2024-05-06T10:01:51-05:00 2023-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2022-07-01 460233030 CHILDREN'S CARE HOSPITAL AND SCHOOL CHIL 6054449500 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 STEVE WILSON CFO 6054449500 2024-05-06 1 STEVE WILSON 999009999 1 LAURIE HANSON CPA P00851848 6053391999 2024-05-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LIFESCAPE STEVE WATKINS 2501 WEST 26TH STREET SIOUX FALLS SD 571052498 41184099 0 X WWW.LIFESCAPESD.ORG X 1952 SD EMPOWERING PEOPLE TO LIVE THEIR BEST LIFE. 13 13 708 556 0 0 1388888 4480887 32792484 36233693 540990 258878 147915 40699 34870277 41014157 0 0 0 0 26354919 27205697 0 0 0 9981182 10386785 36336101 37592482 -1465824 3421675 31115902 35292129 7601995 7465120 23513907 27827009 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 0 31217553 36233693 CHILDREN'S CARE HOSPITAL & SCHOOL (CCHS) IS ADDITIVE TO THE FABRIC OF CARE IN SOUTH DAKOTA BY BEING THE SOLE PROVIDER OF SPECIFIC MEDICAID BASED SERVICES AND SUPPORTS FOR THE CHILDREN OF SOUTH DAKOTA.IN FISCAL YEAR 2023, CCHS PROVIDED SERVICES FOR OVER 2,880 INDIVIDUALS FROM 6 STATES, FROM BIRTH THROUGH AGE 21 WITH DISABILITIES OR REHABILITATION NEEDS IN ALL OF ITS PROGRAMS. IN SOUTH DAKOTA ALONE, MORE THAN 2,570 CHILDREN SERVED WERE FROM 64 OF SOUTH DAKOTA'S 66 COUNTIES AND 249 TOWNS AND CITIES. 849 OF THOSE CHILDREN RECEIVED MORE THAN ONE SERVICE FROM LIFESCAPE. OUTPATIENT AND OUTREACH SERVICES, WHICH ARE COMMUNITY BASED, SERVED MORE THAN 2,700 OF THOSE CHILDREN IN SIOUX FALLS AND RAPID CITY, SD. SERVICES INCLUDE 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, 295 CHILDREN RECEIVED FREE AUTISM SCREENINGS AND 113 CHILDREN WERE EVALUATED FOR AUTISM. LIFESCAPE HAS MORE THAN A DOZEN BOARD CERTIFIED BEHAVIOR ANALYSTS IN THE STATE, WHICH HAS LED TO 27% DROP IN CHILDREN WAITING TO BE SEEN FOR AUTISM AND APPLIED BEHAVIOR ANALYSIS SERVICES. LIFESCAPE'S CHILDREN'S SPECIALTY HOSPITAL CONTINUES TO BE THE ONLY PEDIATRIC REHABILITATION HOSPITAL IN SOUTH DAKOTA. IN FY23, 28 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 70 DAY STUDENTS AT THE 26TH STREET CAMPUS AND PATHWAYS TO LIFE SCHOOL. 31217553 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 30 0 1 708 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 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 309623 35981 STEVE WILSON CFO 22.00 28.00 X 0 185196 30583 CHARLENE CONNELLY RN 70.00 0.00 X 197860 0 4710 KRISTIN TUTTLE VP OF MED. & THERAPY SERVICE 40.00 5.00 X 138782 0 11422 REBECCA WEELDREYER DIRECTOR OF NURSING 45.00 0.00 X 121441 0 19975 VICKI ISLER DIRECTOR OF EDUCATION 45.00 0.00 X 112295 0 14142 MARLI SCHIPPERS CHAIR 1.00 3.50 X X 0 0 0 LARRY FENTON VICE CHAIR 1.00 3.00 X X 0 0 0 BOB MCNANEY SECRETARY 1.00 3.00 X X 0 0 0 JAY SOUKUP TREASURER 1.00 3.00 X X 0 0 0 JASON HARRIS PAST CHAIR 1.00 3.50 X X 0 0 0 JACK HOPKINS DIRECTOR UNTIL 12/22 1.00 3.00 X 0 0 0 DOUG BERKLAND DIRECTOR/MEMBER-AT-LARGE 1.00 3.00 X 0 0 0 MARK STERNHAGEN DIRECTOR/MEMBER-AT-LARGE UNTIL 12/22 1.00 3.00 X 0 0 0 DR JOSH PAULI DIRECTOR 1.00 3.00 X 0 0 0 PATTY PETERS DIRECTOR UNTIL 12/22 1.00 3.00 X 0 0 0 KIMBERLY NOONEY DIRECTOR 1.00 3.00 X 0 0 0 TYLER HAAHR FOUNDATION IMMEDIATE PAST CHAIR 1.00 3.00 X 0 0 0 ERICA DEBOER DIRECTOR 1.00 3.00 X 0 0 0 JASON HUBERS DIRECTOR 1.00 3.00 X 0 0 0 RICK KILEY DIRECTOR FROM 01/23 1.00 3.00 X 0 0 0 ERIK NYBERG DIRECTOR 1.00 3.00 X 0 0 0 570378 494819 116813 4 0 1 0 LIFESCAPE 2501 W 26TH STREET SIOUX FALLS SD 57105 SHARED SERVICES 2241049 SANFORD USD MEDICAL CENTER PO BOX 5064 SIOUX FALLS SD 571175064 RESP. THERAPY; IT SVCS 498671 KOCH HAZARD ARCHITECTS 431 N PHILLIPS 200 SIOUX FALLS SD 57104 ARCHITECT SERVICES 446026 HENRY CARLSON CONSTRUCTION 1205 W RUSSELL ST SIOUX FALLS SD 57104 CONSTRUCTION 295871 SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND ST SIOUX FALLS SD 57117 PHYSICIAN SERVICES 258516 7 4444737 36150 775 4480887 PATIENT/RESIDENT FEES 623000 35826482 35826482 OTHER SERVICE REVENUE 900099 407211 407211 36233693 428820 428820 23707 0 23707 23707 23707 169942 -169942 -169942 -169942 INSURANCE PROCEEDS 900099 16992 16992 16992 41014157 36233693 0 299577 21078287 19717865 1360422 438729 414365 24364 4066564 3598920 467644 1622117 1523829 98288 13681 13681 85749 85749 17278 17278 3703692 1180154 2523538 189418 189418 387725 227009 160716 9248 9248 1385832 863496 522336 58977 51924 7053 53965 31330 22635 115972 115972 945916 908881 37035 322904 267658 55246 OTHER SUPPLIES 1612129 1440870 171259 MAINTENANCE AND REPAIR 414923 166759 248164 DUES AND SUBSCRIPTIONS 217391 63013 154378 851985 734954 117031 37592482 31217553 6374929 0 X 1611310 3068536 6272040 6347031 29700 38379 41158 48228 34117403 24976825 6788902 9140578 14043878 14829911 2328914 1819466 31115902 35292129 2304601 2810110 3754138 3281906 1543256 1373104 7601995 7465120 X 23189699 27504237 324208 322772 23513907 27827009 31115902 35292129 X 3421675 813674 77753 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 4778 0 0 1 12500 0 0 17278 0 PART II-B, LINE 1: CHILDREN'S CARE HOSPITAL & 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. 3294793 3294793 20683589 17527662 3155927 7090343 6344522 745821 3048678 1104641 1944037 9140578 INTERCOMPANY RECEIVABLE 153588 INVESTMENT IN DAKOTA TRUCK UNDERWRITERS 437496 OPERATING LEASE RIGHT OF USE ASSET 1228382 1819466 ASSETS HELD IN TRUST 116530 OPERATING LEASE LIABILITY 1256574 1373104 X 41824724 813674 115415 929089 40895635 118522 118522 41014157 37511575 0 37511575 80907 80907 37592482 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 193,596. BANK FEES RECLASSIFIED FOR 990 -78,181. PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 2,679. NET ASSET WITH DONOR RESTRICTIONS 115,843. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 2,726. BANK FEES RECLASSIFIED FOR 990 78,181. 1 1 X 1 X 1 X 175.000000000000 1 0 0 24089394 22534106 1555288 0.04140 24089394 22534106 1555288 0.04140 24089394 22534106 1555288 0.04140 1 132000 0 36276 87904 -51628 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 TO PROVIDE 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/ABOUT-US/THE 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 SERVICES2. LACK OF COMMUNITY AND CAREGIVER EDUCATION ON LIFESCAPE SERVICES AND COMMUNITY RESOURCES3. 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.NEEDS IDENTIFIED BUT NOT ADDRESSED: TRANSPORTATION AND INSURANCE COVERAGE WILL NOT BE ADDRESSED AS WE DON'T HAVE THE ABILITY TO DIRECTLY IMPACT THESE AREAS. WE ALSO ARE 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. IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS:1. ACCESSING SPECIALTY HOSPITAL AND OUTPATIENT SERVICES: LACK OF COORDINATION OF CONNECTING FAMILIES WITH RESOURCES: A NEW HOSPITAL FAMILY HANDBOOK WAS DEVELOPED AND IS BEING PROVIDED TO FAMILIES UPON ADMISSION.2. LACK OF COMMUNITY AND CAREGIVER EDUCATION ON LIFESCAPE SERVICES AND COMMUNITY RESOURCES: 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.3. INADEQUATE AVAILABILITY OF APPROPRIATE MEDICAL AND COMMUNITY-BASED SERVICES IN IDENTIFIED AREAS: WE WERE ABLE TO INCREASE OUR NUMBER OF AUTISM EVALUATION AND FREE SCREENINGS TO HELP MEET GROWING DEMAND, OUTPATIENT AUTISM TEAM DEVELOPED A SCREENING TOOL FOR ADOLESCENCE TO BETTER GUIDE APPROPRIATE RESOURCES FOR PATIENTS. INCREASED RECRUITING EFFORTS FOR CLINICAL PSYCHOLOGISTS. UPDATED AUTISM SCREENINGS TO A STAR (SITUATION, TASK, ACTION, RESULT) EVALUATION TO INCREASE IDENTIFICATION OF EARLY INTERVENTION NEEDS. 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. 1 1 - CHILDREN'S CARE HOSPITAL & SCHOOL 7110 JORDAN DRIVE RAPID CITY SD 57702 OUTPATIENT REHABILITATION CENTER 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 FALLS OUTPATIENT CLINICS. 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 PAGES 15-16. 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 THE 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.- 556 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 1 0 STEVEN WATKINS CEO 0 308359 0 0 0 1264 0 7668 0 28776 0 346067 0 0 STEVE WILSON CFO 0 183987 0 0 0 1209 0 4851 0 26195 0 216242 0 0 CHARLENE CONNELLY RN 189814 0 7906 0 140 0 4710 0 192 0 202762 0 0 0 KRISTIN TUTTLE VP OF MED. & THERAPY SERVICE 138476 0 150 0 156 0 2822 0 9004 0 150608 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. PART I, LINE 7 CHARLENE CONNELLY RECEIVED A RETENTION BONUS. REBECCA WEELDREYER RECEIVED AN APPRECIATION BONUS, CONTINGENT ON FULL-TIME EMPLOYMENT THROUGH SEPTEMBER 30, 2023. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 480315509 83755VJ47 2017-11-01 5736456 REFINANCING OF 2007 BONDS 0 0 0 A 2626456 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 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/28/2022 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 MARLI SCHIPPERS, LARRY FENTON, BOB MCNANEY, JAY SOUKUP, JACK HOPKINS, JASON HARRIS, DOUG BERKLAND, MARK STERNHAGEN, JOSH PAULI, PATTY PETERS, KIMBERLY NOONEY, TYLER HAAHR, ERICA DEBOER, JASON HUBERS, RICK KILEY, AND ERIK NYBERG. 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 77,753. 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 2275611 1589907 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 2020916 FMV