.00 X 158824 0 22306 Mark Schulte VP Rapid City Market 55.00 0.00 X 411968 0 62831 Tasha Frisinger VP of Nursing 55.00 0.00 X 319664 0 48698 Patrick Woodard Chief Information Officer 47.02 7.98 X 621118 0 66971 Barbara Hespen Pres. Custer Market&System CNO 16.50 38.50 X 0 358964 57574 Joseph Tuma MD Physician - Cardiology 40.00 0.00 X 1889073 0 140510 Charan Mungara MD Physician - Cardiology 40.00 0.00 X 1394909 0 107917 Bhaskar Purushottam MD Physician - Cardiology 40.00 0.00 X 1471104 0 140912 Siri Knutsen Larson MD Physician - Dermatology 40.00 0.00 X 1442327 0 150006 Ethan Levine MD Physician - Cardiology 40.00 0.00 X 1559974 0 113818 13499884 2291071 1753941 757 0 1 0 Travel Nurse Across America LLC 5020 Northshore Drive North Little Rock AR 72118 Contract Labor 54603945 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Professional services 14063229 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 30368 Professional services 13303042 Weatherby Medical Staffing PO Box 972633 Dallas TX 75397 Contract labor 10691613 Mainsail Holdco LLC 1506 6th Avenue Suite 3 Columbus GA 31901 Professional services 4970687 407 26775 39618 3422862 60613 3489255 Pharmacy 621400 254910124 246774273 8135851 Laboratory 621500 121055797 118131899 2923898 Surgical Services 621110 101940015 101940015 MIS CT Scan 621500 46073280 46073280 Cardiac Services 621110 23918997 23918997 514374696 512266637 2108059 1062272909 14341484 14341484 320292 320292 3285327 3150819 134508 134508 134508 10443932 0 10443932 10443932 10443932 1063944 26775 228708 835236 835236 304958 303483 1475 1475 1091839091 1049106576 13167808 26075452 X 440813 440813 5630839 904132 4726707 273698 273698 400214477 327913913 71524671 775893 8674070 7028887 1628611 16572 2022084 1638562 379659 3863 25152631 20000876 5097352 54403 5685826 1458357 4227328 141 1055939 1055939 393490 393490 43734 43734 153298576 124908423 28390072 81 1387027 9450 1366697 10880 19592135 10318923 8827701 445511 28595013 5820553 22624960 149500 28226544 10616784 17598637 11123 2185461 1527531 639361 18569 1673048 51132 1621916 10260828 10260392 436 53314589 38752387 14505477 56725 5943757 915907 5027850 Medical Supplies 205031148 204766723 260470 3955 Interco Supplies/Servic 97595738 96094523 1501215 Federal income tax expe 4946 4946 3124415 497288 2626591 536 1059820826 864199254 194073820 1547752 52052042 28678144 9765128 10945519 133132371 151035675 28753819 30501133 17773530 20195081 992244516 514858676 493668317 477385840 312214814 345299192 356323249 400835313 7223666 6682046 11548088 12955277 1422455024 1484513220 94745939 96206820 329259000 321605074 26285000 26285000 75105950 88332020 525395889 532428914 X 870979020 928131802 26080115 23952504 897059135 952084306 1422455024 1484513220 X 32018265 39476691 23222 -16493007 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 43734 43734 0 Part II-B, Line 1: Annual dues were paid to the South Dakota Association of Healthcare Organizations. A portion of the dues are applicable to lobbying activities. For calendar year 2025 dues, which were paid in fiscal year 2025, in the amount of $389,578, 4.00% 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 2025 dues, which were paid in fiscal year 2025, in the amount of $72,183, 39.00% was used for lobbying purposes. In fiscal year 2025, $43,734 contribution expense were incurred regarding lobbying. 1755429 7500 1747929 1662929 100000 7500 1755429 1662929 1662929 1662929 1662929 1662929 1662929 0.00000 1.00000 0.00000 0 0 22892330 22892330 623012258 264186502 358825756 319637986 243606330 76031656 26701942 7065844 19636098 477385840 Equity Securities and Funds - Domestic 79907965 F Equity Securities and Funds - International 85103831 F Investment in Privately Held Companies 5116855 F Investment in West Dakota Health Care/Monument Health Network 43000231 C Private Equity/Debt 152181459 F Real Estate Funds 1647422 F Absolute Return Assets - Hedge Funds 33877550 F 400835313 Other Long Term Liabilities 30273051 Due from related party 52260090 Accrued pension liability 5798879 88332020 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 $1,747,929 endowment funds, $677,332 are restricted to be used for grants/scholarships to students in a healthcare program, $612,197 is restricted for use in the pediatrics unit, $100,000 for promotion of a healthy community, $197,400 for cardiac services, $100,000 for hospice patients, $36,000 for plants in public areas and $25,000 for cancer care. Part X, Line 2: References to "Monument Health" apply to all entities controlled by Monument Health, Inc. and its subsidiaries. This includes the reporting entity. Monument Health believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. Monument Health would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investment 61011000 North America - Canada and Mexico, but not the United States 0 0 Investment 132000 0 0 0 0 0 0 61143000 0 61143000 1 0 1 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. Schedule F, Part IV: The organization reviews its direct and indirect investments during the tax period for determining required foreign filings. Line 1: The organization makes direct and indirect transfers to foreign corporations and foreign partnerships. The organization would file Form 926 or Form 8865 if the transfers met the requirements for filing. The organization's transfers to foreign corporations did require filing Form 926. The organization's transfers to foreign partnerships did not require filing Form 8865. Lines 3 and 5: The organization has ownership interests in foreign corporations and foreign partnerships. The organization would file Form 5471 or Form 8865 if the ownership met the requirements for filing. The organization's ownership in foreign corporations required filing Form 5471. The organization's ownership in foreign partnerships did not require filing Form 8865. Line 4: The organization invests in partnershiH ps that hold direct or indirect interests in passive foreign investment companies (PFICs). The organization would file Form 8621s for underlying investments that generate unrelated business income. The organization would not file Form 8621s where the investment partnerships have properly filed Form 8621s, or where the underlying investments did not generate any unrelated business income. The organization did not require filing Form 8621. Golden Guitar Gala 457877 26775 431102 3914 33661 33864 5057 Hospice Ball 129240 129240 23589 19088 5805 12 483304 483304 4570 24798 5101 10000 51839 1070421 26775 1043646 4570 52301 38762 62952 62701 221286 822360 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 6338466 6338466 0.00600 140354706 99088472 41266234 0.03890 146693172 99088472 47604700 0.04490 14 3419 7282831 7282831 0.00690 3 144643482 88018276 56625206 0.05340 997137 997137 0.00090 17 3419 152923450 88018276 64905174 0.06120 17 3419 299616622 187106748 112509874 0.10610 1 3768 3768 0.00000 1 69790 69790 0.00010 1 11596 11596 0.00000 3 85154 85154 0.00010 1 67279575 253899342 253807837 91505 X 1 1 1 Medical & Dental Building Office Building 0.71450 0.28550 2 The Imaging Center LLC Medical Imaging 0.50000 0.50000 3 Same Day Surgery Center Specialty and Ambulatory Services 0.40000 0.60000 4 Western Providers Inc PHO 0.50000 0.50000 2 1 Monument Health Rapid City Hospital 353 Fairmont Blvd Rapid City SD 57701 www.monument.health 10558 X X X X X 1 Specialty Hosp; 8 PB clinics; 1 behavioral health facility 2 Same Day Surgery Center 651 Cathedral Drive Rapid City SD 57701 www.samedaysurgerycenter.org 10581 X Monument Health Rapid City Hospital Inc 1 0 0 1 X X X X X X X X X 24 1 1 0 1 X monument.health/chna/ X X 1 24 1 monument.health/chna/ 0 1 X 250.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X See Section C, Line 16a-c X See Section C, Line 16a-c X See Section C, Line 16a-c X X X X X X X 1 X 0 X X X X 1 X 0 0 Same Day Surgery Center 2 0 0 1 X X X X X X X X X 24 1 1 0 1 X See Section C, Line 7d X See Section C, Line 7d X X 1 24 1 See Section C, Line 7d 0 1 X 250.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X See Section C, Line 16a-c X See Section C, Line 16a-c X See Section C, Line 16a-c X X X X X X X 1 X 0 X X X X 0 X X 0 0 Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 5: As part of the community health needs assessment, an online key informant survey was conducted that solicited input from individuals who have a broad interest in the health of the community. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall.Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. A total of 118 community stakeholders comprised of physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders completed the key informant survey for the Monument Health service area. Same Day Surgery Center Part V, Section B, Line 5: As part of the community health needs assessment, an online key informant survey was conducted that solicited input from individuals who have a broad interest in the health of the community. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. A total of 118 community stakeholders comprised of physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders completed the key informant survey for the Monument health service area. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 6a: The Community Health Needs Assessment was undertaken by Monument Health, including: Monument Health Rapid City Hospital, Same Day Surgery Center, and Monument Health Network (Monument Health Spearfish Hospital, Monument Health Sturgis Hospital, Monument Health Lead-Deadwood Hospital, and Monument Health Custer Hospital). Under a management contract with Monument Health, Hans P. Peterson Memorial Hospital in Philip, SD, also collaborated on the project. Hans P. Peterson Memorial Hospital provided funding for their portion of the assessment. Same Day Surgery Center Part V, Section B, Line 6a: The Community Health Needs Assessment was undertaken by Monument Health, including: Monument Health Rapid City Hospital, Same Day Surgery Center, Monument Health Network (Monument Health Spearfish Hospital, Monument Health Sturgis Hospital, Monument Health Lead-Deadwood Hospital, and Monument Health Custer Hospital). Under a management contract with Monument Health, Hans P. Peterson Memorial Hospital in Philip, SD, also collaborated on the project. Hans P. Peterson Memorial Hospital provided funding for their portion of the assessment. Same Day Surgery Center Part V, Section B, Line 7d: samedaysurgerycenter.org/community-health-needs-assessment/ Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 11: During FY25, Monument Health focused on the following priority areas identified through the most recent Community Health Needs Assessment (CHNA): Cancer Heart Disease and Stroke Diabetes, Nutrition, Physical Activity and Weight Mental Health and Substance Abuse Access to Medical ServicesTeams comprised of representatives from Rapid City Hospital, Same Day Surgery Center, Monument Health Network, and the community worked on the priority areas selected for each facility's Community Health Improvement Plan (CHIP).The needs identified during the FY25 CHNA were also identified in the prior CHNA.Cancer Added a 6th Medical Oncologist (locums supported). New patient visits totaled 2,421 (up from 2,390 in the previous year). 10,569 completed chemotherapy visits (12% increase over the previous year). Average of 43 appointments/day (up 10% from 30/day). 13,053 radiation treatments (9.5% increase). Brachytherapy: 84 patients and 193 procedures (12% and 47% increases, respectively). Introduced Lutathera and Pluvicto (radiopharmaceuticals), new biosimilars and MARS Brachytherapy (Low Dose Rate MRI-Assisted Radiosurgery). Palliative Care Physician added in clinic for 130 days annually. Cancer-specific CTs launched in May 2025, serving up to 32 patients/week. Breast clinical trial participation increased from 2% in the previous year to 3.5%. Programs, grants and donations continue to remove financial barriers to care. Radiation Oncology department earned APEx accreditation, becoming the first in South Dakota to do so. This validates high-quality, safe patient care. Hosted March for Mammos, Hope in the Hills Train Event and the 4th Annual Survivors Day Event. Cancer Genetics & Risk Assessments, promotional video on CCI homepage, and resource booths promoting MH services were part of the cancer education plan.Heart Disease and Stroke Advanced Heart Failure inpatient team approach was started over a year ago. After one year, the team has seen 602 inpatients with an overall readmission rate of 14%. American Heart Association Registry was started last year. Registry data has already led to improvements in discharge medications, documentation of contraindications, clinic visits 7 days post-discharge, patient education and orders for follow-up labs. Monument Health successfully completed 107 TAVR (Transcatheter Aortic Valve Replacement) implants this year, continuing its commitment to a single-visit team approach. Patients receive comprehensive pre-evaluations from both Interventional and Surgical Cardiology, ensuring they have all the necessary information to make informed decisions about their care. There were 64 LAAO (Left Atrial Appendage Occlusion) device implants this year. Overall, intra- or post-procedure complications have been at 0%. Monument Health was awarded the Chest Pain-MI Platinum Achievement Award for the 13th consecutive year, reflecting sustained excellence in acute myocardial infarction care. The Monument Health Cardiology Program cared for 392 AMI cases this year, with Q3 setting a new record of 156 AMIs in a single quarter. Monument Health has participated in the A-Fib "Get With The Guidelines" program through the American Heart Association for three years, achieving the highest honor permitted this year and last. Monument Health Peripheral Vascular Intervention in both Claudication and Critical Limb Ischemia continues to show success with decreased follow-up re-treatment and major amputations. Coronary angiography and PCI volumes showed stability across recent years, reinforcing consistency in cardiovascular services. In-hospital and operative mortality trends for CABG and valve cases continue to be lower than peer benchmarks.Diabetes 195 free community health diabetes risk assessments were completed across 15 community events. Monument Health offered Diabetes Prevention Programs and collaborated with Better Choices Better Health initiatives. Medicare DPP classes began in Fall 2024, alongside a 16-week Pathway to Wellness program in several locations. The annual Diabetes Symposium held in November 2024 was a success, with over 300 participants. The 6th Annual Symposium is planned for November 13, 2025. Hospitalists worked with endocrinologists for effective discharge planning. Nurses were tasked with teaching insulin injection techniques including measuring how often patients self-administered insulin prior to discharge. Implemented Diabetes MyChart Care Companion, a web-based patient support tool for chronic disease management. Added a system-wide Diabetes RN who rounds to support outlying caregivers. New staff, including a DNP and two CNPs, were added to handle inpatient diabetes caseloads. The hospital APP coverage prioritizes care continuity and transition to outpatient services for consulted patients. Continued partnership with nursing triage services for post-hospital diabetes assessments performed during discharge phone calls. Referred identified patients to outpatient diabetes education services per outlined criteria. Regular diabetes outreach clinics were held monthly in seven different communities outside of Rapid City. Standardized and simplified the referral process for both services. Ongoing assessment of caregiver skill sets to determine where additional education is needed to improve and expand services. Implemented Tidepool+ Professional to pull blood glucose and insulin pump data into electronic health records for quicker access, reduced delays and improved chart accuracy.Mental Health Partnered with Signet Health to lead administrative operations, staff training, service expansion, and recruitment. The psychiatric services team expanded with new psychiatrists added in the past year. Efforts focused on ASAM 4.0 certification, optimizing treatment assessments, expanding dual diagnosis services and integrating behavioral health with addiction medicine. The team evaluated the use of additional ACTs under the Licensed Addiction Counselor model. Labor challenges were addressed through active recruitment and collaboration with Talent Acquisition. Safety improvements included anti-ligature modifications, panic buttons, upgraded security systems, hardened infrastructure and psych-safe furniture installations. Clinical programming expanded to seven days per week, incorporating trauma-informed care and CBT principles. Daily schedules were posted, and facility aesthetics were refreshed with paint, wall wraps and redesigned spaces including a trauma-responsive sensory room and safer courtyard. Initiatives included psychiatric nurse certification prep, Mental Health First Aid training, monthly nurse leader development, Lean Board quality spotlight, updated agitation scale, walking rounds and nursing leader rounding. A trauma-responsive restraint chair was introduced and IOP feasibility was evaluated. Referral and admissions processes were streamlined in collaboration with the Transfer Center and Performance Management. A Stoplight Report increased transparency in referral criteria, and PARC was implemented to support disposition and aftercare logistics. Monthly stakeholder meetings supported ongoing improvements. Connections were built with IHS stakeholders, and behavioral health participated in Population Health meetings and joined the Care Campus Advisory Board. Appointment rescheduling processes were optimized, billing gaps were assessed, and IOP service feasibility was reviewed.Access to Medical Services Completed new primary care and urgent care clinic in Box Elder Completed new primary care and urgent care clinic in Rapid Valley Completed phase one of the Spearfish Hospital expansion Finished buildout in Rapid City Flormann Street Clinic to expand Primary CareIn acknowledging the wide range of priority health issues revealed through the CHNA process, Monument Health Rapid City Hospital determined it could only focus on those which it deemed most pressing, most under-addressed, and within the ability to influence. The areas identified during the CHNA process that will not be directly addressed through this implementation plan are disabling conditions, housing, infant health & family planning, injury & violence, oral health, respiratory disease, sexual health and tobacco use. These identified needs are being addressed by other organizations in the community, are outside our core area of expertise or require resources that are not available at this time. Same Day Surgery Center Part V, Section B, Line 11: Same Day Surgery Center will address the following two priority areas identified through the most recent CHNA: Cancer and Nutrition, Physical Activity and Weight. Both needs are a continuation of needs identified in the prior CHNA.Teams comprised of representatives from Rapid City Hospital, Same Day Surgery, Monument Health Network, and the community worked on the priority areas selected for each facility's Community Health Improvement Plan (CHIP).Cancer Supported Tough Enough to Wear Pink, transferred funds to MH Foundation (department of MHRCH) to address needs of community cancer patients. Provided screenings and education at community health fairs/events Improved patient education materials, offerings, and practices to focus on the importance of cancer prevention and early detection to reduce cancer incidence in our region Participated in cancer fundraisers and awareness walk(s)Nutrition, Physical Activity and Weight Provided screenings and education at community health fairs/events Participated in food drives and distribution for food-insecure populations Encouraged physical activity through community activities Staff supported Love Inc.'s banquet and baked numerous goods that sold for over $10,000 to donate to local churches and food banks Participate at local shelters to serve and provide food to reduce hunger throughout our communityIn acknowledging the wide range of priority health issues revealed through the CHNA process, Same Day Surgery Center determined it could only focus on those which it deemed most pressing, most under-addressed, and within the ability to influence. The areas identified during the CHNA process that will not be directly addressed through this implementation plan are access to health care, diabetes, heart disease & stroke, housing, infant health & family planning, injury & violence, mental health, oral health, respiratory disease, sexual health, disabling conditions, substance abuse and tobacco use. These identified needs are being addressed by other organizations in the community, are outside our core area of expertise or require resources that are not available at this time. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 13h: Must reside within 200 mile radius of the location where the service was received.Presumptive eligibility may be used. Same Day Surgery Center Part V, Section B, Line 13h: Must reside within 200 mile radius of the location where the service was received.Presumptive eligibility may be used. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 16j: A summary of the hospital's financial assistance policy is posted for all patients at various points of entry, including on the facility website, in waiting rooms, and in the admissions office. The policy in its entirety is also available upon request. The financial assistance policy application form was translated into the primary language spoken by limited English proficient populations. This is posted on the website listed for line 16a. Same Day Surgery Center Part V, Section B, Line 16j: A summary of the hospital's financial assistance policy is posted for all patients at various points of entry, including on the facility website, in waiting rooms, and in the admissions office. The policy in its entirety is also available upon request. The financial assistance policy application form was translated into the primary language spoken by limited English proficient populations. This is posted on the website listed for line 16a. Monument Health Rapid City Hospital, Inc. Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Same Day Surgery Center Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Lines 16a-c Monument Health Rapid City Hospital The Financial Assistance Policy, Application form, and plain language summary are available at https://monument.health/financial-assistance/ Part V, Lines 16a-c Same Day Surgery Center The Financial Assistance Policy, Application form, and plain language summary are available at https://www.samedaysurgerycenter.org/community-health-needs-assessment/ 5 1 - Monument Health Home Care-Hospice House 224 Elk St Rapid Ctiy SD 57701 End of Life Care 2 - Monument Health Dialysis Center 132 Yankee St Spearfish SD 57783 Dialysis Center 3 - Monument Health Home Care-Spearfish 1440 North Main Street Spearfish SD 57783 End of Life Care 4 - Monument Health Medical Clinic 122 7th Ave Wall SD 57790 Clinic 5 - Monument Health Dialysis Center 955 East North St Rapid Ctiy SD 57701 Dialysis Center Part I, Line 3c: References to "Monument Health" apply to all entities controlled by Monument Health, Inc. and its subsidiaries. This includes the reporting entity.Financial assistance debt reduction write-offs for free or discounted care are based on an income matrix utilizing the current Federal Poverty Level (FPL) income guidelines after satisfying applicable co-pay requirements. The income matrix may be updated annually as the FPL income guidelines are released.Presumptive eligibility may be used if all other financial assistance avenues are exhausted. Part I, Line 6a: Monument Health Rapid City Hospital is included in the community benefit report prepared by Monument Health. This report is available at the facilities and can be found at:https://monument.health/about-us/mission-vision-values/ Part I, Line 7: Ratio of patient care cost to charges is used for the calculation of cost of services provided for lines 7a, 7b and 7g. Actual costs are used for the calculation of costs of services provided for lines 7e and 7i. Part II, Community Building Activities: Monument Health provides numerous community benefit health events and screenings throughout the Black Hills Region. Monument Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Monument Health provides in-kind support and employee volunteers to help support community health events and activities. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 15 and 16. Part III, Line 8: The Medicare surplus or deficit is derived from the actual payments received from the Medicare program for services provided to patients with Medicare coverage. The payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our communities. Part III, Line 9b: The collection policy requires invoking of the financial assistance policy (FAP) at any time a patient expresses financial difficulty in meeting their debt obligation. Upon invoking the FAP, all collection activity is suspended. If the patient is approved for charity, then the account is closed out of the collection process and classified as charity. If a patient expresses financial concern but fails to complete the application process, additional notification is sent to the patient prior to re-instituting collection activity. We are following the 501(r) Final Regulations timelines for notifications and collections. Part VI, Line 2: We gather additional data on needed services from patient surveys, advisory councils and patient and family advisory councils. Part VI, Line 3: Financial Assistance Program brochures explaining the policy, a copy of the policy and Financial Assistance applications are available at each point of entry. Signs alerting patients to the availability of Financial Assistance are prominently displayed and a plain language summary describing the Financial Assistance program accompanies one billing statement for hospital services sent to the patient. The Financial Assistance policy, plain language summary and Financial Assistance application are provided free upon request and are also available on the hospital website at www.monument.health. Monument Health contracts with Midland Medical Group (an unrelated entity) to meet with uninsured patients to assist them with finding a funding source or applying for financial assistance; and our self-pay outsource partner also communicates any funding and financial assistance opportunities with our patients. Part VI, Line 4: Monument Health and its affiliates provide health care services to the 360,000 people who live in the Black Hills of South Dakota and the surrounding region, as well as thousands of visitors each year. Monument Health serves a 38-county region comprised of western South Dakota, southeastern Montana, northeastern Wyoming, southwestern North Dakota and northwestern Nebraska. Part VI, Line 5: Monument Health collaborates with agencies and community-wide coalitions to address prioritized health needs within the communities we serve. Monument Health addresses its community's health needs by: 1) Community members serve on governing boards, advisory councils and family member councils; 2) developing new programs and initiatives to address identified health needs: and 3) promoting an understanding of these health needs among other community organizations and within the public itself. Monument Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Monument Health provides in-kind support and employee volunteers to help support community health events and activities. Part VI, Line 6: Monument Health is committed to partnering with the communities it serves to meet the needs of each respective community. Monument Health, Inc. is the parent organization of Monument Health Rapid City Hospital, Inc., Monument Health Network, Inc., and Monument Health Physicians, Inc. These corporations work together to meet the health care needs of the region. 1 Elevate Rapid City PO Box 747 Rapid City SD 57701 460118545 501(c)(6) 153500 0 Community development South Dakota Ellsworth Development Authority PO Box 477 Rapid City SD 57709 271166754 Other Exempt Entity 10000 0 Community development American Heart Association Inc 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 12250 0 Donation United Way of the Black Hills 621 6th St Suite100 Rapid City SD 57701 460259754 501(c)(3) 12750 0 Donation SD Governor's Office of Economic Development 711 E Wells Ave Pierre SD 57501 466000364 Government 15000 0 Donation Black Hills State University Foundation 1200 University St Unit 9506 Spearfish SD 57799 237428348 501(c)(3) 15063 0 Donation City of Box Elder 420 Villa Dr Box Elder SD 57719 460281490 Government 6000 0 Donation Historic Rapid City 1015 12th Street Rapid City SD 57701 460424536 501(c)(3) 150000 0 Donation Central States Fair Inc 800 San Francisco Street Rapid City SD 57701 460238981 Other Exempt Entity 20000 0 Donation University Of South Dakota 414 East Clark Street Julian 212 Vermillion SD 57069 466000364 State of SD 9250 0 Donation Beef Logic Inc 122 E Sioux Ave Suite B Pierre SD 57501 872043795 501(c)(3) 9000 0 Donaiton Helpline Center Inc 402 Saint Joseph Street Suite 10 Rapid City SD 57701 237424387 501(c)(3) 8000 0 Donation SDAHO Organizations 3708 West Brooks Place Suite 1 Sioux Falls SD 57106 460254666 501(c)(3) 7500 0 Donation Spearfish Trails Coalition 524 N 7th Street Spearfish SD 57783 991114015 501(c)(3) 12500 0 Donation 11 3 Part I, Line 2: The governing board and management of the receiving organization develop programs which enhance the charitable mission of the organization. Disbursement of grant or contribution funds for these programs are made in accordance with the established procedures within the organization and are subject to the conditions established by the organization's governing board and management. These procedures are developed to ensure that distributed funds are adequately monitored for appropriate usage. 0 1 0 0 0 0 0 1 0 Paulette R Davidson President & CEO 0 1209056 0 518300 0 204751 0 236721 0 30869 0 2199697 0 179411 Joseph Tuma MD Physician - Cardiology 1355112 0 469241 0 64720 0 107724 0 32787 0 2029584 0 64720 0 Ethan Levine MD Physician - Cardiology 1041455 0 486935 0 31584 0 77906 0 35912 0 1673792 0 31584 0 Bhaskar Purushottam MD Physician - Cardiology 1250332 0 141644 0 79128 0 102841 0 38070 0 1612015 0 79128 0 Siri Knutsen Larson MD Physician - Dermatology 1130800 0 254066 0 57461 0 108024 0 41982 0 1592333 0 57461 0 Charan Mungara MD Physician - Cardiology 1367409 0 27500 0 0 0 91395 0 16522 0 1502826 0 0 0 Brad Archer MD Chief Medical Officer 673864 0 207500 0 90667 0 104064 0 29971 0 1106066 0 74827 0 John Pierce President Rapid City Hospital and Ma 574785 0 179100 0 68178 0 86102 0 35810 0 943975 0 42838 0 Patrick Woodard Chief Information Officer 456171 0 139800 0 25147 0 54641 0 12330 0 688089 0 0 0 Austin Willuweit Chief Financial Officer 391653 0 101700 0 35242 0 48706 0 35461 0 612762 0 10367 0 Jacob Weasel MD Board Member/Employed Physician 452741 0 7000 0 34747 0 38686 0 33565 0 566739 0 34747 0 Mark A Thompson Chief Bus Dev Officer Until 12/2024 337511 0 143700 0 24163 0 22324 0 26921 0 554619 0 0 0 Michael Tilles VP Operations-Rapid City Market 338452 0 83300 0 32155 0 31505 0 17391 0 502803 0 17436 0 Mark Schulte VP Rapid City Market 305392 0 77800 0 28776 0 27916 0 34915 0 474799 0 12226 0 Bobbie Schneller DO Board Member/Employed Physician 360549 0 15358 0 25378 0 35129 0 29172 0 465586 0 25378 0 Barbara Hespen Pres. Custer Market&System CNO 0 256230 0 81400 0 21334 0 26955 0 30619 0 416538 0 0 Tasha Frisinger VP of Nursing 244348 0 61500 0 13816 0 23076 0 25622 0 368362 0 0 0 Mark Longacre until 53124 VP Operations-Rapid City Market 139705 0 21 0 19098 0 9371 0 12935 0 181130 0 14367 0 Part I, Line 3 The Executive Committee, which is a committee of the Monument Health (parent) Board, reviews and approves base salary and total compensation ranges for all executives within the Monument Health System. Part I, Line 4b Monument Health provides a supplemental nonqualified retirement plan and a flexible benefit plan that can include deferred compensation for its executives and physicians. The following individuals had amounts deferred into the account as reported in Schedule J, Column C: Paulette Davidson 220,732 Patrick Woodard 46,016 Austin Willuweit 38,388 Brad Archer MD 88,964 Tasha Frisinger 12,640 Mark Longacre 4,097 John Pierce 65,412 Mark Schulte 16,951 Michael Tilles 21,138 Siri Knutsen Larson MD 92,924 Charan Mungara MD 77,595 Bhaskar Purushottam MD 86,852 Ethan Levine MD 67,081 Joseph Tuma MD 88,293 Bobbie Schneller DO 23,205 Barbara Hespen 18,330 Jacob Weasel MD 31,751 The following individuals had supplemental non-qualified retirement plan amounts included in Schedule J, column B(iii) that were previously reported as deferred compensation on Form 990. These amounts are identified in Schedule J, Column F: Paulette Davidson 179,411 Archer Brad MD 74,827 Austin Willuweit 10,367 Mark Longacre 14,367 John Pierce 42,838 Mark Schulte 12,226 Michael Tilles 17,436 Siri Knutsen Larson MD 57,461 Bhaskar Purushottam MD 79,128 Ethan Levine MD 31,584 Joseph Tuma MD 64,720 Bobbie Schneller DO 25,378 Jacob Weasel MD 34,747 Part I, Line 7 Executives and Other Employees of System Entities will be eligible to receive annual incentive awards that are competitive with the incentives offered by the organizations in the System's Peer group(s) in accordance with the terms of the Monument Health, Inc. Annual Incentive Plan for Selected Executives and Other Employees (Incentive Plan). In accordance with this plan, the parent Board's Executive Committee will review and approve all incentive compensation performance measures and all awards, if any. The committee ensures that the total compensation, including incentive awards, is reasonable. A SD Health & Educational Facilities Authority 460315509 83755VE26 2017-09-07 238488122 Refund Series 2010 and 2011 Bond; Hospital buildings and equipment 0 0 0 B SD Health & Educational Facilities Authority 460315509 83755VM76 2020-10-27 138442836 See Part VI 0 0 0 A 51489122 241560080 1807893 185230960 54521227 2019 0 1 1 1 B 19487836 139921863 1143985 85179027 53598850 2023 0 0 1 1 A 0 1 1 0 1 0 0.00700 0.01220 0.01920 0 0 1 B 0 0 0 0 0.00440 0.00000 0.00440 0 0 0 A 0 0 0 1 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: SD Health & Educational Facilities Authority Date the Rebate Computation was Performed: 09/07/2022 Form 990, Schedule K, Part I, Line B Description of Purpose: Hospital Buildings Constructing and Renovating & Equipment, Refund Series 2015 Bonds and Termination of Interest Rate Swap relating to refunded bond. Schedule K, Part II, Line 3, Bond A The issue price on Part I, column (e) is different than the amount on Part II, line 3 due to interest earned during the construction phase on the proceeds of $3,071,958. Schedule K, Part II, Line 3, Bond B The issue price on Part I, Column (e) is different than the amount on Part II, Line 3 due to interest earned during the construction phase on the proceeds of $1,479,027. Amy Kress Family member of Mark Thompson 19065 Employee compensation 0 Becky Sharp Family member of Mark Thompson 149452 Employee compensation 0 Vicki Thompson Family member of Mark Thompson 31705 Employee compensation 0 Alyssa Brunner Family member of Director 73476 Employee compensation 0 X 2 60613 FMV 0 0 0 0 Part I, Column (b): Column B represents the number of contribution received. Form 990, Part VI, Section A, line 1a The membership of the Executive Committee of the Corporation shall consist of the following: Chair of the Board of Directors, Vice Chair of the Board of Directors, two other Board members appointed by the Chair, and the Corporation's President. The Chair of the Board of Directors shall serve as the Chair of the Executive Committee. Directors on the Executive Committee shall serve during the term of office they hold which places them on the Executive Committee, or, for the two Chair-appointed members, for a term of one (1) year or until their successors are appointed. The Executive Committee, when the Board of Directors is not in session, shall have and may exercise all of the authority of the Board of Directors, except to the extent, if any, that such authority shall be limited by a motion or resolution of the Board of Directors or that is authority reserved to the Member. It is intended that the powers of the Executive Committee to act for the whole Board be confined to such urgent matters as reasonably should not be deferred until the next regularly-scheduled meeting of the full Board. Form 990, Part VI, Section A, line 2 Paulette Davidson has a business relationship with 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: Barbara Hespen. Jacob Weasel, MD has a business relationship with Paulette Davidson due to his role on the Board of the supporting organization. Form 990, Part VI, Section A, line 6 Monument Health, Inc. is the sole member of Monument Health Rapid City Hospital, Inc. Form 990, Part VI, Section A, line 7a The organization's sole member and supporting organization, Monument Health, Inc., appoints the members of Monument Health Rapid City Hospital's governing body. The bylaws require that at least one member of Monument Health Rapid City Hospital's board also serves as a voting member of the sole member's board to better assure the sole member's continued responsiveness to Monument Health Rapid City Hospital. Form 990, Part VI, Section A, line 7b Monument Health, Inc. provides compliance, governance, financial, and planning support to its Supported Organizations to best assure the functions and services of the Supported Organizations are coordinated and supported in a manner that furthers the shared charitable mission of the Supported Organizations and MHI, as a whole. Monument Health, Inc. has final authority in significant business decisions affecting Supported Organizations. Form 990, Part VI, Section B, line 11b The 990 is prepared and reviewed by an independent accounting firm. It is then reviewed internally by management. The Form 990 is further reviewed, prior to filing, by the organization's board of directors through a portal to the organization's internal information system, to which each board member has access. Educational sessions have been provided to board members on how to access the portal. Form 990, Part VI, Section B, line 12c As part of the annual disclosure of potential conflicts process, all board members, officers, and management are required to complete an annual disclosure statement on financial interests and conflicting interests. At Board and Board Committee meetings, the meeting agenda includes an initial item "Conflicts of Interest" where the Chair asks members if they have any conflicting interests or financial interests related to an agenda item. If a conflicting or financial interest is disclosed, it is noted in the minutes and there is discussion or determination of whether the disclosure requires the board or committee member to be excused from discussion or action on that agenda item. Board or committee members whose disclosure is found to be a conflict may be invited to speak on the matter by the Chair, but are not permitted to vote on the matter and may be required to leave the meeting during discussion, after they have made any comments invited by the Chair. Failure to comply with the Conflict of Interest policy constitutes grounds for removal from office or membership on the Board or Board Committee and, in the case of all employees, termination of employment. Form 990, Part VI, Section B, line 15a The Executive Committee of Monument Health, Inc (MHI; parent) annually engages an independent third party compensation firm to conduct a review of all executives, Vice President level and above, to determine an appropriate compensation range in which their compensation would be established. The independent compensation consultant provided peer group market comparative data for base salary, total cash compensation, benefits and total compensation for executives. The CEO or her designee determines the actual base salary of the executives within the committee-approved base salary range based on experience and performance, providing the total compensation is within the targeted market percentile, e.g. 50th percentile. Each year, the independent consultant meets with Committee members and presents data upon which the Committee determines all elements of compensation for the member's CEO (base salary, total cash compensation, benefits and total compensation) and reaffirms the organization's executive compensation philosophy, which includes the targeted market percentile for all other executives. Actual compensation is paid by Monument Health Rapid City Hospital and charged to Monument Health, Inc. Form 990, Part VI, Section C, line 19 The Articles of Incorporation of the organization are filed in the office of the Secretary of State of South Dakota and are available to the public from the Office of the Secretary of State. Other documents (Bylaws, conflict of interest policy and financial statements) are not posted for the public but are available or described in other public documents or sites such as offering statements in bond issues or municipal securities rulemaking board's electronic municipal market access (EMMA) data port. Form 990, Part IX, line 11g Contract labor: Program service expenses 96,189,465. Management and general expenses 234,103. Fundraising expenses 0. Total expenses 96,423,568. Professional Fees: Program service expenses 122,202. Management and general expenses 636,935. Fundraising expenses 0. Total expenses 759,137. Purchased Service: Program service expenses 28,596,756. Management and general expenses 27,519,034. Fundraising expenses 81. Total expenses 56,115,871. Form 990, Part XI, line 9: Released from restriction -7,937,724. Reverse Auxiliary net income 5,050. Record Accum. Pension Liability -8,473,228. Reverse Medical Staff Net Income -87,105. Form 990, Part X, Line 20: The issue price of the bonds includes the filing organization's share of the entire bond issue, which was issued to Monument Health, Inc. on behalf of the Monument Health Obligated Group. The Monument Health Obligated Group consists of Monument Health, Inc., Monument Health Rapid City Hospital, Inc., Monument Health Network, Inc. and Monument Health Physicians, Inc. In accordance with the IRS instructions, information related to the tax exempt bond reporting is being reported on the Monument Health Rapid City Hospital, Inc. tax return. Monument Health Home Plus LLC 2925 Regional Way PO Box 6000 Rapid City SD 57701 364841157 Healthcare Services SD 161563402 17551936 Monument Health Rapid City Hospital Inc Monument Health Inc 353 Fairmont Blvd Rapid City SD 57701 201487506 Healthcare SD 501(c)(3) Line 12c, III-FI N/A 0 Monument Health Network Inc 353 Fairmont Blvd Rapid City SD 57701 460360899 Healthcare SD 501(c)(3) Line 3 Monument Health Inc 0 Monument Health Physicians Inc 353 Fairmont Blvd Rapid City SD 57701 460372454 Healthcare SD 501(c)(3) PF Monument Health Inc 0 Same Day Surgery Center 651 Cathedral Drive Rapid City SD 57701 411889892 Medical Services SD Monument Health Rapid City Hospital Inc RELATED 1998194 1423854 0 1 0.40000 Medical & Dental Building 2805 S 5th St Rapid City SD 57701 460339629 Medical Office Bldg SD Monument Health Rapid City Hospital Inc Investment 554771 1707082 0 1 0.71450 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 Same Day Surgery Center F 2360000 FMV Medical & Dental Building P 571608 FMV Same Day Surgery Center L 5998622 FMV