Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
Rapid City Regional Hospital Inc |
460319070 | Yes | 962,641 | 0 | ||
| (B)
Regional Health Network Inc |
460360899 | Yes | 217,019 | 0 | ||
| (C)
Regional Health Physicians Inc |
460372454 | Yes | 212,866 | 0 | ||
Total 3
|
1,392,526 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section A, Line 1: | Regional Health, Inc. is organized and shall be operated exclusively for charitable, educational, and scientific purposes exclusively for the benefit of, to perform the functions of, or to carry out the purposes of Rapid City Regional Hospital, Inc., Regional Health Network, Inc. and Regional Health Physicians, Inc. |
| Part IV, Section D, Line 3: | During FY15 and previously, the membership of Regional Health, Inc.'s, (RHI) Investment Committee and its Compliance and Audit Committee included members of the Boards of its Supported Organizations. Of the six (6) members of the RHI Investment Committee, two (2) members also served on the Board of Directors of Rapid City Regional Hospital, Inc. (Dishman) or Regional Health Network, Inc. (Cappa), and one (1) other Investment Committee member previously served on the Regional Health Network, Inc. Board (Dahlstrom). |
| Part IV, Section E, Line 3a: | The Governance Committee of the RHI Board of Directors evaluates the performance of the RHI Board and the Boards of its Supported Organizations annually; appoints or reappoints the members of the RHI Board and the Boards of its Supported Organizations as the terms of their respective members expire or become vacant; reviews and recommends amendments to the articles of incorporation or bylaws of RHI and its Supported Organizations, as needed; reviews disclosures made by its and its Supported Organizations' Board members in the Conflict of Interest Disclosure forms completed annually; and develops and recommends approval of an annual Education Plan for the members of RHI Board and the Boards of its Supported Organizations. |
| Part IV, Section E, Line 3b: | The RHI Board, as the sole member of each of its supported organizations, exercises a substantial degree of direction over the policies, programs and activities of each supported organization through reserved powers stated in the articles of incorporation of each supported organization. The reserve powers include approval of amendments to the articles of incorporation, bylaws, mission, vision and values of the supported organizations; appointment of the members of the boards of the supported organizations; selection of the independent auditor of all the related organizations; approval of the capital and operating budgets of the supported organizations; provision of all treasury functions; authority to establish plans, processes and policies related to business strategy, corporate compliance, human resources, performance improvement, customer satisfaction, risk management and safety; and authority to approve expenditures over certain monetary thresholds as well as the incurrence of debt or entry into affiliations, joint ventures and mergers. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part IV, Line 24a: | Bond Issues: The issue price of the bonds includes the filing organization's share of the entire bond issue, which was issued to Rapid City Regional Hospital on behalf of the Obligated Group. The Obligated Group consists of Rapid City Regional Hospital, Regional Health Inc, Regional Health Network Inc, and Regional Health Physicians Inc. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Rapid City Regional Hospital's tax return. |
| Form 990, Part V, Line 1a: | All 1099's are issued centrally by Rapid City Regional Hospital, Inc., a related organization. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee of the Corporation shall consist of the following: Chairman of the Board of Trustees, Vice Chairman, Secretary, Treasurer, President, and the most recent past Chairman of the Board of Trustees unless such person is otherwise a member of the Committee (and only if the person continues to be a member of the Board of Trustees). The Executive Committee, when the Board of Trustees is not in session, shall have and may exercise all of the authority of the Board of Trustees, except to the extent, if any, that such authority shall be limited by a motion or resolution of the Board of Trustees and except also that the Executive Committee shall not have the authority of the Board of Trustees in reference to amending the Articles of Incorporation of the Corporation; adopting a plan of merger, consolidation, or affiliation; the sale, lease, or other disposition of all or substantially all of the property and assets of the Corporation or of the System; a voluntary dissolution of the Corporation or a revocation thereof; or amending the Bylaws of the Corporation. Additionally, where action requiring the exercise of Board authority is needed on a matter that is within the authority delegated to the Board's Compliance and Audit Committee the Executive Committee may not act. |
| 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 staff or, are employees of a supported organization. |
| Form 990, Part VI, Section A, line 2 | Charles E. Hart, MD (retired 02/28/15) and Brent R. Phillips have a business relationship with the following individuals due to being the CEO of the supporting organization that exercises reserve powers over the supported organizations that employ each of these individuals: Joseph Sluka Jr., Mark Thompson, Mark Brodin, Sharmila Chandran, Maureen Henson, Jennifer Horton, Richard Latuchie, Mary Masten, Terry Graber, MD, and David Klocke, MD. Charles Hart, MD has a personal business relationship with Jonathan Dahlstrom. Directors John Brewer and Ross McKie both serve on the Black Hills Community Bank Board of Directors. |
| 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 trustees through a portal to the organization's internal information system, to which each board member has access. Educational sessions have been provided to each board member on how to access the portal. |
| Form 990, Part VI, Section B, line 12c | As a part of the annual disclosure of potential conflicts process, all board members, officers, and management receive a copy of the conflict of interest policy and sign an acknowledgement they have read and understand it. Additionally, they are each required to complete a disclosure statement. Annually, a summary list of all conflicts disclosed by board members is prepared and provided to the full board so board members are aware of the conflicts/interests of other board members and are able to point out conflicts if an individual member with a conflict forgets. Additionally, the agenda for each board meeting and each board committee meeting includes an initial agenda item "Conflicts of Interest" where board members are asked if they have any conflicts related to the other items on the agenda. All employees are covered by the conflict of interest policy but completion of the annual disclosure statement is limited to board and board committee members, management, and certain physicians. When a proposed transaction involves a board member, the transaction is reviewed by the compliance and audit committee. At meetings, board members who have a conflict of interest may be invited to speak on the matter by the chairman, but are not permitted to vote on the matter and are required to leave the meeting during discussion, after they have made any comments invited by the chair. Failure to comply with this policy constitutes ground for removal from office or membership and in the case of all employees, termination of employment. |
| Form 990, Part VI, Section B, line 15a | The Compliance and Audit committee of the sole member's board, a committee that includes only board members deemed "independent", determines all elements of compensation for the member's CEO (base salary, total cash compensation, benefits and total compensation). For other executive staff, the committee determines the appropriate base salary, cash compensation and total compensation ranges. The CEO of the member or his designee determines the actual base salary of the other executives within the committee-approved base salary range based on performance, while the committee authorizes any incentive compensation awarded to executives and any additional benefits offered to executives. The committee retains an independent compensation consultant, Sullivan & Cotter, to provide peer group market comparative data for base salary, total cash compensation, benefits and total compensation for executives. Sullivan and Cotter most recently completed a market assessment, and the committee approved compensation elements and ranges based thereon, in April and June of 2015. |
| Form 990, Part VI, Section C, line 19 | The Articles of Incorporation of the organization are filed in the office of the Secretary of State of South Dakota and are available to the public at the Secretary of State's website. Other documents (Bylaws, conflict of interest policy and financial statements) are not posted for the public but are available or described in other public documents or sites such as offering statements in bond issues or municipal securities rulemaking board's electronic municipal market access (EMMA) data port. |
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