2018-05-14T12:17:52-05:00 2017-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-07-01 460233030 CHILDREN'S CARE HOSPITAL AND SCHOOL CHIL 6054449500 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 STEVE WILSON CFO 6054449500 2018-05-11 1 LAURIE HANSON P00851848 6053391999 2018-05-11 2016 2022-09-23 18:48:47Z LIFESCAPE ANNE RIECK MCFARLAND 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 26643979 0 X WWW.LIFESCAPESD.ORG X 1952 SD WE EMPOWER CHILDREN AND ADULTS WITH DISABILITIES TO LEAD FULFILLING LIVES. 18 17 619 1524 0 0 2262134 682579 24214472 25664855 153498 175492 139375 103393 26769479 26626319 0 65942 0 0 16623049 17737881 0 0 0 8067096 8170487 24690145 25974310 2079334 652009 24233203 24391435 6340229 7766580 17892974 16624855 X WE EMPOWER CHILDREN AND ADULTS WITH DISABILITIES TO LEAD FULFILLING LIVES. 0 0 21524598 65942 25664855 CHILDREN'S CARE PROVIDED SERVICES FOR AN ESTIMATED 2500 INDIVIDUALS WITH SPECIAL NEEDS IN ALL OF ITS PROGRAMS LAST FISCAL YEAR.CCHS OUTPATIENT/OUTREACH SERVICES (COMMUNITY-BASED SERVICES) SERVED 2449-THE MAJORITY CHILDREN. SERVICES ARE DELIVERED FROM CENTERS IN SIOUX FALLS AND RAPID CITY. 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 ARE OFFERED IN SIOUX FALLS AND RAPID CITY AS AN OUTPATIENT SERVICE, AND FULL AUTISM EVALUATIONS ARE PROVIDED BY OUR MULTIDISCIPLINARY AUTISM EVALUATION TEAM, LED BY A PEDIATRIC PSYCHIATRIST. 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. PROFESSIONALS FROM SIOUX FALLS AND RAPID CITY DROVE OVER 220,000 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.LIFESCAPE ABLEKIDS IN SIOUX CITY (ACQUIRED AUGUST 1, 2016) PROVIDES OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND SPEECH-LANGUAGE THERAPY FOR CHILDREN IN THE SIOUX CITY AREA. A MONTHLY ORTHOTICS CLINIC FOR CHILDREN AND ADULTS, WITH STAFF FROM SIOUX FALLS, IS ALSO HELD AT THE ABLEKIDS SITE. DIAGNOSES TREATED INCLUDE DEVELOPMENTAL DELAYS AND DISABILITIES; ORTHOPEDIC AND NEUROLOGICAL CONDITIONS; AUTISM SPECTRUM DISORDERS; PEDIATRIC INCONTINENCE OF BOWEL AND/OR BLADDER (OVER AGE 4); SENSORY PROCESSING DISORDERS; TORTICOLLIS AND PLAGIOCEPHALY; AND FEEDING AND SWALLOWING DIFFICULTIES, INCLUDING PICKY EATERS.RESIDENTIAL, INPATIENT AND DAY PROGRAMS IN SIOUX FALLS, SD SERVED 152 CHILDREN. CHILDREN WERE MOSTLY FROM SOUTH DAKOTA, WITH CHILDREN FROM MINNESOTA, IOWA, AND ALASKA 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 2016-2017 WAS 9.0 FOR SPECIALTY HOSPITAL, 49.8 FOR RESIDENTIAL, AND 41.3 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. 21524598 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 1 0 0 1 43 0 1 619 1 0 0 0 0 0 0 0 0 0 0 X 18 17 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X STEVE WILSON 6054449800 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 DR PATTY PETERS CHAIR 1.00 2.50 X X 0 0 0 GAYLE VER HEY VICE CHAIR 1.00 2.00 X X 0 0 0 JOHN ROZELL TREASURER 1.00 2.00 X X 0 0 0 JEFF HAZARD SECRETARY 1.00 2.00 X X 0 0 0 JACK HOPKINS IMMEDIATE PAST CHAIR 1.00 2.50 X X 0 0 0 JASON HARRIS MEMBER-AT-LARGE 1.00 2.00 X X 0 0 0 ANNE RIECK MCFARLAND CEO 23.00 27.00 X X 0 211387 12192 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 JON SODERHOLM 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 MARLI SCHIPPERS BEG 012017 DIRECTOR 1.00 2.00 X 0 0 0 CURT HOHMAN DIRECTOR/FOUNDATION PAST CHAIR 1.00 2.50 X 0 0 0 JEFF NELSON DIRECTOR/CURRENT FOUNDATION CHAIR 1.00 2.50 X 0 0 0 BRANDI KOWALCZYK CFO (UNTIL 11/2016) 21.00 29.00 X 0 102354 14028 STEVE WILSON CFO (BEG 01/2017) 22.00 28.00 X 0 0 0 0 313741 26220 0 0 1 0 LIFESCAPE 2501 W 26TH STREET SIOUX FALLS SD 57105 SHARED SERVICES 1762349 SANFORD USD MEDICAL CENTER PO BOX 5074 SIOUX FALLS SD 571175074 RESP. THERAPY; IT SVCS 393234 JOHNSON CONTROLS PO BOX 730068 DALLAS TX 75373 TECHNOLOGY SERVICES 240626 SANFORD CHILDREN'S SPECIALTY CLINIC PO BOX 5039 SIOUX FALLS SD 571175039 PHYSICIAN SERVICES 216721 4 82316 556608 28580 15075 682579 PATIENT/RESIDENT FEES 623000 25373699 25373699 OTHER SERVICE REVENUE 900099 291156 291156 25664855 185352 185352 105893 0 105893 105893 105893 9860 -9860 -9860 -9860 5300 82316 7800 -2500 -2500 26626319 25664855 0 278885 65892 65892 50 50 14521277 13666601 854676 251704 242294 9410 1910275 1664155 246120 1054625 1042969 11656 1982061 1982061 4409 4409 51654 51654 23623 23623 1069007 714785 354222 82765 6020 76745 268808 161613 107195 4100 4100 765179 726734 38445 75782 71517 4265 65558 28929 36629 287989 287989 1142591 1142591 213373 213373 OTHER SUPPLIES 1130109 1079644 50465 MAINTENANCE AND REPAIR 281897 239329 42568 BAD DEBTS 110400 110400 DUES AND SUBSCRIPTIONS 59827 23098 36729 551355 537977 13378 25974310 21524598 4449712 0 90921 65942 652 24327 737041 30588 5594021 6013657 19194 30808 14705 24122 28783863 20510518 8787294 8273345 4232368 4346256 100608 4848580 5572051 24233203 24391435 -102771 1735537 6370000 6009026 73000 22017 6340229 7766580 X 17614162 16425337 262041 182746 16771 16772 17892974 16624855 24233203 24391435 X 652009 222234 -241883 -1900479 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 126 0 1 1 23623 0 0 23749 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 21197677 14630771 6566906 6703912 5645907 1058005 452058 233840 218218 8273345 INVESTMENT IN DAKOTA TRUCK UNDERWRITERS 171921 INTERCOMPANY RECEIVABLE 5400130 5572051 ASSETS HELD IN TRUST 22017 22017 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). IT IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. CHILDREN'S CARE HOSPITAL AND SCHOOL HAS DETERMINED THAT IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED 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. MALL WALK 87616 82316 5300 5300 2500 87616 82316 5300 5300 2500 7800 -2500 1 1 X 1 X 1 X 175.000000000000 1 0 0 15344873 14636223 708650 0.02740 15344873 14636223 708650 0.02740 15344873 14636223 708650 0.02740 0 110400 0 26660 67376 -40716 X 1 1 1 1 CHILDREN'S CARE HOSPITAL & SCHOOL 2501 W 26TH ST 1020 W 18TH ST 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 15 1 0 0 1 X SEE 7D X X 1 15 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/BILLING_COLLECTIONS_FINANCIAL_ASSISTANCE X HTTPS://WWW.LIFESCAPESD.ORG/BILLING_COLLECTIONS_FINANCIAL_ASSISTANCE X HTTPS://WWW.LIFESCAPESD.ORG/BILLING_COLLECTIONS_FINANCIAL_ASSISTANCE X X X X 1 X 0 X X X X X 1 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 COMMUNITY SUPPORT PROVIDERS, COMMUNITY HEALTH CLINICS/CENTERS, INDIAN HEALTH SERVICES, PARENTS, HEALTH & HUMAN SERVICES STATE AGENCIES, PARENT RESOURCE CENTERS, PHYSICIANS, AS WELL AS OTHER AGENCIES WITH KNOWLEDGE OF COMMUNITY HEALTH NEEDS. THESE STAKEHOLDERS WERE 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/COMMUNITY-HEALTH-NEEDS-ASSESMENTTHE IMPLEMENTATION STRATEGY CAN BE FOUND ON PAGE 26 OF THE CHNA REPORT. CHILDREN'S CARE HOSPITAL & SCHOOL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED TWO KEY PRIORITY AREAS OF NEED:1) LACK OF MENTAL HEALTH SERVICES AND PROVIDERS-OUR PSYCHOLOGY DEPARTMENT HAS INCREASED TO 2 FTE'S. WE ARE WORKING TO HIRE ANOTHER PSYCHOLOGIST TO HELP MEET THE NEEDS AT OUR OUTPATIENT CLINIC.-WE CONTINUE TO EDUCATE PROVIDERS, STAFF AND FAMILIES ON OUR PSYCHOLOGY SERVICES AS WELL AS GENERAL MENTAL HEALTH NEEDS.-WE HAVE IDENTIFIED PROGRAMS WHERE PSYCHOLOGY WOULD BE BENEFICIAL TO BE PART OF THE INTERDISCIPLINARY TEAM AND ARE WORKING ON HOW TO INCORPORATE THEM.-WE HAVE OPENED UP 2 ADDITIONAL AUTISM EVALUATION SLOTS AND CONTINUE TO WORK TOWARD ADDING ADDITIONAL TIMES.2) BARRIERS THAT IMPEDE ACCESS TO HEALTHCARE FOR NON-ENGLISH SPEAKING IMMIGRANTS. -WE MET WITH LUTHERAN SOCIAL SERVICES TO COLLABORATE ON HOW CCHS CAN HELP NON-ENGLISH SPEAKING REFUGEE IMMIGRANT FAMILIES REALIZE THE IMPORTANCE OF THERAPY SERVICES. WE WILL BE WORKING ON A TRAINING WITH THE STAFF OF LUTHERAN SOCIAL SERVICES IN THE NEAR FUTURE. WE WILL ALSO BE REACHING OUT TO A COMMUNITY HEALTH PROVIDER THAT SEES A HIGHER VOLUME OF REFUGEES WHO SPEAK MANY DIFFERENT LANGUAGES FOR ADDITIONAL GUIDANCE.-WE HAVE WORKED WITH AN ADDITIONAL TRANSLATOR SERVICE THAT DOES NOT BILL PATIENTS FOR APPOINTMENTS WHERE THE FAMILIES DID NOT SHOW. WE WILL ALSO BE LOOKING INTO A NEW TABLET TRANSLATION SERVICE.ADDITIONALLY, THERE WERE OTHER PRIORITIES IDENTIFIED THAT WE WILL NOT ADDRESS: 1) BROADEN GUIDELINES/INCREASE ACCESS TO LOW FEE/SLIDING SCALE SERVICES FOR PEOPLE IN POVERTY/WORKING POOR WHO ARE UNDERSERVED. AS A PROVIDER WITH LIMITED REIMBURSEMENT, WE ARE NOT ABLE TO IMPACT GUIDELINES FOR THESE SERVICES. 2) IMPROVE RESPONSIVENESS, TIMELINESS OF SERVICES ON INDIAN RESERVATIONS; INCREASE SERVICES FOR NATIVE AMERICANS WHO ARE UNDERSERVED; PROVIDE PRENATAL CARE TO NATIVE AMERICANS. LIFESCAPE SERVES MANY PEOPLE WHO ARE NATIVE AMERICAN THROUGH INPATIENT, OUTPATIENT AND OUTREACH SERVICES WITH OUTREACH SERVICES LIMITED TO SCHOOL BASED THERAPY ONLY. IT IS BEYOND OUR SCOPE TO PROVIDE MEDICAL SERVICES ON THE RESERVATIONS AND ALSO BEYOND OUR SCOPE TO PROVIDE PRENATAL CARE TO WOMEN. 3) INCREASE OUTREACH PROGRAMS INTO RURAL AREAS INCLUDING TELEMEDICINE. AS STATED, LIFESCAPE'S OUTREACH SERVICES ARE PRIMARILY SCHOOL-BASED. REIMBURSEMENT AND LICENSING REQUIREMENTS LIMIT EXPANSION OF OUTREACH EFFORTS. 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 PROVIDES 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 THEY HAVE CONFIRMED NO FAP 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 $110,400 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. 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 STATEMENTS THAT DESCRIBE THE BAD DEBT EXPENSE ARE ON NOTE 1 PAGE 8. 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 V, LINE 16I FINANCIAL ASSISTANCE POLICY DESCRIPTION OF FAILURETYPE OF FAILURE: 501(R)(4) - THE HOSPITAL IS REQUIRED TO TRANSLATE THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND FINANCIAL ASSISTANCE POLICY APPLICATION INTO SPANISH AS MORE THAN THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL SPEAKS SPANISH AS A PRIMARY LANGUAGE. THE HOSPITAL DID NOT TRANSLATE THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY OR FINANCIAL ASSISTANCE APPLICATION INTO SPANISH. CAUSE OF THE FAILURE: THE HOSPITAL FACILITY DID NOT REALIZE THE FAP, PLAIN LANGUAGE SUMMARY, AND APPLICATION WERE REQUIRED TO BE TRANSLATED. THE FACILITY USES AN INTERPRETER TELEPHONE SERVICE THAT ALLOWS FOR INTERPRETATION IN 200 LANGUAGES AND DIALECTS, INCLUDING SPANISH. THIS SERVICE CAN BE USED BY LIMITED ENGLISH PROFICIENCY (LEP) PATIENTS FOR QUESTIONS RELATED TO THE FINANCIAL ASSISTANCE POLICY.FACILITY OR FACILITIES WHERE THE FAILURE OCCURRED: THE FAILURE OCCURRED IN ALL FACILITIES OPERATED UNDER CHILDREN'S CARE HOSPITAL AND SCHOOL. THE DATE(S) OF THE FAILURE AND ITS DISCOVERY: MAY 4, 2018 THE NUMBER OF OCCURRENCES: UNKNOWNDESCRIPTION OF THE CORRECTION OF THE FAILUREMETHOD OF CORRECTION: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE IN THE PROCESS OF BEING TRANSLATED INTO SPANISH. THE DOCUMENTS WILL BE MADE AVAILABLE AT EACH FACILITY AND ON THE WEBSITE.DATE OF CORRECTION: NO LATER THAN MAY 31, 2018DESCRIPTION OF THE PRACTICES OR PROCEDURES PUT INTO PLACETHE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION WILL BE TRANSLATED INTO SPANISH AND POSTED ON THE WEBSITE AT HTTPS://WWW.LIFESCAPESD.ORG/BILLING_COLLECTIONS_FINANCIAL_ASSISTANCE. THE TRANSLATED DOCUMENTS WILL ALSO AVAILABLE AT EACH FACILITY. 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 2,500 CHILDREN AND THEIR FAMILIES IN 63 COUNTIES THROUGHOUT SOUTH DAKOTA EVERY YEAR. ADDITIONAL CHILDREN AND FAMILIES ARE SERVED THROUGHOUT NORTHWEST IOWA, SOUTHWEST MINNESOTA, NEBRASKA, WYOMING AND ALASKA. 68 SOUTH DAKOTA PUBLIC AND TRIBAL SCHOOL DISTRICTS ALSO RELY ON CCHS. CHILDREN FROM 14 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.- 1,524 VOLUNTEERS ASSISTED WITH ALL ASPECTS OF CCHS OPERATIONS. VOLUNTEERS ASSIST CCHS STAFF WITH ADMINISTRATIVE TASKS IN RECEPTION, FINANCE, 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) 65892 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 0 210120 0 0 0 1267 0 4265 0 8520 0 224172 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 460315509 83755VLQ5 2007-03-29 8705000 DEFEASANCE OF BONDS ISSUED NOVEMBER 1, 1999 0 0 0 A 2670000 8859230 640612 177184 8043636 2007 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/29/2013 SCHEDULE K, PART II THE DIFFERENCE BETWEEN THE TOTAL PROCEEDS OF ISSUE ON PART II LINE 3 AND THE ISSUE PRICE ON PART I LINE A COLUMN (E) OF $154,230 REPRESENTS THE NET ORIGINAL ISSUE PREMIUM ON THE 2007 BOND. SCHEDULE K, PART IV, LINE 7 MANAGEMENT IS AWARE OF THE PROVISIONS IN THE BOND DOCUMENTS FOR MONITORING ARBITRAGE, AND THE CFO MONITORS FOR COMPLIANCE. 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, P. DANIEL DONOHUE, JOE HENKIN, MOLLY MCCARTHY, JON SODERHOLM, LARRY FENTON, MARK STERNHAGEN, CLAUDIA VUCUREVICH, TERRI GRABLANDER, MARLI SCHIPPERS, CURT HOHMAN, AND JEFF NELSON. THE BUSINESS RELATIONSHIP EXISTS BECAUSE ANNE MCFARLAND WAS PAID BY LIFESCAPE FROM 7/1/16 THROUGH 6/30/17. PERSONS LISTED AS HAVING A BUSINESS RELATIONSHIP WITH HER 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 XI, LINE 9: INTERCOMPANY TRANSFERS -1,900,479. 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 2170940 1318426 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 2602458 FMV