2020-05-05T13:31:57-05:00 2019-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2018-07-01 460233030 CHILDREN'S CARE HOSPITAL AND SCHOOL CHIL 6054449500 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 STEVE WILSON CFO 6054449500 2020-05-04 1 LAURIE HANSON P00851848 6053391999 2020-05-04 67.130.171.59 2020-05-04 15:20:55 CD P C5ADF3E96DC5FD5E5884512D59AB882B10EDFEC1 F7BA031C655DF5D2BE7843B8A6CBF62E51E7FB61 2018 2020-09-23 17:36:50Z LIFESCAPE STEVE WATKINS 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 31437234 0 X WWW.LIFESCAPESD.ORG X 1952 SD WE EMPOWER CHILDREN AND ADULTS WITH DISABILITIES TO LEAD FULFILLING LIVES. 19 18 703 1750 0 0 592292 729498 27752454 30413036 234145 214644 65331 74934 28644222 31432112 14200 18005 0 0 18884957 20176451 0 0 0 8431799 8941035 27330956 29135491 1313266 2296621 25119382 27789126 7215911 7407836 17903471 20381290 X WE EMPOWER CHILDREN AND ADULTS WITH DISABILITIES TO LEAD FULFILLING LIVES. 0 0 23868348 18005 30413036 CHILDREN'S CARE PROVIDED SERVICES FOR OVER 2700 INDIVIDUALS WITH SPECIAL NEEDS IN ALL OF ITS PROGRAMS LAST FISCAL YEAR.CCHS OUTPATIENT/OUTREACH SERVICES (COMMUNITY-BASED SERVICES) SERVED 2541 PEOPLE, 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) ARE THE MAIN SERVICES OFFERED AT THESE SITES, PLUS ASSISTIVE TECHNOLOGY, SEATING & POSITIONING, AND POWERED MOBILITY SERVICES. OTHER SERVICES: WHEELCHAIR SEATING & POSITIONING EVALUATIONS; ADAPTIVE AQUATICS (SIOUX FALLS ONLY); AND SUMMER SKILLS "CAMPS" FOR CHILDREN WITH SPECIAL NEEDS. 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. IN MAY 2019, LIFESCAPE OPENED A SECOND OUTPATIENT CLINIC IN SIOUX FALLS, AUTISM & CHILD DEVELOPMENT CENTER AT LIFESCAPE. ALL OUTPATIENT BEHAVIORAL SERVICES ARE PROVIDED HERE, AS WELL AS OTHER THERAPIES. ABA SERVICES WERE ALSO ADDED IN RAPID CITY IN FY19. OUTREACH PROVIDES SERVICES TO CHILDREN IN THEIR OWN ENVIRONMENT-THEIR HOME, SCHOOL, OR DAYCARE CENTER. PROFESSIONALS FROM SIOUX FALLS AND RAPID CITY DROVE OVER 200,000 MILES DURING THE FISCAL YEAR ACROSS SOUTH DAKOTA PROVIDING SERVICES TO CHILDREN, INCLUDING PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND CONSULTATION IN SCHOOL PSYCHOLOGY AND SPECIAL EDUCATION.RESIDENTIAL, INPATIENT AND DAY PROGRAMS IN SIOUX FALLS, SD SERVED 168 CHILDREN. CHILDREN WERE MOSTLY FROM SOUTH DAKOTA, WITH CHILDREN FROM MINNESOTA, IOWA, NEBRASKA, AND NORTH DAKOTA 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 FIVE BOARD CERTIFIED BEHAVIOR ANALYSTS. AVERAGE DAILY CENSUS FOR FY19 WAS 7.5 FOR SPECIALTY HOSPITAL, 56.8 FOR RESIDENTIAL, AND 71.5 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. 23868348 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 39 0 1 703 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 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 GAYLE VER HEY CHAIR 1.00 2.50 X X 0 0 0 JASON HARRIS VICE CHAIR 1.00 2.00 X X 0 0 0 JON SODERHOLM TREASURER 1.00 2.00 X X 0 0 0 MARLI SCHIPPERS SECRETARY 1.00 2.00 X X 0 0 0 DR PATTY PETERS IMMEDIATE PAST CHAIR 1.00 2.50 X X 0 0 0 JOHN ROZELL MEMBER-AT-LARGE 1.00 2.00 X X 0 0 0 ANNE RIECK MCFARLAND CEO UNTIL 01/04/2019 23.00 27.00 X X 0 219177 12582 STEVEN WATKINS CEO FROM 10/15/2018 23.00 27.00 X X 0 52133 1752 JACK HOPKINS DIRECTOR 1.00 2.00 X 0 0 0 P DANIEL DONOHUE DIRECTOR 1.00 2.00 X 0 0 0 JOE HENKIN DIRECTOR 1.00 2.00 X 0 0 0 MOLLY MCCARTHY DIRECTOR 1.00 2.00 X 0 0 0 DR LARRY FENTON DIRECTOR 1.00 2.00 X 0 0 0 MARK STERNHAGEN DIRECTOR 1.00 2.00 X 0 0 0 CLAUDIA VUCUREVICH DIRECTOR 1.00 2.00 X 0 0 0 TERRI GRABLANDER DIRECTOR 1.00 2.00 X 0 0 0 CURT HOHMAN DIRECTOR UNTIL 12/2018 0.50 0.50 X 0 0 0 JEFF NELSON DIRECTOR/PAST FOUNDATION CHAIR 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 FROM 01/2019 1.00 2.00 X 0 0 0 JEFF HAZARD DIRECTOR 1.00 2.00 X 0 0 0 STEVE WILSON CFO 22.00 28.00 X 0 162784 25187 VICKI ISLER DIR. OF ED. AND RES. SERVICES 40.00 0.00 X 102064 0 13100 102064 434094 52621 1 0 1 0 LIFESCAPE 2501 W 26TH STREET SIOUX FALLS SD 57105 SHARED SERVICES 1906810 SANFORD USD MEDICAL CENTER PO BOX 5064 SIOUX FALLS SD 571175074 RESP. THERAPY; IT SVCS 469948 SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND ST SIOUX FALLS SD 57117 PHYSICIAN SERVICES 208211 3 671269 15340 42889 729498 PATIENT/RESIDENT FEES 623000 30213809 30213809 OTHER SERVICE REVENUE 900099 199227 199227 30413036 183575 183575 60254 0 60254 60254 60254 24907 6162 0 0 24907 6162 31069 31069 19802 5122 14680 14680 31432112 30413036 0 289578 X 18005 18005 16556869 15710641 846228 309495 302831 6664 2103490 1724565 378925 1206597 1146008 60589 12310 12310 75141 75141 3097177 700421 2396756 94810 8372 86438 454639 325455 129184 5566 5566 974526 506027 468499 51179 42781 8398 101189 51397 49792 160881 182 160699 1048589 979255 69334 223392 203031 20361 OTHER SUPPLIES 1398854 1191803 207051 MAINTENANCE AND REPAIR 386150 172039 214111 BAD DEBTS 114000 114000 DUES AND SUBSCRIPTIONS 90412 51349 39063 652220 620186 32034 29135491 23868348 5267143 0 641087 1119067 5598655 6248890 23337 23900 24967 29126 29693230 21596675 7969232 8096555 3562123 3672155 87275 73228 7212706 8526205 25119382 27789126 1644611 2271212 5000 9208 5528068 5100835 38232 26581 7215911 7407836 X 17721389 20156319 165311 208200 16771 16771 17903471 20381290 25119382 27789126 X 2296621 104651 76547 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 39 0 0 1 5337 0 0 5376 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. 430216 430216 20565391 15435415 5129976 6784492 5907471 877021 1913131 253789 1659342 8096555 INVESTMENT IN DAKOTA TRUCK UNDERWRITERS 322622 INTERCOMPANY RECEIVABLE 8203583 8526205 ASSETS HELD IN TRUST 26581 26581 X PART X, LINE 2: CHILDREN'S CARE HOSPITAL AND SCHOOL IS ORGANIZED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. THE ORGANIZATION HAS DETERMINED THAT IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND IS NOT REQUIRED TO FILE AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. 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. AUTUMN NIGHT 16925 16925 2865 16925 16925 2865 2865 14060 1 1 X 1 X 1 X 175.000000000000 1 0 0 17576614 17652524 0 0.00000 17576614 17652524 0 0.00000 0 17576614 17652524 0 0.00000 0 114000 0 54427 101677 -47250 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 1 1 X 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 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: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE TAX YEAR AND AS SUCH THE HOSPITAL HAS NOT TAKEN SPECIFIC ACTIONS WITH RESPECT TO THE CURRENT IMPLEMENTATION STRATEGY. THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE IDENTIFIED AND THE FOLLOWING ACTIONS WILL BE TAKEN BY THE HOSPITAL DURING FUTURE YEARS.PRIORITY 1: THERE IS A LACK OF MENTAL HEALTH SERVICES AND PROVIDERS IN OUR SERVICE AREA. A PSYCHOLOGIST TRAINED IN PARENT-CHILD INTERACTION THERAPY WILL CONTINUE TO PROVIDE MENTAL HEALTH SERVICES. WE ARE PUTTING A FLYER TOGETHER FOR MENTAL HEALTH REFERRAL SOURCES. PRIORITY 2: THERE IS A LACK OF PARENT TRAINING AND EDUCATION IN OUR SERVICE AREA. THE TRAINING DEPARTMENT WILL COLLECT INFORMATION FROM OUR STAFF ON AREAS OF EXPERTISE SO THAT WE HAVE AN INVENTORY OF TOPIC AREAS TO DRAW FROM FOR STAFF AND PARENT TRAININGS. THE THERAPY DEPARTMENT HAS DEVELOPED A MENTORSHIP PROGRAM TO ASSIST WITH STAFF DEVELOPMENT AND GROWTH.THE THERAPY DEPARTMENTS HAVE INITIATED TRAINING COURSES THAT WILL BE HELD MONTHLY ON VARIOUS TOPICS TO ASSIST WITH TRAINING ACROSS ALL THERAPY SERVICE AREAS. RAPID CITY AND SIOUX CITY ARE ABLE TO ATTEND TRAINING ONLINE. PRIORITY 3: THERE IS A LACK OF COORDINATION OF CONNECTING FAMILIES TO RESOURCES IN OUR SERVICE AREA. THE REHAB TEAM IS RESEARCHING AND DEVELOPING RESOURCES FOR FAMILIES TO ACCESS. WE CONTINUE TO LOOK AT WAYS TO HOUSE THE INFORMATION SO THAT IT IS EASILY ACCESSIBLE TO FAMILIES. THIS IS PART OF OUR CARF ACCREDITATION PROCESS. THE GOAL IS TO HAVE THIS PROJECT DEVELOPED AND IMPLEMENTED BY THE END OF APRIL, 2020.MANY OF THESE ACTIVITIES ARE CONTINUATIONS OF ACTIVITIES THE HOSPITAL HAS BEEN CONDUCTING RELATED TO THE PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT. 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 15E: THE FINANCIAL ASSISTANCE POLICY STATES NOTIFICATION ABOUT CHARITY CARE AVAILABLE FROM CCHS SHALL INCLUDE A CONTACT NUMBER AND WILL BE DISSEMINATED BY VARIOUS MEANS, INCLUDING BUT NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND IN THE BUSINESS OFFICE. 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. 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 OUTREACH. THE COST IS CALCULATED BY MULTIPLYING THE MEDICAID CHARGES TIMES THE COST-TO-CHARGE RATIO, AS DETERMINED THROUGH USE OF THE GENERAL LEDGER. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $114,000 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: OUR COMMUNITY BUILDING EVENTS HELPED BRING AWARENESS TO THERAPY RESOURCES AVAILABLE IN THE COMMUNITY THAT FAMILIES CAN ACCESS. EDUCATING FAMILIES ON RESOURCES FOR THE CHILDREN IS AN IMPORTANT ASPECT IN THE COMMUNITY. THE EARLIER THERAPIES ARE ACCESSED THE BETTER THE OUTCOME. PART III, LINE 2: PAYMENTS ON ACCOUNTS THAT ARE WRITTEN OFF ARE NORMALLY MADE DIRECTLY TO THE COLLECTION AGENCY. IN THE RARE EVENT THAT A PAYMENT IS RECEIVED DIRECTLY BY CCHS, CCHS NOTIFIES THE COLLECTION AGENCY OF ITS RECEIPT OF THE PAYMENT SO THE PATIENT'S ACCOUNT BALANCE CAN BE ADJUSTED. 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 THE BAD DEBT EXPENSE IS AT NOTE 1 PAGE 10. 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. PART VI, LINE 4: CCHS SERVES APPROXIMATELY 2,700 CHILDREN AND THEIR FAMILIES IN 60 COUNTIES THROUGHOUT SOUTH DAKOTA EVERY YEAR. ADDITIONAL CHILDREN AND FAMILIES ARE SERVED THROUGHOUT NORTHWEST IOWA, SOUTHWEST MINNESOTA, NEBRASKA, AND WYOMING. 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.- 1750 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. 1 LIFESCAPE FOUNDATION 2501 WEST 26TH STREET SIOUX FALLS SD 57105 460353254 501(C)(3) 18005 GENERAL ASSISTANCE 1 PART I, LINE 2: LIFESCAPE AMBASSADORS, AN AUXILIARY ORGANIZATION OPERATING UNDER THE FEDERAL TAX IDENTIFICATION NUMBER OF CHILDREN'S CARE HOSPITAL AND SCHOOL, RAISES FUNDS FOR THE BENEFIT OF THE PARENT, LIFESCAPE, AND IT'S RELATED ENTITIES. 0 0 0 0 0 0 0 0 0 ANNE RIECK MCFARLAND CEO UNTIL 01/04/2019 0 218385 0 0 0 792 0 3928 0 9085 0 232190 0 0 STEVE WILSON CFO 0 162268 0 0 0 516 0 2668 0 22950 0 188402 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 936456 5736456 106780 597971 5031805 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 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 ANNE MCFARLAND HAS A BUSINESS RELATIONSHIP WITH PATTY PETERS, GAYLE VER HEY, JOHN ROZELL, JEFF HAZARD, JACK HOPKINS, JASON HARRIS, P. DANIEL DONOHUE, JOE HENKIN, MOLLY MCCARTHY, JON SODERHOLM, LARRY FENTON, MARK STERNHAGEN, CLAUDIA VUCUREVICH, TERRI GRABLANDER, MARLI SCHIPPERS, CURT HOHMAN, NAN BAKER AND JEFF NELSON. THE BUSINESS RELATIONSHIP EXISTS BECAUSE ANNE MCFARLAND WAS PAID BY LIFESCAPE FROM 7/1/18 THROUGH 01/2019. PERSONS LISTED AS HAVING A BUSINESS RELATIONSHIP WITH HER SERVE ON THE BOARD OF LIFESCAPE. STEVE WATKINS, THE NEW CEO FROM 10/2018, HAS A BUSINESS RELATIONSHIP WITH PATTY PETERS, GAYLE VER HEY, JOHN ROZELL, JEFF HAZARD, JACK HOPKINS, JASON HARRIS, P. DANIEL DONOHUE, JOE HENKIN, MOLLY MCCARTHY, JON SODERHOLM, LARRY FENTON, MARK STERNHAGEN, CLAUDIA VUCUREVICH, TERRI GRABLANDER, MARLI SCHIPPERS, CURT HOHMAN, NAN BAKER AND JEFF NELSON. 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. 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 40,180. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,180. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 650,314. MANAGEMENT AND GENERAL EXPENSES 380,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,030,754. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 9,927. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,927. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,056. OUTSIDE SPEAKER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,058. OUTSIDE TRAINING SESSION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,207. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,207. SHARED SERVICE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,985,995. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,985,995. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS 76,547. 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 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 -12472 1781283 1.00000 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 REHABILITATION MEDICAL SUPPLY Q 1867408 FMV