Community Benefit Insight - Tax-exempt hospital

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Regional Health Physicians Inc

Spearfish Regional Surgery Center

1316 10th St
Spearfish, SD 57783

Bed count	4	Medicare provider number	430094	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 460372454

Display data for year:

Community Benefit Spending- 2013
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

14.59%

Spending by Community Benefit Category- 2013
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2013

Additional data

Community Benefit Expenditures: 2013

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,382,326 2.84 %
Medicaid as % of operating expenses	$ 2,500,670 2.98 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 7,347,892 8.76 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 2,871 0.00 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 586 0.00 %
Community building* as % of operating expenses	$ 604 0.00 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	1
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	1
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 604 0.00 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 0 0 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 604 100 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2013

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 717,082 0.86 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 20,682 2.88 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:

Reported to credit agency	Not available
Filed lawsuit	Not available
Placed liens on residence	Not available
Issue body attachments? (an order by the court commanding a sheriff or other official to physically bring before the court a person who is guilty of contempt of court)	Not available

Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2013

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES
Did the tax-exempt hospital execute the implementation strategy?	YES
Did the tax-exempt hospital participate in the development of a community-wide plan?	Not available

Supplemental Information: 2013

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 5776951 including grants of $ 0) (Revenue $ 4797088)
Regional Health Physicians Spearfish Queen City Regional Medical Clinic Primary Care - provide clinic services to patients.

4B (Expenses $ 5186582 including grants of $ 0) (Revenue $ 6817288)
Regional Health Physicians Spearfish Surgery Center Specialty Hospital - provide ambulatory surgery services.

4C (Expenses $ 4667550 including grants of $ 0) (Revenue $ 3485302)
Regional Health Physicians Aspen Regional Medical Clinic Primary Care - provide clinic services to patients.

4D (Expenses $ 47333925 including grants of $ 0) (Revenue $ 41970587)
Regional Health maintains clinics in surrounding communities to provide general and specialized medical services to people within the Black Hills Region.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Spearfish Regional Surgery Center
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.

Spearfish Regional Surgery Center
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.

Spearfish Regional Surgery Center
Part V, Section B, Line 6i: The implementation strategy is available at: http://www.regionalhealth.com/About-Us/Community-Needs-Assessment.aspx?furl=chna or upon request.

Spearfish Regional Surgery Center
Part V, Section B, Line 7: In review of the needs identified in the CHNA, Spearfish Regional Surgery Center has identified the areas below that will not be addressed due to prioritization of health needs:1) Conditions of Aging: Limited expertise and population served excluded this as an area chosen for action by Spearfish Regional Surgery Center.2) Injury & Violence Prevention: Spearfish Regional Surgery Center believes this priority area falls within the purview of the county health department and other community organizations. Lower priority excluded this as an area chosen for action.3) Maternal, Infant, Child Health: Spearfish Regional Surgery Center does not have an obstetrical program and performs only a small volume of pediatric surgery. Lower priority excluded this as an area chosen for action.4) Nutrition, Physical Activity & Weight Status: Spearfish Regional Surgery Center contracts dietary and physical therapy services through Spearfish Regional Hospital. Limited expertise excluded this as an area chosen for action. 5) Oral Health: Spearfish Regional Surgery Center is the only facility in the Northern Hills providing general anesthesia dental service, however lower priority excluded this as an area chosen for action.6) Respiratory Diseases: Spearfish Regional Surgery Center contracts respiratory therapy services through Spearfish Regional Hospital. Lower priority excluded this as an area chosen for action.7) Substance Abuse: Spearfish Regional Surgery Center 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.8) Tobacco Use: Spearfish Regional Surgery Center 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.Spearfish Regional Surgery Center began to execute the implementation strategy during fiscal year 2014. The needs that are being addressed are as follows: 1) access to health services; 2) diabetes; and 3) mental health and mental disorders.

Spearfish Regional Surgery Center
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, waiting rooms, and admissions office. The policy in its entirety is also available upon request.

Spearfish Regional Surgery Center
Part V, Section B, Line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
"Form 990, Schedule H:References to ""Regional Health"" apply to all entities controlled or leased by Regional Health, Inc. This includes the reporting entity.Part I, Line 3c: Financial assistance debt reduction write-offs for free or discounted care are based on an income matrix utilizing the current Federal Poverty Level (FPL) income guidelines after satisfying applicable co-pay requirements. The income matrix may be updated annually as the FPL guidelines are released."

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 the following url: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, Line 7g:
The costs attributable to a physician clinic included in Subsidized Health Services on line 7g is $23,708,766.

Part I, Ln 7 Col(f):
The bad debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column, is $717,082.

Part II, Community Building Activities:
Regional Health provides numerous community benefit health events and screenings throughout the Black Hills Region. Regional Health also provides financial support to other nonprofit organizations to help support community health outreach. Additionally, Regional Health provides in-kind support and employee volunteers to help support community health events and activities.

Part III, Line 2:
The bad debt reported on line 2 is at charges as reported on the financial statements.

Part III, Line 3:
The estimated amount of bad debt attributable to patients eligible under the financial assistance policy is determined through a review of the bad debt records to identify patient accounts that would be eligible for a discount under the financial assistance policy. The organization follows HFMA Statement 15, however the amount reported on Part III, Line 3 reflects amounts not previously determined to be charity care in prior years, however were determined in the current year to be charity care amounts.

Part III, Line 4:
The footnote to the financial statements that describes bad debt expense is located on 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 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) 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 our website, information is available at all admission areas, and we have financial counselors at each location, (except Urgent Cares) to meet with all uninsured patients to assist them with finding funding sources or applying for financial assistance. We also have a self-pay collection center, (not outsourced) that communicates any funding and financial assistance opportunities to our patients, as well as the outsourced resources.

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.

Operating expenses	$ 83,865,975
Total amount spent on community benefits as % of operating expenses	$ 12,234,345 14.59 %