Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
CHILDREN'S CARE HOSPITAL AND SCHOOL DBA LIFESCAPE |
460233030 | 3 | Yes | 700,198 | 0 | |
| (B)
SOUTH DAKOTA ACHIEVE DBA LIFESCAPE |
237072116 | 2 | Yes | 2,323,855 | 77,075 | |
|
Total 2
|
3,024,053 | 77,075 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART IV, SECTION A, LINE 6 | IN ADDITION TO PROVIDING DIRECT SUPPORT TO THE SUPPORTED ORGANIZATIONS, THE FOUNDATION PROVIDES SUPPORT TO INDIVIDUALS WHO ARE PART OF THE CHARITABLE CLASS BENEFITED BY ITS SUPPORTED ORGANIZATIONS AND PROVIDED LIMITED FINANCIAL ASSISTANCE TO STAFF WHO EXPERIENCED FINANCIAL HARDSHIP DUE TO COVID-19. |
| SCHEDULE A, SECTION B, TYPE I, LINE 1 | MEMBERS OF THE BOARD OF DIRECTORS SHALL BE NOMINATED BY LIFESCAPE FOUNDATION. THE BOARD OF DIRECTORS OF LIFESCAPE, A SUPPORTED ORGANIZATION AND PARENT TO SOUTH DAKOTA ACHIEVE AND CHILDREN'S CARE HOSPITAL AND SCHOOL, SHALL DECIDE TO ACCEPT OR REJECT EACH PROPOSED NOMINEE. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART V, LINE 2A | NUMBER OF EMPLOYEES ON W-3: LIFESCAPE FOUNDATION HAS ITS OWN EMPLOYEES, HOWEVER, COMPENSATION IS PAID BY LIFESCAPE, THE COMMON PAYMASTER. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR OF THE BOARD OF DIRECTORS (WHO SHALL ACT AS CHAIR), THE VICE CHAIR, THE IMMEDIATE PAST CHAIR, THE CHIEF EXECUTIVE OFFICER OF LIFESCAPE, THE SECRETARY, THE TREASURER, AND ONE (1) OTHER DIRECTOR APPOINTED BY THE CHAIR. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE WILL IN CONJUNCTION WITH THE LIFESCAPE BOARD OF DIRECTORS RECOMMEND TO THE BOARD OF DIRECTORS THE ENGAGEMENT OF THE SERVICES OF A QUALIFIED PUBLIC ACCOUNTING FIRM TO AUDIT THE FINANCIAL AFFAIRS OF THE CORPORATION, PREPARE THE 990 REPORT, AND MAKE A REPORT CONCERNING THE FINANCIAL POSITION OF THE CORPORATION TO THE BOARD OF DIRECTORS ANNUALLY. THE EXECUTIVE COMMITTEE SHALL HAVE INPUT INTO LIFESCAPE'S CHIEF EXECUTIVE OFFICER'S ANNUAL PERFORMANCE EVALUATION. |
| FORM 990, PART VI, SECTION A, LINE 2 | STEVE WATKINS, THE CEO OF LIFESCAPE, HAS A BUSINESS RELATIONSHIP WITH GAYLE VER HEY, JEFF NELSON, NAN BAKER AND JASON HARRIS. 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, JESSICA WELLS AND STEVE WILSON HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE INVESTMENT COMMITTEE SHALL CONSIST OF AT LEAST FOUR 4) AND NO MORE THAN NINE (9) DIRECTORS APPOINTED BY THE CHAIR. DIRECTORS FROM LIFESCAPE MAY BE APPOINTED TO SERVE AS EX-OFFICIO COMMITTEE MEMBERS AS DEEMED NECESSARY. THE COMMITTEE SHALL MEET AT LEAST BI-ANNUALLY. ITS PURPOSE IS TO REVIEW THE INVESTMENT PHILOSOPHY AND ASSET ALLOCATION AND MAKE RECOMMENDATIONS TO THE FULL BOARD OF DIRECTORS; TO RECOMMEND INVESTMENT AND SPENDING POLICIES THAT REFLECT THE INVESTMENT PHILOSOPHY ADOPTED BY THE BOARD OF DIRECTORS; TO SELECT AND RETAIN APPROPRIATE CONSULTANTS AND MONEY MANAGERS; AND TO MONITOR THE PERFORMANCE OF INVESTMENTS AGAINST ESTABLISHED OBJECTIVES AND REPORT TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DIRECTORS SHALL BE NOMINATED BY THE FOUNDATION, BUT THE BOARD OF DIRECTORS OF LIFESCAPE HAS RESPONSIBILITY FOR ACCEPTING OR REJECTING THE NOMINATIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FOUNDATION PRESIDENT AND THE CFO WILL REVIEW THE RETURN. A FINAL COPY WILL BE SHARED WITH THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY POTENTIAL CONFLICT OF INTEREST SHALL BE DISCLOSED BY THE DIRECTOR WHO IS INVOLVED; PROVIDED, HOWEVER, THAT ANY DIRECTOR MAY PROVIDE NOTICE OF A POTENTIAL CONFLICT OF INTEREST TO THE CHAIR WHEN SUCH DIRECTOR BECOMES AWARE OF A POTENTIAL CONFLICT OF INTEREST, WHETHER SUCH POTENTIAL CONFLICT OF INTEREST INVOLVES THAT DIRECTOR OR NOT. THE BOARD OF DIRECTORS WILL DETERMINE WHETHER OR NOT A CONFLICT OF INTEREST EXISTS AND THE DIRECTOR WITH THE POTENTIAL CONFLICT OF INTEREST SHALL NOT PARTICIPATE IN THIS DETERMINATION. IF THE BOARD OF DIRECTORS DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE DIRECTOR WITH THE CONFLICT SHALL ABSTAIN FROM VOTING ON ANY RESOLUTION OF THE BOARD OF DIRECTORS INVOLVING THE ISSUE OR SUBJECT MATTER FROM WHICH THE CONFLICT HAS ARISEN AND, IF APPROPRIATE, SUCH DIRECTOR WILL RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSION OF THAT ISSUE OR SUBJECT MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE FOUNDATION BOARD IS MADE UP OF COMMUNITY MEMBERS AND HAS A DESIGNATED COMMITTEE TO REVIEW AND APPROVE THE COMPENSATION OF THE PRESIDENT OF THE FOUNDATION. THIS COMMITTEE CONSISTS OF THE PAST CHAIR, CURRENT CHAIR, AND INCOMING CHAIR OF THE VOLUNTEER BOARD OF DIRECTORS AS WELL AS THE PRESIDENT/CEO OF LIFESCAPE. THE COMMITTEE MEETS AT LEAST ONCE A YEAR TO REVIEW AND EVALUATE THE PERFORMANCE OF THE PRESIDENT AND TO SET THE SALARY AND PERFORMANCE STANDARDS FOR THE UPCOMING YEAR USING COMPARABILITY DATA FROM SEVERAL SOURCES AS WELL AS EMPIRICAL MEASURES OF RESULTS OF THE PREVIOUS YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS ARE NOT AVAILABLE FOR PUBLIC ACCESS. |
| FORM 990, PART X, LINE 20: | LIFESCAPE FOUNDATION IS PART OF THE LIFESCAPE OBLIGATED GROUP WHICH CONSISTS OF LIFESCAPE, CHILDREN'S CARE HOSPITAL AND SCHOOL D/B/A LIFESCAPE, SOUTH DAKOTA ACHIEVE D/B/A LIFESCAPE, AND LIFESCAPE FOUNDATION. THE FOUNDATION WAS NOT ALLOCATED ANY SHARE OF THE BOND ISSUE, AND THUS DOES NOT HAVE AN AMOUNT ON LINE 20. |
| FORM 990, PART XI, LINE 9: | CHANGE IN SPLIT INTEREST AGREEMENTS 11,049. |
| Software ID: | |
| Software Version: |