2023-05-02T13:58:25-05:00 2022-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-07-01 460233030 CHILDREN'S CARE HOSPITAL AND SCHOOL CHIL 6054449500 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 STEVE WILSON CFO 6054449500 2023-05-02 1 STEVE WILSON 999009999 LAURIE HANSON CPA P00851848 6053391999 2023-05-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z LIFESCAPE STEVE WATKINS 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 34870446 0 X WWW.LIFESCAPESD.ORG X 1952 SD EMPOWERING PEOPLE TO LIVE THEIR BEST LIFE. 15 15 699 548 0 0 3936144 1388888 32285303 32792484 244588 540990 147053 147915 36613088 34870277 0 0 0 0 23456954 26354919 0 0 0 9311731 9981182 32768685 36336101 3844403 -1465824 35904421 31115902 8712265 7601995 27192156 23513907 X EMPOWERING PEOPLE TO LIVE THEIR BEST LIFE.VISION STATEMENT:LIFESCAPE WILL BE AN INNOVATIVE ORGANIZATION, PROVIDING EXCEPTIONAL SERVICES AND CREATIVE SOLUTIONS FOR PEOPLE WITH VARIED NEEDS AND COMPLEX CARE ACROSS THEIR LIFE SPAN. KEY FACTORS IN ACCOMPLISHING THIS ARE COLLABORATIVE PARTNERSHIPS, STRIVING TO BECOME A DESTINATION FOR RESEARCH, AS WELL AS DEVELOPING, IMPLEMENTING, AND TRAINING OF TECHNOLOGY-BASED SOLUTIONS TO IMPROVE THE LIVES OF PEOPLE WE SUPPORT. 0 1 30172895 32792484 CHILDREN'S CARE HOSPITAL & SCHOOL (CCHS) PROVIDED SERVICES FOR OVER 3,090 INDIVIDUALS FROM BIRTH THROUGH AGE 21 WITH DISABILITIES OR REHABILITATION NEEDS IN ALL OF ITS PROGRAMS LAST FISCAL YEAR. CHILDREN SERVED WERE FROM 64 OF SOUTH DAKOTA'S 66 COUNTIES. OUTPATIENT AND OUTREACH SERVICES, WHICH ARE COMMUNITY BASED, SERVED MORE THAN 3,000 CHILDREN IN SIOUX FALLS AND RAPID CITY, SD. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, THERAPIES RANGING FROM PHYSICAL AND OCCUPATIONAL TO SPEECH-LANGUAGE PATHOLOGY, BEHAVIORAL THERAPY, ASSISTIVE TECHNOLOGY, SEATING AND POSITIONING, AND POWERED MOBILITY SERVICES. IN SIOUX FALLS AND RAPID CITY OUTPATIENT CLINICS, 262 CHILDREN RECEIVED FREE AUTISM SCREENINGS AND 142 CHILDREN WERE EVALUATED FOR AUTISM. LIFESCAPE HAS 10 BOARD CERTIFIED BEHAVIOR ANALYSTS IN THE STATE, FIVE OF WHOM WERE HIRED IN FY22 AT OUR SIOUX FALLS AUTISM AND CHILD DEVELOPMENT CENTER AND 26TH STREET CHILDREN'S CAMPUS. WITH THE NUMBER OF CHILDREN WHO NEED BEHAVIORAL SERVICES INCREASING, LIFESCAPE ALSO WORKED TO HIRE MORE REGISTERED BEHAVIOR TECHNICIANS (RBTS). IN FY22, 11 FULL-TIME RBTS WERE HIRED IN SIOUX FALLS, ALONG WITH 1 PART-TIME AND ONE UNSCHEDULED PART-TIME RBT. IN RAPID CITY, 5 FULL-TIME RBTS AND ONE UPT WERE HIRED. LIFESCAPE'S CHILDREN'S SPECIALTY HOSPITAL CONTINUES TO BE THE ONLY PEDIATRIC REHABILITATION HOSPITAL IN SOUTH DAKOTA. IN FY22, 37 CHILDREN WERE SERVED IN THE HOSPITAL. IN THE RESIDENTIAL PROGRAM AND INTERMEDIATE CARE FACILITY, 56 CHILDREN WERE SERVED, MOST OF WHOM ALSO ATTENDED LIFESCAPE'S SPECIALTY SCHOOLS. IN ADDITION, THERE WERE OVER 58-DAY STUDENTS AT THE 26TH STREET CAMPUS AND PATHWAYS TO LIFE SCHOOL. WHILE CHILDREN SERVED WERE PRIMARILY FROM SOUTH DAKOTA, MANY WERE ALSO FROM NEIGHBORING STATES. ALL HAD ACCESS TO LIFESCAPE'S MANY EXPERTS THAT INCLUDE BOARD CERTIFIED BEHAVIOR ANALYSTS, SOCIAL WORKERS, CASE MANAGERS, DIETITIANS, PSYCHOLOGISTS AND MORE. 30172895 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 34 0 1 699 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X STEVE WILSON 6054449820 4100 S WESTERN AVE SIOUX FALLS SD 57105 STEVEN WATKINS CEO 23.00 27.00 X 0 285408 33834 STEVE WILSON CFO 22.00 28.00 X 0 181366 29021 CHARLENE CONNELLY RN 40.00 0.00 X 165875 0 4079 KRISTIN TUTTLE VP OF MED. & THERAPY SERVI 40.00 0.00 X 128879 0 10756 VICKI ISLER DIRECTOR OF EDUCATION AND SUPERINTENDENT 40.00 0.00 X 112705 0 13672 REBECCA WEELDREYER DIRECTOR OF NURSING 40.00 0.00 X 106182 0 18548 KIMBERLY WINCKLER RN 40.00 0.00 X 102790 0 9850 JASON HARRIS CHAIR/IMMEDIATE PAST CHAIR(BEG 01/22) 1.00 3.50 X X 0 0 0 MARLI SCHIPPERS SECRETARY/CHAIR (BEG 01/22) 1.00 3.50 X X 0 0 0 LARRY FENTON VICE CHAIR 1.00 3.00 X X 0 0 0 JACK HOPKINS TREASURER/DIRECTOR (BEG 01/22) 1.00 3.00 X X 0 0 0 JAY SOUKUP DIRECTOR /TREASURER (BEG 01/2022) 1.00 3.00 X X 0 0 0 BOB MCNANEY DIRECTOR/SECRETARY (BEG 01/22) 1.00 3.00 X X 0 0 0 JOHN ROZELL MEMBER-AT-LARGE (JULY-DEC) 1.00 3.00 X X 0 0 0 DOUG BERKLAND DIRECTOR (BEG 01/22) 1.00 3.00 X 0 0 0 P DANIEL DONOHUE DIRECTOR (JULY-DEC) 1.00 3.00 X 0 0 0 JOE HENKIN DIRECTOR (JULY-DEC) 1.00 3.00 X 0 0 0 MOLLY MCCARTHY DIRECTOR (JULY-DEC) 1.00 3.00 X 0 0 0 JON SODERHOLM DIRECTOR (JULY-DEC) 1.00 3.00 X 0 0 0 MARK STERNHAGEN DIRECTOR/MEMBER AT LARGE (BEG 01/22) 1.00 3.00 X 0 0 0 AMY PREATOR DIRECTOR (JULY-DEC) 1.00 3.00 X 0 0 0 NAN BAKER DIRECTOR/PAST FOUNDATION CHAIR 1.00 3.00 X 0 0 0 DR JOSH PAULI DIRECTOR 1.00 3.00 X 0 0 0 PATTY PETERS DIRECTOR 1.00 3.00 X 0 0 0 KIMBERLY NOONEY DIRECTOR 1.00 3.00 X 0 0 0 TYLER HAAHR FOUNDATION CHAIR 1.00 3.00 X 0 0 0 ERICA DEBOER DIRECTOR (BEG 04/22) 1.00 3.00 X 0 0 0 JASON HUBERS DIRECTOR (BEG 06/22) 1.00 3.00 X 0 0 0 616431 466774 119760 5 0 1 0 LIFESCAPE 2501 W 26TH STREET SIOUX FALLS SD 57105 SHARED SERVICES 2145013 SANFORD USD MEDICAL CENTER PO BOX 5064 SIOUX FALLS SD 571175064 RESP. THERAPY; IT SVCS 481668 SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND ST SIOUX FALLS SD 57117 PHYSICIAN SERVICES 282036 HENRY CARLSON CONSTRUCTION 1205 W RUSSELL ST SIOUX FALLS SD 57104 CONSTRUCTION 193283 EIDE BAILLY LLP PO BOX 5125 SIOUX FALLS SD 571175125 AUDIT AND TAX SERVICES 102480 5 1136914 153600 98374 4707 1388888 PATIENT/RESIDENT FEES 623000 32495558 32495558 OTHER SERVICE REVENUE 900099 296926 296926 32792484 204033 204033 30456 0 30456 30456 30456 161365 175592 0 0 161365 175592 336957 336957 202 169 33 33 INSURANCE PROCEEDS 900099 117426 117426 117426 34870277 32792484 0 688905 20437406 19230372 1207034 419918 397128 22790 3918537 3323308 595229 1579058 1491758 87300 38136 38136 65640 65640 13346 13346 3498949 1150402 2348547 235540 4167 231373 395913 229658 166255 3864 3864 1449036 959435 489601 39817 29132 10685 63208 34850 28358 133372 133372 928554 889868 38686 287882 238211 49671 OTHER SUPPLIES 1462297 1289452 172845 MAINTENANCE AND REPAIR 479200 211263 267937 DUES AND SUBSCRIPTIONS 256340 73032 183308 630088 607513 22575 36336101 30172895 6163206 0 X 3675428 1611310 6036384 6272040 28532 29700 35635 41158 30900828 24111926 6890245 6788902 7587603 14043878 63550 0 11587044 2328914 35904421 31115902 2431904 2304601 4211371 3754138 1979896 1458328 89094 84928 8712265 7601995 X 26884529 23189699 307627 324208 27192156 23513907 35904421 31115902 X -1465824 -2167546 -44879 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 846 0 0 1 12500 0 0 13346 0 PART II-B, LINE 1: CHILDREN'S CARE HOSPITAL AND SCHOOL (CCHS) CONTRACTS FOR LOBBYING SERVICES. THE LOBBYIST IS IN DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS AND GOVERNMENT OFFICIALS DURING THE STATE'S 30-40 DAY LEGISLATIVE SESSION. THE LOBBYIST HELPS CCHS DEFINE ISSUES AND MAKE CONTACT WITH APPROPRIATE LEGISLATIVE AND EXECUTIVE BRANCH PERSONNEL TO MAKE SURE THEY TRULY UNDERSTAND HOW ISSUES THAT MAY BE IN FRONT OF THEM WILL AFFECT CCHS. LOBBYING REVOLVES AROUND PROPOSED BUDGETARY ISSUES AS WELL AS ADVOCATING FOR THE WELFARE OF PEOPLE SERVED BY CCHS. 1090996 1090996 20351679 17076467 3275212 7091479 6237954 853525 2366674 797505 1569169 6788902 INTERCOMPANY RECEIVABLE 494820 INVESTMENT IN DAKOTA TRUCK UNDERWRITERS 405303 OPERATING LEASE RIGHT OF USE ASSET 1428791 2328914 ASSETS HELD IN TRUST 84928 84928 X 32578654 -2167546 -44879 -2212425 34791079 79198 79198 34870277 36257132 0 36257132 78969 78969 36336101 PART X, LINE 2: THE ORGANIZATION 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. THE ORGANIZATION 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION -44,879. PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 1,141. BANK FEES RECLASSIFIED FOR 990 78,057. OTHER CHANGE IN NET ASSETS PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 912. BANK FEES RECLASSIFIED FOR 990 78,057. 1 1 X 1 X 1 X 175.000000000000 1 0 0 22586118 17548341 5037777 0.13860 22586118 17548341 5037777 0.13860 22586118 17548341 5037777 0.13860 1 120000 51586 132327 -80741 X 1 1 1 1 CHILDREN'S CARE HOSPITAL & SCHOOL 2501 W 26TH 1020 W 18TH 7220 W 41ST SIOUX FALLS SD 57105 WWW.LIFESCAPESD.ORG 10562 X X CHILDREN'S CARE HOSPITAL & SCHOOL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE 7D X X 1 21 1 SEE 7D 0 1 X 100.000000000000 175.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://WWW.LIFESCAPESD.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.LIFESCAPESD.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.LIFESCAPESD.ORG/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 0 X X 0 0 CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 5: KEY INFORMATIONAL INTERVIEWS/SURVEYS WERE CONDUCTED. THE LIFESCAPE ADVISORY COMMITTEE SELECTED INDIVIDUALS WITH A WIDE RANGE OF BACKGROUNDS IN HEALTH-RELATED AGENCIES AND WITH HEALTH-RELATED QUALIFICATIONS TO PARTICIPATE IN THE INTERVIEWS. THESE INDIVIDUALS REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY LIFESCAPE. INTERVIEWS AND SURVEYS WERE PROVIDED FEBRUARY 23RD- MARCH 15TH, 2022. UNDERSERVED POPULATIONS THAT WE REACHED OUT TO FOR FEEDBACK INCLUDE: PEOPLE WITH AUTISM, NON-AUTISM RELATED MENTAL HEALTH DIAGNOSES AND CONCERNS, MEDICALLY COMPLEX NEEDS AND PARENTS OR CAREGIVERS OF THOSE WITH COMPLEX NEEDS. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 7D: HTTPS://WWW.LIFESCAPESD.ORG/ABOUTTHE IMPLEMENTATION STRATEGY CAN BE FOUND ON PAGE 16 OF THE CHNA REPORT. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 11: THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT REVEALED THE FOLLOWING PRIORITY NEEDS:1. ACCESSING SPECIALTY HOSPITAL AND OUTPATIENT SERVICES:2. LACK OF COMMUNITY AND CAREGIVER EDUCATION ON LIFESCAPE SERVICES AND COMMUNITY RESOURCES:3. INADEQUATE AVAILABILITY OF APPROPRIATE MEDICAL AND COMMUNITY-BASED SERVICES IN IDENTIFIED AREAS: PEDIATRIC SKILLED NURSING/PEDIATRIC HOME HEALTH/RESPITE CARE; MENTAL HEALTH; AND AUTISM/ABA.MANY OF THE IDENTIFIED NEEDS ARE A CONTINUATION OF NEEDS IDENTIFIED IN THE PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT.THE ORGANIZATION ADDRESSED THE 2018 IDENTIFIED PRIORITY NEEDS AS FOLLOWS:1. DEVELOPED ONLINE PARENT TRAINING FORMAT THAT IS FOUND ON OUR WEBSITE, AWARDED 2 GRANTS TO HELP SUPPORT ONLINE EDUCATIONAL PLATFORMS, DIRECTORY OF SERVICES WAS DEVELOPED FOR HOSPITAL SERVICES AND DISSEMINATED TO COMMUNITY RESOURCES AND PROVIDERS.2. A NEW HOSPITAL FAMILY HANDBOOK WAS DEVELOPED AND IS BEING PROVIDED TO FAMILIES UPON ADMISSION.3. WE WERE ABLE TO INCREASE OUR NUMBER OF AUTISM EVALUATIONS AND FREE SCREENINGS TO HELP MEET GROWING DEMAND. THE OUTPATIENT AUTISM TEAM DEVELOPED A SCREENING TOOL FOR ADOLESCENTS TO BETTER GUIDE APPROPRIATE RESOURCES FOR PATIENTS.TRANSPORTATION AND INSURANCE COVERAGE WERE NEEDS THAT WE CHOSE NOT TO ADDRESS AS WE DON'T HAVE THE ABILITY TO DIRECTLY IMPACT THESE AREAS. WE ALSO WERE NOT ABLE TO ADDRESS THE NEED FOR ADDITIONAL LOCATIONS FOR THOSE AGING OUT OF SERVICES WITH HIGH MEDICAL NEEDS DUE TO FINANCIAL CONSTRAINTS OF DEVELOPING A NEW LOCATION. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 13B: THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT THROUGH OTHER SOURCES, WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH CHARITY CARE ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, CHILDREN'S CARE HOSPITAL AND SCHOOL COULD USE OUTSIDE AGENCIES IN DETERMINING ESTIMATED INCOME AMOUNTS FOR THE BASIS OF DETERMINING CHARITY CARE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. STATE-FUNDED PRESCRIPTION PROGRAMS;2. HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC;3. PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);4. FOOD STAMP ELIGIBILITY;5. SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY;6. ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAM THAT ARE UNFUNDED (E.G., MEDICAID SPEND-DOWN);7. LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; AND,8. PATIENT IS DECEASED WITH NO KNOWN ESTATE. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE MAY BE USED IF NECESSARY. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 24: THE POLICY DOES NOT COVER ELECTIVE PROCEDURES AND NO FAP-ELIGIBLE PATIENTS HAD ELECTIVE PROCEDURES. 2 1 - CHILDREN'S CARE HOSPITAL & SCHOOL 7110 JORDAN DRIVE RAPID CITY SD 57702 OUTPATIENT REHABILITATION CENTER 2 - CHILDREN'S CARE HOSPITAL AND SCHOOL 2524 GLENN AVENUE SIOUX CITY IA 51106 OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPY PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES TO DETERMINE FAP ELIGIBILITY, CCHS USES AN ASSET TEST, REVIEWS INSURANCE STATUS, CONSIDERS MEDICAL INDIGENCY, AND REVIEWS INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: LINE 7B UNREIMBURSED MEDICAID IS THE COST OF MEDICAID PROVIDED FOR INPATIENTS, PATIENTS AT THE RAPID CITY REHAB CENTER, RAPID CITY OUTREACH, SIOUX FALLS OUTREACH, AND SIOUX CITY OUTPATIENT CENTER. THE COST IS CALCULATED BY MULTIPLYING THE MEDICAID CHARGES TIMES THE COST-TO-CHARGE RATIO, AS DETERMINED THROUGH USE OF THE GENERAL LEDGER. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: NO PART OF THE AMOUNT ON LINE 2 WAS DETERMINED TO BE CHARITY CARE ELIGIBLE. PART III, LINE 4: THE FINANCIAL STATEMENT FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSION IS AT NOTE 1 PAGES 16-17. PART III, LINE 8: NO PART OF THE SHORTFALL ON LINE 7 IS TREATED AS COMMUNITY BENEFIT. THE HOSPITAL HAS MEDICARE CERTIFICATION BECAUSE IT IS REQUIRED IN ORDER TO OPERATE. THE OVERALL COST-TO-CHARGE RATIO BASED ON AUDITED FINANCIAL STATEMENTS WAS USED TO CALCULATE COST. PART III, LINE 9B: PRIOR TO ENGAGING IN ECAS, LIFESCAPE'S REVENUE CYCLE STAFF WILL IDENTIFY WHETHER REASONABLE EFFORTS WERE MADE TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IF A PATIENT SUBMITS A COMPLETE HOSPITAL FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, LIFESCAPE WILL SUSPEND ECAS AND MAKE AN ELIGIBILITY DETERMINATION BEFORE RESUMING ECA ACTIVITY. PART VI, LINE 2: CCHS RELIES ON ITS BOARD MEMBERS AND BOARD MEMBERS OF LIFESCAPE FOUNDATION WHO REPRESENT ALL REGIONS OF THE STATE, ITS MEDICAL STAFF, AND SCHOOL DISTRICTS WHOSE STUDENTS IT SERVES TO HELP ADVISE OF HEALTH CARE NEEDS OF THEIR RESPECTIVE COMMUNITIES. CCHS ALSO CONDUCTS REGULAR MEETINGS WITH PARENTS AND PATIENTS TO HELP ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. PART VI, LINE 3: RESIDENTIAL AND INPATIENT SERVICES ARE ALWAYS PRE-AUTHORIZED BY A THIRD PARTY PAYER AND ANY PATIENT RESPONSIBILITY IS DISCUSSED WITH THE RESIDENT'S GUARANTOR UPON ADMISSION. FINANCIAL COUNSELING IS AVAILABLE FOR OUTPATIENT SERVICES. THIS STARTS WITH CCHS VERIFYING THAT PATIENT'S INSURANCE IS EFFECTIVE AND CONTACTING INSURANCE WITH DIAGNOSIS AND PROCEDURE CODES TO CHECK COVERAGE. NEXT, THE PARENT/GUARANTOR IS CONTACTED TO INFORM THEM OF THE APPROXIMATE AMOUNT FOR WHICH THEY'LL BE FINANCIALLY RESPONSIBLE. THEY ARE ASKED TO SIGN A PRIVATE PAY AGREEMENT BEFORE SERVICES ARE PROVIDED. BECAUSE CCHS DOES NOT PROVIDE EMERGENCY SERVICES, THERE IS ALWAYS TIME TO GET FORMS SIGNED BEFORE SERVICES ARE RENDERED. PART VI, LINE 4: CCHS SERVES APPROXIMATELY 3,000 CHILDREN AND THEIR FAMILIES IN 64 COUNTIES THROUGHOUT SOUTH DAKOTA EVERY YEAR. ADDITIONAL CHILDREN AND FAMILIES ARE SERVED THROUGHOUT MINNESOTA, IOWA AND NORTH DAKOTA. APPROXIMATELY 65 SOUTH DAKOTA PUBLIC AND TRIBAL SCHOOL DISTRICTS ALSO RELY ON CCHS AND CHILDREN FROM SEVERAL PUBLIC OR PRIVATE AGENCIES AND PROGRAMS ARE ALSO SERVED. NO OTHER HOSPITALS IN THE AREA PROVIDE SIMILAR SERVICES. PART VI, LINE 5: - ALL CCHS GOVERNING BODY MEMBERS RESIDE IN DIFFERENT PARTS OF ITS PRIMARY SERVICE AREA IN SOUTH DAKOTA. ALL BOARD MEMBERS ARE INDEPENDENT OF CCHS AND SERVE IN A VOLUNTEER CAPACITY.- CCHS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES.- CCHS USES SURPLUS FUNDS TO ENHANCE SERVICES TO PATIENTS, FUND BUILDING IMPROVEMENTS OR EXPANSIONS, AND IMPROVE CARE BY PROVIDING ADDITIONAL TRAINING TO STAFF.- CCHS IS THE ONLY PROVIDER IN SOUTH DAKOTA OFFERING 24-HOUR, INTEGRATED MEDICAL, BEHAVIORAL, AND SPECIAL EDUCATION SERVICES FOR CHILDREN AGES BIRTH TO 21. CCHS SERVES FAMILIES AND SCHOOLS WHO ARE UNABLE TO SUPPORT CHILDREN WITH SEVERE BEHAVIORS WHO MAY HARM THEMSELVES OR OTHERS. MEDICAL PROGRAMMING IS PROVIDED TO FILL THE GAP BETWEEN SERVICES PROVIDED IN THE HOME AND SCHOOL DISTRICT AND SERVICES PROVIDED AT ACUTE CARE HOSPITALS.- CCHS HAS SEVERAL CLINICAL AFFILIATION AGREEMENTS WITH SURROUNDING AREA SCHOOLS TO PROVIDE TRAINING EXPERIENCE FOR PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS, NURSES AND PSYCHOLOGY STUDENTS.- CCHS PARTICIPATES IN THE MEDICARE PROGRAM, SEVERAL STATE MEDICAID PROGRAMS, AND THE BIRTH TO 3 PROGRAM.- 548 VOLUNTEERS ASSISTED WITH ALL ASPECTS OF CCHS OPERATIONS. VOLUNTEERS ASSIST CCHS STAFF WITH ADMINISTRATIVE TASKS IN RECEPTION, MEDICAL RECORDS AND FUNDRAISING, AND PROVIDE SUPPORT TO PROFESSIONALS IN RESIDENTIAL AREAS. 0 0 0 0 0 0 0 0 0 STEVEN WATKINS CEO 0 284892 0 0 0 516 0 7269 0 26995 0 319672 0 0 STEVE WILSON CFO 0 180800 0 0 0 566 0 4692 0 24758 0 210816 0 0 CHARLENE CONNELLY RN 163517 0 2106 0 252 0 4079 0 169 0 170123 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED PARTY, LIFESCAPE, TO DETERMINE COMPENSATION FOR THE CEO AND CFO. LIFESCAPE USES THE METHODS LISTED IN PART I, LINE 3 TO DETERMINE COMPENSATION. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 480315509 83755VJ47 2017-11-01 5736456 REFINANCING OF 2007 BONDS 0 0 0 A 2186456 5736456 106780 597971 5031805 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 FORM 990, PART III, LINE 3 WE DISCONTINUED OPERATIONS AT ABLEKIDS OUTPATIENT CLINIC IN SIOUX CITY, IOWA AS OF JUNE 3, 2022. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHAIR, VICE CHAIR, SECRETARY, TREASURER, IMMEDIATE PAST CHAIR, CHIEF EXECUTIVE OFFICER, AND ONE DIRECTOR. THE COMMITTEE CAN ACT ON BEHALF OF THE BOARD BETWEEN BOARD MEETINGS. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE MUST BE RATIFIED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 STEVE WATKINS HAS A BUSINESS RELATIONSHIP WITH PATTY PETERS, JOHN ROZELL, JAY SOUKUP, JACK HOPKINS, JASON HARRIS, P. DANIEL DONOHUE, JOE HENKIN, MOLLY MCCARTHY, JON SODERHOLM, LARRY FENTON, MARK STERNHAGEN, KIMBERLY NOONEY, MARLI SCHIPPERS, JOSH PAULI, NAN BAKER, AMY PREATOR, BOB MCNANEY, TYLER HAAHR, DOUG BERKLAND, ERICA DEBOER AND JASON HUBERS. THE BUSINESS RELATIONSHIP EXISTS BECAUSE STEVE WATKINS WAS PAID BY LIFESCAPE. PERSONS LISTED AS HAVING A BUSINESS RELATIONSHIP WITH HIM SERVE ON THE BOARD OF LIFESCAPE. ADDITIONALLY, STEVE WATKINS AND STEVE WILSON HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS LIFESCAPE, A SOUTH DAKOTA NON-PROFIT, EXEMPT UNDER INTERNAL REVENUE CODE 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY THE MEMBER AND SHALL BE THE SAME PERSONS WHO SERVE AS THE DIRECTORS OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND A FINAL COPY OF THE 990 IS SHARED WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C LIFESCAPE HAS A CONFLICT OF INTEREST POLICY THAT IS SIGNED ANNUALLY BY EACH MEMBER OF THE BOARD OF DIRECTORS. IN ADDITION, A CONFLICT LETTER IS SENT TO ALL BOARD MEMBERS AND SENIOR LEADERS OF LIFESCAPE TO COMPLETE AND TO DISCLOSE ANY POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND CFO OF CCHS ARE COMPENSATED BY LIFESCAPE, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART X, LINE 20: THE ISSUE PRICE OF THE BONDS INCLUDES THE FILING ORGANIZATION'S SHARE OF THE ENTIRE BOND ISSUE, WHICH WAS ISSUED TO LIFESCAPE ON BEHALF OF THE LIFESCAPE OBLIGATED GROUP. THE LIFESCAPE OBLIGATED GROUP CONSISTS OF LIFESCAPE, CHILDREN'S CARE HOSPITAL AND SCHOOL D/B/A LIFESCAPE, SOUTH DAKOTA ACHIEVE D/B/A LIFESCAPE, AND LIFESCAPE FOUNDATION. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTION -44,879. LIFESCAPE 4100 S WESTERN AVE SIOUX FALLS SD 57105 465151247 ASSIST CHILDREN'S CARE HOSPITAL & SCHOOL AND SD ACHIEVE SD 501(C)(3) LINE 12A, I N/A 0 SOUTH DAKOTA ACHIEVE DBA LIFESCAPE 4100 S WESTERN AVE SIOUX FALLS SD 57105 237072116 PROVIDE SUPPORT SERVICES TO PEOPLE WITH DEVELOPMENTAL DISABILITIES SD 501(C)(3) LINE 2 LIFESCAPE 0 LIFESCAPE FOUNDATION 2501 WEST 26TH STREET SIOUX FALLS SD 57105 460353254 SUPPORT PROGRAMS & SERVICES OF LIFESCAPE ENTITIES SD 501(C)(3) LINE 12A, I LIFESCAPE 0 SIOUX RESIDENTIAL SERVICES INC - AKA HARVEST APARTMENTS 4100 S WESTERN AVE SIOUX FALLS SD 57105 460378935 HUD PROPERTY FOR INDIVIDUALS SUPPORTED BY SDA SD 501(C)(3) LINE 10 SOUTH DAKOTA ACHIEVE DBA LIFESCAPE 0 HAYWARD MEMORIAL TESTAMENTARY TRUST 100 S PHILIPS AVE SIOUX FALLS SD 57104 466010897 PROVIDE BENEFITS TO ORGANIZATIONS THAT PROMOTE CHARITABLE PURPOSES SD 501(C)(3) LINE 12A, I N/A 0 BEACON APARTMENTS LIMITED PARTNERSHIP 4100 S WESTERN AVE SIOUX FALLS SD 57105 471232136 LOW INCOME HOUSING SD N/A 0 0 REHABILITATION MEDICAL SUPPLY 1020 W 18TH ST SIOUX FALLS SD 57104 411936988 SALES & SERVICE OF DURABLE MEDICAL EQUIPMENT, ORTHOTICS, & PROSTHETICS SD CHILDREN'S CARE HOSPITAL AND SCHOOL C 2176694 1843349 1.00000 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 REHABILITATION MEDICAL SUPPLY Q 1885446 FMV