2014-05-14T06:42:21-05:00 2013-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2012-07-01 460360899 Regional Health Network Inc REGI 6057559130 2925 Regional Way Rapid City SD 57701 Mark Thompson 6057559130 2014-05-08 1 Kim Hunwardsen CPA P00484560 6122536500 2014-05-08 2012 2015-11-30 17:44:51Z Charles E Hart MD M 2925 Regional Way Rapid City SD 57701 91123145 0 X www.regionalhealth.com X 1981 SD To provide and support health care excellence in partnership with the communities we serve. 13 7 967 197 2427633 -500620 193289 241046 82965196 90746210 118209 52874 37852 47202 83314546 91087332 0 0 0 0 43461740 46376571 0 0 0 30405327 36683071 73867067 83059642 9447479 8027690 52913755 54401427 29103824 22563806 23809931 31837621 X To provide and support health care excellence in partnership with the communities we serve. 0 0 5125345 19830874 Spearfish Regional Hospital surgical services 3156264 4027666 Custer Regional Senior Care long-term care skilled nursing 2504260 4629632 Sturgis Regional Senior Care long-term care skilled nursing 49080633 62258038 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. 49080633 62258038 59866502 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 1 0 0 0 0 0 1 1 1 0 0 1 0 0 967 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Mark Thompson 6057559130 2925 Regional Way Rapid City SD 57701 Ross Lamphere 1.40 0.00 X X 0 0 0 Thomas Groeger MD 1.20 40.00 X X 0 207396 54350 Richard Tysdal 1.00 0.00 X X 0 0 0 Terry Graber 1.50 40.00 X X 0 394064 64173 Lee B Bailey MD 40.90 0.00 X 277949 0 44212 Peter J Cappa 2.00 2.00 X 0 0 0 Jonathan Dahlstrom 1.60 1.60 X 0 0 0 Robert Haivala 1.20 0.00 X 0 0 0 Judith Larson 1.30 0.00 X 0 0 0 Dusty Pinske 1.50 0.00 X 0 0 0 David Thom 1.60 0.00 X 0 0 0 Charles E Hart MD 8.30 51.80 X X 0 994824 55181 Timothy H Sughrue 8.80 46.30 X X 0 742560 57208 Joseph C Sluka Jr 7.60 47.40 X 0 546963 62576 Mark A Thompson 7.60 47.40 X 0 489624 72816 Mark F Brodin 7.60 47.40 X 0 244240 51837 Glenn E Bryant 55.00 0.00 X 273241 0 35371 Shawn Y DeGroot 7.60 47.40 X 0 191663 30995 Dale E Gisi 7.60 47.40 X 0 155380 21543 Jennifer D Horton 7.60 47.40 X 0 197112 35622 Van Hyde 55.00 0.00 X 196598 0 41011 Richard S Latuchie 7.60 47.40 X 0 333183 45241 Mary E Masten 7.60 47.40 X 0 420927 57426 Robert O McGlone 7.60 47.40 X 0 295324 51386 Veronica L Schmidt 55.00 0.00 X 160461 0 25041 Sherry Bea Smith 55.00 0.00 X 197273 0 33452 Larry W Veitz 55.00 0.00 X 246770 0 58735 Christopher K Fromm MD 40.00 0.00 X 271217 0 43530 William K Heston 40.00 0.00 X 189772 0 17327 Curtis J Liedtke DO 40.00 0.00 X 251497 0 16188 Donald M Potts MD 40.00 0.00 X 223975 0 31487 Thomas Reid 40.00 0.00 X 226539 0 21615 2515292 5213260 1028323 30 0 1 0 Sentry Data System Inc 600 Fairway Drive Suite 201 Deerfield Beach FL 33441 Pharmacy Claims Processing 276700 Alliance Recruiting Resources PO Box 4356 Dept 61 Houston TX 772104356 Temporary Physician Staffing Services 262220 DMS Health Technologies Inc 26273 Network Place Chicago IL 606731262 Mobil MRI Diagnostic Services 258626 GE Medical Systems 75 Remittance Drive Suite 1080 Chicago IL 606751080 Equipment Purchases, Repairs & Service 236295 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 Patient Therapy Services 164022 10 39178 116790 85078 241046 Acute Care Hospital IP and OP 623000 59821000 59821000 Long Term Care Facilities 623000 9465000 9465000 Physician Clinics 621110 2478000 2478000 Assisted Living Facilities 623000 2394000 2394000 Home Care Services 621610 1792000 1792000 14796210 12368577 2427633 90746210 52874 52874 83015 39178 35813 47202 47202 91087332 88318577 2427633 100076 1669237 352813 1316424 35318084 29271607 6046477 813536 674258 139278 6155191 5101416 1053775 2420523 1934152 486371 25975 25975 13061 13061 2960329 1938661 1021668 86295 28329 57966 271069 168190 102879 715268 546259 169009 1848378 682524 1165854 209713 165847 43866 198563 138532 60031 47016 137 46879 4094501 2198512 1895989 289669 48460 241209 Intercompany supplies a 9690387 1975344 7715043 Medical supplies 7537329 7537329 Bad Debt Expense 3907149 3907149 Maint-Equip-Contr 965382 931937 33445 3822987 2265046 1557941 83059642 59866502 23193140 0 932042 188242 10940177 11612167 1366936 1357499 515440 451839 87850622 48734394 37875684 39116228 255087 271573 62430 1028389 1341449 52913755 54401427 4483286 4074410 24620538 18489396 29103824 22563806 X 22741766 30640869 968165 1096752 100000 100000 23809931 31837621 52913755 54401427 8027690 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13061 13061 0 Explanation of Lobbying Activities: 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 2012 dues, which were paid in fiscal year 2013, in the amount of $81,580, 4.854% 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 2012 dues, which were paid in fiscal year 2013, in the amount of $37,954, 23.980% was used for lobbying purposes. 100000 100000 100000 100000 100000 100000 100000 100000 100000 100000 1.00000 0 0 8868079 8868079 43866477 22156922 21709555 32915559 25070135 7845424 2200507 1507337 693170 39116228 Due to Related Parties-Investment 18489396 18489396 X Description of Intended Use of Endowment Funds: 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. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Regional Health Network, Inc. is organized as a nonprofit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Regional Health Network, Inc. is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). In addition, Regional Health Network, Inc. may be subject to income tax on income that is derived from business activities that are unrelated to its tax exempt purpose. Regional Health Network, Inc. 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 Network, Inc. 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 Network's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2009. Hospice Ball 65500 500 65000 2450 15349 2775 2706 Golf Tournament 26635 8620 18015 7991 1084 2 30058 30058 3458 122193 39178 83015 2450 23340 2775 7248 35813 47202 1 1 X 0 0 1 1 1 0 1 1 2965545 2965545 0.03750 9785144 8142408 1642736 0.02080 12750689 8142408 4608281 0.05830 12 1195 25812 25812 0.00030 180046 161529 18517 0.00020 5 3838 26580 26580 0.00030 17 5033 232438 161529 70909 0.00080 17 5033 12983127 8303937 4679190 0.05910 2 755 755 0.00000 2 1206 22575 22575 0.00030 4 1206 23330 23330 0.00030 1 3907149 191302 22901092 23034187 -133095 X 1 1 4 1 Spearfish Regional Hospital

1440 N Main Street Spearfish SD 57783

X X X A 2 Custer Regional Hospital

1039 Montgomery Street Custer SD 57730

X X X X A 3 Sturgis Regional Hospital

949 Harmon Street Sturgis SD 57785

X X X X A 4 Lead-Deadwood Regional Hospital

61 Charles Street Deadwood SD 57732

X X X X A Facility Reporting Group - A 1 X X X X X X X X X 12 1 1 1 X X X X 0 0 1 0 0 1 X X 0 1 X X 1 0 X X X 1 X 0 1 2 Custer Regional Senior Care

1065 Montgomery Street Custer SD 57730

Skilled long-term nursing home facility Sturgis Regional Senior Care

949 Harmon Street Sturgis SD 57785

Skilled long-term nursing home facility Part I, Line 3c: Supplemental Schedule H Information:References to "Regional Health" apply to all entities controlled or leased by Regional Health, Inc. This includes the reporting entity.Part I, Line 3c:Regional Health uses low income housing guidelines from Housing and Urban Development for determining financial assistance eligibility. The income guidelines, along with the number of dependents within the household are used in a matrix to determine the percent discount applied to the outstanding balance. Discounts range from 100% to 10% of the balance. The financial assistance policy (i.e. charity policy) also has a catastrophic provision which limits a patient/guarantor's exposure to the lesser of the financial assistance reductions or 20% of the family's annual gross income. Part I, Line 6a: A community benefit report is completed by Regional Health, the parent organization, for all related organizations and made available to the public on its website at http://www.regionalhealth.com/About-Us/Community-Report.aspx 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, L7 Col(f): The bad debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column, is $3,907,149. Part II: 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 health events and activities. Part III, Line 4: The bad debt reported on line 2 is at charges as reported on the financial statements.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, however were determined in the current year to be charity care amounts.The footnote to the financial statements that describes bad debt expense is located on pages seven and eight 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 expressed 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) Proposed 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, one 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, we have information available 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 the 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. Part V, Line 8 Facility Reporting Group A See below Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 3: As part of the community health needs assessment, one 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. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 4: 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. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 5c: The Community Health Needs Assessment is made widely available to the public at the following url: www.regionalhealth.com/chna Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 6i: Due to the timing of the adoption of the implementation strategy SPRH has not had the time to execute the implementation strategy. The implementation strategy was made available upon request. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 7: 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.Due to the timing of the adoption of the implementation strategy SPRH has not had the time to execute the implementation strategy. The needs that will be addressed in the future 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. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 10: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 11: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 12h: Means testing of net assets in excess of 200% of household income will be considered income for the purpose of the financial assistance program. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 14g: A summary of the Hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, emergency and waiting rooms, and admissions office. The policy in its entirety is also available upon request. Facility 1 -- Spearfish Regional Hospital Part V, Section B, line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other 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 elective procedures. Facility 2 -- Custer Regional Hospital Part V, Section B, line 3: As part of the community health needs assessment, one 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. Facility 2 -- Custer Regional Hospital Part V, Section B, line 4: 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. Facility 2 -- Custer Regional Hospital Part V, Section B, line 5c: The Community Health Needs Assessment is made widely available to the public at the following url: www.regionalhealth.com/chna Facility 2 -- Custer Regional Hospital Part V, Section B, line 6i: Due to the timing of the adoption of the implementation strategy CRH has not had the time to execute the implementation strategy. The implementation strategy was made available upon request. Facility 2 -- Custer Regional Hospital Part V, Section B, line 7: 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 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 which CRH will continue to be open to for 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.Due to the timing of the adoption of the implementation strategy CRH has not had the time to execute the implementation strategy. The needs that will be addressed in the future are as follows: 1) diabetes; 2) heart disease and stroke; and 3) nutrition, physical activity and weight status. Facility 2 -- Custer Regional Hospital Part V, Section B, line 10: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 2 -- Custer Regional Hospital Part V, Section B, line 11: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 2 -- Custer Regional Hospital Part V, Section B, line 12h: Means testing of net assets in excess of 200% of household income will be considered income for the purpose of the financial assistance program. Facility 2 -- Custer Regional Hospital Part V, Section B, line 14g: A summary of the Hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, emergency and waiting rooms, and admissions office. The policy in its entirety is also available upon request. Facility 2 -- Custer Regional Hospital Part V, Section B, line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other 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 elective procedures. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 3: As part of the community health needs assessment, one 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. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 4: 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. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 5c: The Community Health Needs Assessment is made widely available to the public at the following url: www.regionalhealth.com/chna Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 6i: Due to the timing of the adoption of the implementation strategy SRH has not had the time to execute the implementation strategy. The implementation strategy was made available upon request. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 7: 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 existed. 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 opportunity arises.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 opportunity arises.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.Due to the timing of the adoption of the implementation strategy SRH has not had the time to execute the implementation strategy. The needs that will be addressed in the future are as follows: 1) conditions of aging; 2) diabetes; 3) mental health and mental disorders; and 4) nutrition, physical activity and weight status. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 10: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 11: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 12h: Means testing of net assets in excess of 200% of household income will be considered income for the purpose of the financial assistance program. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 14g: A summary of the Hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, emergency and waiting rooms, and admissions office. The policy in its entirety is also available upon request. Facility 3 -- Sturgis Regional Hospital Part V, Section B, line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other 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 elective procedures. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 3: As part of the community health needs assessment, one 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. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 4: 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. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 5c: The Community Health Needs Assessment is made widely available to the public at the following url: www.regionalhealth.com/chna Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 6i: Due to the timing of the adoption of the implementation strategy LDRH has not had the time to execute the implementation strategy. The implementation strategy was made available upon request. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 7: 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 existed. 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 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.Due to the timing of the adoption of the implementation strategy LDRH has not had the time to execute the implementation strategy. The needs that will be addressed in the future are as follows: 1) diabetes; 2) injury and violence prevention; 3) mental health and mental disorders; and 4) nutrition, physical activity and weight status. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 10: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 11: Housing and Urban Development (HUD) income limits as designated for the State of South Dakota are used to determine eligibility for providing free or discounted care. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 12h: Means testing of net assets in excess of 200% of household income will be considered income for the purpose of the financial assistance program. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 14g: A summary of the Hospital's financial assistance policy is posted for all patients at various points of entry, on the facility website, emergency and waiting rooms, and admissions office. The policy in its entirety is also available upon request. Facility 4 -- Lead-Deadwood Regional Hospital Part V, Section B, line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other 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 elective procedures. 0 1 0 0 0 0 0 0 0 Thomas Groeger MD 0 202371 0 5025 0 0 0 48301 0 6049 0 261746 0 0 Terry Graber 0 394039 0 25 0 0 0 59736 0 4437 0 458237 0 0 Lee B Bailey MD 277924 0 25 0 0 0 38348 0 5864 0 322161 0 0 0 Charles E Hart MD 0 735994 0 252694 0 6136 0 47785 0 7396 0 1050005 0 0 Timothy H Sughrue 0 574517 0 165514 0 2529 0 49690 0 7518 0 799768 0 0 Joseph C Sluka Jr 0 396322 0 140393 0 10248 0 54920 0 7656 0 609539 0 0 Mark A Thompson 0 370699 0 118925 0 0 0 65653 0 7163 0 562440 0 0 Mark F Brodin 0 205381 0 38859 0 0 0 45606 0 6231 0 296077 0 0 Glenn E Bryant 224590 0 48651 0 0 0 29011 0 6360 0 308612 0 0 0 Shawn Y DeGroot 0 146876 0 44787 0 0 0 26495 0 4500 0 222658 0 0 Dale E Gisi 0 135184 0 20196 0 0 0 14296 0 7247 0 176923 0 0 Jennifer D Horton 0 159290 0 37822 0 0 0 28842 0 6780 0 232734 0 0 Van Hyde 159819 0 36779 0 0 0 34265 0 6746 0 237609 0 0 0 Richard S Latuchie 0 272900 0 60283 0 0 0 39735 0 5506 0 378424 0 0 Mary E Masten 0 356206 0 64721 0 0 0 50247 0 7179 0 478353 0 0 Robert O McGlone 0 240711 0 54613 0 0 0 45846 0 5540 0 346710 0 0 Veronica L Schmidt 129829 0 30632 0 0 0 17530 0 7511 0 185502 0 0 0 Sherry Bea Smith 163938 0 33335 0 0 0 25475 0 7977 0 230725 0 0 0 Larry W Veitz 200530 0 46240 0 0 0 51823 0 6912 0 305505 0 0 0 Christopher K Fromm MD 271192 0 25 0 0 0 38819 0 4711 0 314747 0 0 0 William K Heston 189747 0 25 0 0 0 12528 0 4799 0 207099 0 0 0 Curtis J Liedtke DO 251172 0 25 0 300 0 15380 0 808 0 267685 0 0 0 Donald M Potts MD 223950 0 25 0 0 0 27844 0 3643 0 255462 0 0 0 Thomas Reid 226514 0 25 0 0 0 14774 0 6841 0 248154 0 0 0 Part I, Line 3 The audit and compliance 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: Joseph C. Sluka Jr. $7,073 Mark A. Thompson $2,223 Custer Community Health Services Inc Board Director David Thom is Board Director of CCHSI 248961 Lease payments to Wedgwood Regional Senior Care and Custer Regional Senior Care, facilities owned by Custer Community Health Services, Inc. 0 Bond Issues Form 990, Part IV, Line 24a All related corporations are equally liable for the repayment of the bonds reported on the Rapid City Regional Hospital Form 990. 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 Charles E. Hart, MD has a business relationship with the following individuals due to being the CEO of the supporting organization that excercises reserve powers over the supported organizations that employ each of these individuals: Thomas Groeger, MD, Terry Graber, Timothy Sughrue, Joseph Sluka Jr., Mark Thompson, Mark Brodin, Shawn DeGroot, Dale Gisi, Jennifer Horton, Richard Latuchie, Mary Masten, and Robert McGlone. 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 members. 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 business decisions made by 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. The compliance and audit committee of the sole member's board, a committee that includes only board members deemed "independent", determines the appropriate base salary range of the CEO of the organization and its other executive staff. The CEO of the member or his designee then determines the actual base salary of the other executives within the committee-approved ranges based on a performance evaluation conducted by the CEO or designee. For determination of the base salary ranges, as well as incentive compensation, benefit plans and perquisites (total compensation), the compliance and audit committee retains an independent consultant, Sullivan and Cotter, to provide survey/comparability data for both base salary and total compensation at least every three years. The survey/compatability data was provided in February 2013 and new market ranges were approved by the compliance and audit committee in October 2013 based on this information. 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. Committee Assuming Responsibility for Oversight of Audit: Part XII, Line 2c Explanation: Independent auditors are engaged by the compliance and audit committee of the Regional Health, Inc. Board of Trustees. Final audit results, on a consolidated basis, are reported by the independent auditors directly to the compliance and audit committee. 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 1 1 1 0 0 1 1 0 0 Regional Health Physicians Inc J 380846 Cost Rapid City Regional Hospital Inc L 1107681 Cost Regional Health Physicians Inc L 485087 Cost Rapid City Regional Hospital Inc M 7364327 Cost Rapid City Regional Hospital Inc P 123871 Cost Rapid City Regional Hospital Inc Q 1626677 Cost