2022-05-12T16:00:08-05:00 2021-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2020-07-01 460233030 CHILDREN'S CARE HOSPITAL AND SCHOOL CHIL 6054449500 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 STEVE WILSON CFO 6054449500 2022-05-12 1 STEVE WILSON 999009999 LAURIE HANSON CPA P00851848 6053391999 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z LIFESCAPE STEVE WATKINS 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 36495231 0 X WWW.LIFESCAPESD.ORG X 1952 SD EMPOWERING PEOPLE TO LIVE THEIR BEST LIFE. 17 17 712 371 0 0 1321521 3936144 31395134 32285303 145741 244588 67006 147053 32929402 36613088 32632 0 0 0 21889343 23456954 0 0 0 8983539 9311731 30905514 32768685 2023888 3844403 29150800 35904421 6659738 8712265 22491062 27192156 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. THROUGH COLLABORATIVE PARTNERSHIPS, LIFESCAPE WILL BECOME A DESTINATION FOR RESEARCH, AND THE DEVELOPMENT, IMPLEMENTATION, AND TRAINING OF TECHNOLOGY-BASED SOLUTIONS TO IMPROVE THE LIVES OF PEOPLE WE SUPPORT. 0 0 27124278 32285303 CHILDREN'S CARE HOSPITAL AND SCHOOL (CCHS) PROVIDED SERVICES FOR OVER 2,770 INDIVIDUALS FROM BIRTH THROUGH AGE 21 WITH DISABILITIES OR REHABILITATION NEEDS IN ALL ITS PROGRAMS LAST FISCAL YEAR.CCHS OUTPATIENT/OUTREACH SERVICES (COMMUNITY-BASED SERVICES) SERVED 2,636--THE MAJORITY CHILDREN. SERVICES ARE DELIVERED FROM CENTERS IN SIOUX FALLS, RAPID CITY, AND SIOUX CITY, IA. THERAPIES (PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH-LANGUAGE PATHOLOGY, BEHAVIOR THERAPY AND PSYCHOLOGY (SIOUX FALLS ONLY)) ARE THE MAIN SERVICES OFFERED AT THESE SITES, PLUS ASSISTIVE TECHNOLOGY, SEATING & POSITIONING, AND POWERED MOBILITY SERVICES. FREE AUTISM SCREENINGS AS WELL AS DIAGNOSTIC AUTISM EVALUATIONS ARE OFFERED IN SIOUX FALLS AND RAPID CITY AS AN OUTPATIENT SERVICE. THE TEAM (TONE EVALUATION AND MANAGEMENT) CLINIC FOR CHILDREN WITH CEREBRAL PALSY IS PHYSICIAN-LED. OUTREACH PROVIDES SERVICES TO CHILDREN IN THEIR OWN ENVIRONMENT--THEIR HOME, SCHOOL, OR DAYCARE CENTER. STAFF ALSO PROVIDE CONSULTATION TO SCHOOLS IN SCHOOL PSYCHOLOGY AND SPECIAL EDUCATION. CCHS ALSO SERVES AS A LEARNING ENVIRONMENT, PROVIDING OVER 150 STUDENTS AFFILIATED WITH 26 HIGHER EDUCATION SCHOOLS WITH INTERNSHIPS, PRACTICUMS, OR CLINICALS. RESIDENTIAL, INPATIENT AND SCHOOL/DAY PROGRAMS IN SIOUX FALLS, SD SERVED 160 CHILDREN. CHILDREN WERE MOSTLY FROM SOUTH DAKOTA, WITH CHILDREN FROM MINNESOTA, IOWA, AND NEBRASKA ALSO SERVED. SERVICES INCLUDE THERAPIES (PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH-LANGUAGE PATHOLOGY, RESPIRATORY THERAPY, MUSIC THERAPY, AND BEHAVIOR THERAPY), NURSING CARE, PSYCHOLOGY, AND SPECIAL EDUCATION. SPECIAL EDUCATION IS OFFERED THROUGH CLASSROOMS FOR CHILDREN OF DIFFERENT AGES AND VARIOUS DIAGNOSES. STUDENTS INCLUDE THOSE IN RESIDENCE AT LIFESCAPE PLUS DAY STUDENTS. BESIDES TEACHERS, OTHER PROFESSIONALS OFFERING SERVICES INCLUDE CASE MANAGERS, SOCIAL WORKERS, DIETITIANS, SCHOOL PSYCHOLOGISTS, BEHAVIOR ANALYSTS, AND BEHAVIOR THERAPISTS. LIFESCAPE EMPLOYS 11 BOARD CERTIFIED BEHAVIOR ANALYSTS (8 MASTER'S LEVEL; 3 DOCTORAL LEVEL). AVERAGE DAILY CENSUS FOR FY21 WAS 11.0 FOR SPECIALTY HOSPITAL, 51.6 FOR RESIDENTIAL, AND 60.42 FOR DAY PROGRAMS. THE EXTENDED SCHOOL YEAR (ESY) PROGRAM OFFERS SUMMER SCHOOL FOR CHILDREN WHO NEED YEAR-ROUND SCHOOLING, BUT WHOSE SCHOOL DISTRICTS DO NOT OFFER THAT SERVICE. THROUGH ITS VARIOUS SERVICES, CCHS SERVED 63 SOUTH DAKOTA SCHOOL DISTRICTS, AS WELL AS MANY SCHOOL DISTRICTS FROM NEIGHBORING STATES IN FY21. 27124278 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 33 0 1 712 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 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 JASON HARRIS CHAIR 1.00 2.50 X X 0 0 0 LARRY FENTON VICE CHAIR 1.00 2.00 X X 0 0 0 JACK HOPKINS TREASURER 1.00 2.00 X X 0 0 0 MARLI SCHIPPERS SECRETARY 1.00 2.00 X X 0 0 0 GAYLE VER HEY IMMEDIATE PAST CHAIR (UNTIL 12/2020) 1.00 2.50 X X 0 0 0 JOHN ROZELL MEMBER-AT-LARGE 1.00 2.00 X X 0 0 0 BOB MCNANEY DIRECTOR (JAN - JUNE 21) 1.00 2.00 X 0 0 0 P DANIEL DONOHUE DIRECTOR 1.00 2.00 X 0 0 0 JOE HENKIN DIRECTOR (UNTIL 12/2020) 1.00 2.00 X 0 0 0 MOLLY MCCARTHY DIRECTOR 1.00 2.00 X 0 0 0 JON SODERHOLM DIRECTOR 1.00 2.00 X 0 0 0 MARK STERNHAGEN DIRECTOR 1.00 2.00 X 0 0 0 AMY PREATOR DIRECTOR 1.00 2.00 X 0 0 0 TERRI GRABLANDER DIRECTOR (UNTIL 12/2020) 1.00 2.00 X 0 0 0 PATTY PETERS DIRECTOR 1.00 2.00 X 0 0 0 JEFF NELSON DIRECTOR (UNTIL 12/2020) 1.00 0.50 X 0 0 0 NAN BAKER DIRECTOR/FOUNDATION CHAIR 1.00 1.50 X 0 0 0 DR JOSH PAULI DIRECTOR 1.00 2.00 X 0 0 0 JAY SOUKUP DIRECTOR (BEG 01/2021) 1.00 2.00 X 0 0 0 KIMBERLY NOONEY DIRECTOR (BEG 02/2021) 1.00 2.00 X 0 0 0 TYLER HAAHR FOUNDATION CHAIR 1.00 2.00 X 0 0 0 STEVEN WATKINS CEO 23.00 27.00 X 0 283909 29223 STEVE WILSON CFO 22.00 28.00 X 0 176260 25454 KRISTIN TUTTLE VP OF MED. & THERAPY SERVICES 40.00 0.00 X 134688 0 9789 VICKI ISLER PRINCIPAL DIR. OF ED. AND RES. SERVICES 40.00 0.00 X 112981 0 9958 247669 460169 74424 2 0 1 0 LIFESCAPE 2501 W 26TH STREET SIOUX FALLS SD 57105 SHARED SERVICES 2026196 SANFORD USD MEDICAL CENTER PO BOX 5064 SIOUX FALLS SD 571175064 RESP. THERAPY; IT SVCS 470943 SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND ST SIOUX FALLS SD 57117 PHYSICIAN SERVICES 221908 3 556429 3373910 5805 3936144 PATIENT/RESIDENT FEES 623000 32077772 32077772 OTHER SERVICE REVENUE 900099 207531 207531 32285303 125246 125246 52472 0 52472 52472 52472 -18321 -101021 18321 101021 119342 119342 1461 1485 -24 -24 INSURANCE PROCEEDS 900099 94605 94605 94605 36613088 32285303 0 391641 X 145261 145261 18026964 16993082 1033882 408047 378971 29076 3474835 2980904 493931 1401847 1317936 83911 12585 12585 64186 64186 16045 16045 3285099 1039033 2246066 88815 3128 85687 388510 170826 217684 4047 4047 1354250 916865 437385 33472 26577 6895 34938 17694 17244 146637 64 146573 909489 863254 46235 250713 214146 36567 OTHER SUPPLIES 1483804 1315033 168771 MAINTENANCE AND REPAIR 405951 202718 203233 DUES AND SUBSCRIPTIONS 232357 83586 148771 600833 584416 16417 32768685 27124278 5644407 0 X 1785086 3675428 6484096 6036384 28406 28532 26892 2015531 30240173 23349928 7454573 6890245 3703063 7587603 67833 63550 9600851 9607148 29150800 35904421 1941628 2431904 4658603 4211371 1979896 59507 89094 6659738 8712265 X 22250933 26884529 240129 307627 22491062 27192156 29150800 35904421 X 3844403 791519 65172 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 196 0 0 1 15849 0 0 16045 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 20577498 16694018 3883480 6999388 6085823 913565 1572291 570087 1002204 6890245 INTERCOMPANY RECEIVABLE 9214212 INVESTMENT IN DAKOTA TRUCK UNDERWRI 392936 9607148 ASSETS HELD IN TRUST 89094 89094 X 37431366 791519 65172 856691 36574675 38413 38413 36613088 32730217 0 32730217 38468 38468 32768685 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 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 65,172. PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 838. BANK FEES RECLASSIFIED FOR 990 37,575. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 893. BANK FEES RECLASSIFIED FOR 990 37,575. 1 1 X 1 X 1 X 175.000000000000 1 0 0 20590529 20363380 227149 0.00690 20590529 20363380 227149 0.00690 20590529 20363380 227149 0.00690 1 120000 54992 125285 -70293 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 18 1 0 0 1 X SEE 7D X X 1 18 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: A GROUP OF COMMUNITY STAKEHOLDERS WITH A WIDE RANGE OF BACKGROUNDS WERE IDENTIFIED WHICH INCLUDED PARENTS, CAREGIVERS, COMMUNITY HEALTH CLINICS/CENTERS, HEALTH & HUMAN SERVICES STATE AGENCIES, SCHOOLS, STATE PROGRAMS, PARENT RESOURCE CENTERS, PHYSICIANS, STAFF, AS WELL AS OTHER AGENCIES WITH KNOWLEDGE OF COMMUNITY HEALTH NEEDS. THESE STAKEHOLDERS WERE SURVEYED OR INTERVIEWED TO GATHER INFORMATION AND OPINIONS REPRESENTING THE BROAD INTEREST OF THE COMMUNITY SERVED WHICH DIRECTLY LEAD TO THE OUTCOME OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 7D: HTTPS://WWW.LIFESCAPESD.ORG/ABOUTTHE IMPLEMENTATION STRATEGY CAN BE FOUND ON PAGE 15 OF THE CHNA REPORT. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 11: PRIORITY 1: THERE IS A LACK OF MENTAL HEALTH SERVICES AND PROVIDERS IN OUR SERVICE AREA. -UNFORTUNATELY, WE WILL BE LOSING 2 OF OUR PSYCHOLOGISTS. WE HAVE WORKED WITH THE FOUNDATION TO INCREASE OUR SIGN ON BONUS TO $15,000 WITH A 3 YEAR STAY AGREEMENT. WE ARE WORKING CLOSELY WITH MARKETING AND THE RECRUITING TEAM TO INCREASE AWARENESS OF OUR PSYCHOLOGY POSITIONS. -WE MET WITH DR. ERMER, PEDIATRIC PSYCHIATRIST, TO DISCUSS WAYS TO HELP MEET THE COMMUNITY PEDIATRIC MENTAL HEALTH NEEDS. PRIORITY #2: THERE IS A LACK OF PARENT TRAINING AND EDUCATION IN OUR SERVICE AREA. -OUR ON-LINE TRAINING FORMAT HAS BEEN FULLY DEVELOPED. WE ARE WORKING ON INCREASING THE NUMBER OF SHORT PARENT TRAININGS PRIOR TO GOING LIVE ON OUR WEBSITE. ESTIMATED IMPLEMENTATION DATE: SUMMER 2022. -DIRECTORY OF SERVICES HAS BEEN PRODUCED AND DISTRIBUTED TO PROVIDERS IN AND AROUND THE STATE OF SOUTH DAKOTA. THE DIRECTORY FOCUSES ON OUTPATIENT THERAPY, RISE CUSTOM SOLUTIONS, AND OUR SPECIALTY HOSPITAL. WE ARE BEGINNING TO MEET WITH PROVIDERS IN THEIR CLINIC TO REVIEW DIRECTORY OF SERVICES. -WE HAVE SECURED 2 GRANTS THAT WILL ASSIST WITH PARENT TRAINING AND PARENT NETWORKING. WORK HAS BEGUN ON THESE GRANTS WITH ESTIMATED COMPLETION DATES BY END OF THE YEAR 2022. PRIORITY # 3: THERE IS A LACK OF COORDINATION OF CONNECTING FAMILIES TO RESOURCES IN OUR SERVICE AREA. -A NEW FAMILY HANDBOOK FOR THE SPECIALTY HOSPITAL HAS BEEN DEVELOPED AND IS BEING DISTRIBUTED TO FAMILIES WE SERVE. IT PROVIDES COMMUNITY RESOURCES FOR THEM TO ACCESS. -WE HAVE BEGUN UTILIZING OUR HOSPITAL SOCIAL WORKER IN OUR OUTPATIENT AUTISM EVALUATIONS. THIS ALLOWS OUR SOCIAL WORKER TO WORK WITH FAMILIES AND HELP OFFER SUGGESTED RESOURCES WHEN APPROPRIATE. 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 20E: LIFESCAPE WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING ECAS TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL BY DOING THE FOLLOWING:1. PROVIDE WRITTEN NOTICE TO THE INDIVIDUAL INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS, INDICATING THAT LIFESCAPE INTENDS TO INITIATE OR HAVE A THIRD-PARTY INITIATE TO OBTAIN PAYMENT FOR CARE, AND PROVIDE A DEADLINE AFTER WHICH ECAS MAY BE PURSUED AND WHICH IS NO LATER THAN 30 DAYS AFTER THE DATE OF WRITTEN NOTICE;2. PROVIDE THE INDIVIDUAL A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THIS WRITTEN NOTICE; AND3. MAKE REASONABLE EFFORTS TO ORALLY NOTIFY INDIVIDUALS ABOUT THE FINANCIAL ASSISTANCE POLICY.ECAS FOR HOSPITAL SERVICES WILL NOT COMMENCE FOR A PERIOD OF 120 DAYS AFTER THE DATE OF FIRST POST-DISCHARGE BILLING STATEMENT FOR THE APPLICABLE MEDICALLY NECESSARY OR EMERGENCY MEDICAL CARE. 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 14-15. 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 2,600 CHILDREN AND THEIR FAMILIES IN 60 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.- 371 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 283393 0 0 0 516 0 5394 0 24258 0 313561 0 0 STEVE WILSON CFO 0 175744 0 0 0 516 0 3572 0 22312 0 202144 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 1761456 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 VI, SECTION A, LINE 1 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, GAYLE VER HEY, JOHN ROZELL, JACK HOPKINS, JASON HARRIS, P. DANIEL DONOHUE, JOE HENKIN, MOLLY MCCARTHY, JON SODERHOLM, LARRY FENTON, MARK STERNHAGEN, TERRI GRABLANDER, MARLI SCHIPPERS, JOSH PAULI, NAN BAKER, AMY PREATOR, BOB MCNANEY, JEFF NELSON, JAY SOUKUP, KIMBERLY NOONEY, AND TYLER HAAHR. 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 IX, LINE 11G RMS - PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 41,286. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,286. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 970,709. MANAGEMENT AND GENERAL EXPENSES 133,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,104,191. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 27,038. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,038. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,087,829. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,087,829. OUTSIDE SPEAKER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,160. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,160. OUTSIDE TRAINING SESSION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,595. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,595. 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 65,172. 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 2353226 1935134 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 1841842 FMV