2023-02-03T15:37:34-06:00 2022-06-30 411431613 BERGANKDV LTD 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2021-07-01 421157665 CHILDSERVE FOUNDATION INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 DAVID MCKENZIE PRESIDENT/COO 5157278750 2023-01-31 1 DAVID MCKENZIE 999009999 BRENT L ALEXANDER CPA P00075113 5157275700 2023-01-31 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z DAVID MCKENZIE PO BOX 707 JOHNSTON IA 501310707 12469177 0 X WWW.CHILDSERVE.ORG X 1981 IA TO ENHANCE THE WELL-BEING OF CHILDREN WITH SPECIAL HEALTHCARE NEEDS BY DEVELOPING, RECEIVING, AND GRANTING FINANCIAL ASSISTANCE TO CHILDSERVE. 19 18 0 18 0 0 1730852 4930257 0 0 621824 406005 627412 1581851 2980088 6918113 2628045 6571289 0 0 444083 646493 0 0 756982 578705 313981 3650833 7531763 -670745 -613650 20989785 15317194 3878231 101989 17111554 15215205 WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 0 0 6571289 6571289 1147702 IN 2021-2022, THE FOUNDATION DISTRIBUTED $6,571,289 TO CHILDSERVE ORGANIZATIONS AND PROGRAMS ACROSS THE STATE. FOUNDATION FUNDS ARE DISTRIBUTED TO PROGRAMS WITH A FOCUS ON ENABLING GROWTH AND EXPANSION TO SERVE MORE CHILDREN AND FAMILIES, OPENING NEW PROGRAMS, ENHANCING FACILITIES; INVESTING IN CARE ENHANCEMENTS THROUGH PROGRAM SUPPORT; AND PURCHASING ADAPTIVE, MEDICAL, OR REHABILITATION EQUIPMENT AND TECHNOLOGY. 6571289 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHILDSERVE 5157278750 PO BOX 707 JOHNSTON IA 501310707 TERI WAHLIG CEO 1.00 39.00 X X 0 447117 84595 NICK GERHART PAST CHAIR 2.00 X X 0 0 0 CHRIS LITTLEFIELD CHAIR 2.00 X X 0 0 0 JOANIE HOUSTON VICE CHAIR 2.00 X X 0 0 0 JOEL NELSON SECRETARY/TREASURER 2.00 X X 0 0 0 VANESSA BLANCHFIELD TRUSTEE 2.00 X 0 0 0 JAY BYERS TRUSTEE 2.00 X 0 0 0 MEGAN CHRISTOFFERSON TRUSTEE 2.00 X 0 0 0 JERRY DEEGAN TRUSTEE 2.00 X 0 0 0 KIM WILLIS TRUSTEE 2.00 X 0 0 0 KYLEE KRIZMANIC TRUSTEE 2.00 X 0 0 0 SUSAN HATTEN TRUSTEE 2.00 X 0 0 0 TOM MAHONEY TRUSTEE 2.00 X 0 0 0 JIM MCCULLOH TRUSTEE 2.00 X 0 0 0 TOM NUCARO TRUSTEE 2.00 X 0 0 0 JC RISEWICK TRUSTEE 2.00 X 0 0 0 LARRY STELTER TRUSTEE 2.00 X 0 0 0 JENNIFER VICENTE TRUSTEE 2.00 X 0 0 0 CATHY LACY TRUSTEE 2.00 X 0 0 0 DAVID MCKENZIE PRESIDENT/COO 1.00 39.00 X 0 362922 75124 ERICA AXIOTIS VP OF DEVELOPMENT 40.00 X 120651 0 20392 120651 810039 180111 1 0 1 0 0 11332 1125642 3793283 11332 4930257 274229 274229 5341045 5209269 131776 131776 131776 775944 11332 341795 434149 434149 FOUNDATION SUPPORT 561000 1147702 1147702 1147702 6918113 1147702 0 840154 6571289 6571289 550593 550593 19895 19895 35923 35923 40082 40082 10989 10989 68701 68701 7642 7642 5181 5181 1095 1095 9334 9334 4234 4234 513 513 ADMINISTRATION SUPPORT 119825 119825 MISCELLANEOUS OPERATING 70099 70099 PUBLIC RELATIONS 9841 9841 DUES AND SUBSCRIPTIONS 2670 2670 3857 3857 7531763 6571289 203492 756982 425175 67793 5927741 590562 2022306 2186246 122272 876167 11495 3495 35062 3130 2247424 31932 8564296 8172085 1519128 1318361 149948 2070553 20989785 15317194 31064 29583 3847167 72406 3878231 101989 X 6129211 6273890 10982343 8941315 17111554 15215205 20989785 15317194 X -613650 -1132977 -149722 X 0 1 X 1 1 1 X X 8 CHILDSERVE HABILITATION CENTER 420680245 10 1 5551315 0 CHILDSERVE HOMES INC 421264664 10 1 117885 0 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC 421264666 10 1 63396 0 CHILDSERVE THERAPY INC 420680420 10 1 173911 0 CHILDSERVE HOMECARE INC 421478832 10 1 500 0 CHILDSERVE INC 421271420 10 1 37523 0 CHILDSERVE COMMUNITY OPTIONS 421390033 10 1 466240 0 CHILDSERVE CLINIC INC 455327981 10 1 160518 0 8 6571288 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5150107 401672 -707156 162628 4681995 3889333 393366 1012394 144986 5150107 3894669 10000 112807 128143 3889333 3797979 1104 235110 139524 3894669 3751917 192097 146035 3797979 0.39245 0.40361 0.20394 0 0 35062 3130 31932 31932 BENEFICIAL INTEREST IN PERPETUAL TRUST 202702 F BENEFICIAL INETEREST IN COMMUNITY TRUST 126952 F BENEFICIAL INTEREST IN TRUST 988707 F 1318361 CASH SURRENDER VALUE OF LIFE INSURANCE 105233 ACCRUED INTEREST RECEIVABLE 12899 DUE TO AFFILIATES 1952421 2070553 ANNUITY PAYABLE 72406 72406 PART V, LINE 4: THE PRIMARY USE OF ENDOWMENT FUNDS IS FOR GRANTS TO OTHER RELATED CHILDSERVE ORGANIZATIONS FOR OPERATING NEEDS AS FURTHER DISCLOSED IN SCHEDULE I. THERE ARE TWO OTHER SMALL ENDOWMENTS FOR WHICH EARNINGS ARE USED FOR NURSING SCHOLARSHIPS AND STAFF EDUCATION. GOLF OUTING 83655 83655 5094 17527 5700 2833 BUBBLE BALL 683051 11332 671719 1103 27213 85266 5800 120828 2 20570 20570 41 2785 3178 1489 787276 11332 775944 6238 47525 94144 5800 125150 278857 497087 1 CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 501310707 420680245 501(C)(3) 5551315 0 PROVIDING PEDIATRIC SKILLED NURSING CARE AND SPECIALTY SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND CHRONIC HEALTH CONDITIONS CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 501310707 421264664 501(C)(3) 117885 0 PROVIDING HEALTH CARE IN COMMUNITY BASED GROUP HOMES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 501310707 420680420 501(C)(3) 173911 0 PROVIDING SKILLED THERAPY AND SPECIALTY PEDIATRIC CLINICS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 501310707 421390033 501(C)(3) 466240 0 PROVIDING INTEGRATED COMMUNITY CARE AND SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS CHILDSERVE CLINICS PO BOX 707 JOHNSTON IA 501310707 455327981 501(C)(3) 160518 0 PROVIDING PEDIATRIC SUB-SPECIALTY MEDICAL SERVICES AND PEDIATRIC REHABILITATION SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS CHILDSERVE MEDICAL EQUIPMENT & SUPPLY PO BOX 707 JOHNSTON IA 501310707 421264666 501(C)(3) 63396 0 PROVIDING MOBILITY EQUIPMENT, SPECIALTY MEDICAL SUPPLIES, AND SERVICES CHILDSERVE INC PO BOX 707 JOHNSTON IA 501310707 421271420 501(C)(3) 37523 0 INFRASTRUCTURE UPGRADES FOR INFORMATION TECHNOLOGY PURPOSES. 7 1 0 1 0 0 0 1 1 0 0 TERI WAHLIG CEO 0 359975 0 87142 0 0 0 79061 0 5534 0 531712 0 0 DAVID MCKENZIE PRESIDENT/COO 0 291239 0 71683 0 0 0 67038 0 8086 0 438046 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF CHILDSERVE, INC. (A RELATED ORGANIZATION) HAS THE RESPONSIBILITY TO OVERSEE THE IMPLEMENTATION OF THE EXECUTIVE COMPENSATION POLICY FOR THE EXECUTIVE POSITIONS AND KEY EMPLOYEES AS DEFINED BY THE IRS. THE EXECUTIVE COMMITTEE WILL APPROVE THE COMPENSATION ARRANGEMENTS FOR THE PRESIDENT/CEO WITHOUT DISCUSSION OR VOTING PARTICIPATION OF THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE WILL DOCUMENT THE BASIS FOR EXECUTIVE COMPENSATION DETERMINATIONS CONCURRENTLY WITH APPROVAL. THE DOCUMENTATION CONTAINS THE COMPARABILITY DATA THAT WAS RELIED ON AND HOW THE DATA WAS OBTAINED. A COMPREHENSIVE MARKET BASED STUDY WILL OBTAIN COMPENSATION DATA FOR EACH KEY EMPLOYEE FROM SIMILAR TYPE AGENCIES AND ORGANIZATIONS EVERY THREE YEARS. DURING THE YEARS WHEN THE COMPREHENSIVE MARKET BASED STUDY IS NOT CONDUCTED, MARKET BASED INFORMATION SUCH AS THE CPI OR COMPARABLE DATA WILL BE USED ANNUALLY TO MAKE ADJUSTMENTS TO THE MIDPOINT. PART I, LINE 6 INCENTIVE PAY IS BASED ON MEETING BUDGETED ORGANIZATIONAL PERFORMANCE METRICS. LARRY STELTER TRUSTEE ON CHILDSERVE FOUNDATION BOARD AND OFFICER OF STELTER COMPANY 22542 WEBSITE MANAGAMENT AND NEWSLETTERS 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S POLICY FOR REVIEW OF THE FORM 990 RETURN INCLUDES REVIEW BY THE INDEPENDENT AUDIT SUBCOMMITTEE OF THE FINANCE COMMITTEE AND DISTRIBUTION TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE GOVERNING BOARD AND KEY EMPLOYEES ARE REQUIRED BY POLICY TO ACKNOWLEDGE IN WRITING THEIR UNDERSTANDING AND COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THIS IS DONE ANNUALLY WITH 100% RESPONSE RATE REQUIRED. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF CHILDSERVE INC. (A RELATED ORGANIZATION) HAS THE RESPONSIBILITY TO OVERSEE THE IMPLEMENTATION OF THE EXECUTIVE COMPENSATION POLICY FOR THE EXECUTIVE POSITIONS AND KEY EMPLOYEES AS DEFINED BY THE IRS. THE EXECUTIVE COMMITTEE WILL APPROVE THE COMPENSATION ARRANGEMENTS FOR THE PRESIDENT/CEO WITHOUT DISCUSSION OR VOTING PARTICIPATION OF THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE WILL DOCUMENT THE BASIS FOR EXECUTIVE COMPENSATION DETERMINATIONS CONCURRENTLY WITH APPROVAL. THE DOCUMENTATION CONTAINS THE COMPARABILITY DATA THAT WAS RELIED ON AND HOW THE DATA WAS OBTAINED. A COMPREHENSIVE MARKET BASED STUDY WILL OBTAIN COMPENSATION DATA FOR EACH KEY EMPLOYEE FROM SIMILAR TYPE AGENCIES AND ORGANIZATIONS EVERY THREE YEARS. DURING THE YEARS WHEN THE COMPREHENSIVE MARKET BASED STUDY IS NOT CONDUCTED, MARKET BASED INFORMATION SUCH AS THE CPI OR COMPARABLE DATA WILL BE USED ANNUALLY TO MAKE ADJUSTMENTS TO THE MIDPOINT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: PLEDGE RECEIVABLE BAD DEBT RECOVERY 30,000. CHANGE IN VALUE OF BENEFICIAL INTEREST IN TRUSTS -179,722. FORM 990, PART IX, LINES 5-10 CHILDSERVE FOUNDATION INC REPORTS COSTS RELATING TO COMPENSATION, SALARIES WAGES, EMPLOYEE BENEFITS, AND PAYROLL TAXES ON SCHEDULE IX, LINES 5-10. CHILDSERVE, INC. (A RELATED ORGANIZATION) SERVES AS A COMMON PAYMASTER FOR THE ORGANIZATION. AS SUCH, CHILDSERVE, INC. IS RESPONSIBLE FOR FILING FORMS 941 AND W-2'S UNDER ITS TAX IDENTIFICATION NUMBER, NOT THE ORGANIZATION'S TAX IDENTIFICATION NUMBER. CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC PO BOX 707 JOHNSTON IA 50131 421264666 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE INC PO BOX 707 JOHNSTON IA 50131 421271420 PARENT COMPANY FOR BENEFIT & SUPPORT OF PROGRAMS/ SERVICES OF CHILDSERVE IA 501(C)(3) LINE 10 0 CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 50131 421390033 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 50131 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 THE CHILDSERVE CLINIC INC PO BOX 707 JOHNSTON IA 50131 455327981 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 CHILDSERVE HABILITATION CENTER B 5551315 BASED ON APPROVED NEEDS CHILDSERVE HOMES INC B 117885 BASED ON APPROVED NEEDS CHILDSERVE THERAPY INC B 173911 BASED ON APPROVED NEEDS CHILDSERVE HABILITATION CENTER Q 974973 BASED ON HISTORICAL SUPPORT % CHILDSERVE INC P 119825 BASED ON PROPORTIONATE REVENUE CHILDSERVE COMMUNITY OPTIONS B 466240 BASED ON APPROVED NEEDS CHILDSERVE CLINIC INC B 160518 BASED ON APPROVED NEEDS CHILDSERVE MEDICAL EQUIPMENT AND SUPPLY B 63396 BASED ON APPROVED NEEDS CHILDSERVE COMMUNITY OPTIONS Q 81946 BASED ON HISTORICAL SUPPORT % CHILDSERVE HABILITATION CENTER R 5724516 ACTUAL CASH TRANSFERRED PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: CHILDSERVE HABILITATION CENTER PRIMARY ACTIVITY: PROVIDE PEDIATRIC SKILLED NURSING AND SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND CHRONIC HEALTH CONDITIONS NAME OF RELATED ORGANIZATION: CHILDSERVE MEDICAL EQUIPMENT & SUPPLY, INC. PRIMARY ACTIVITY: PROVIDE MOBILITY EQUIPMENT, SPECIALTY MEDICAL SUPPLIES, AND SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE THERAPY, INC. PRIMARY ACTIVITY: PROVIDE SKILLED THERAPY AND AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE COMMUNITY OPTIONS PRIMARY ACTIVITY: PROVIDE INTEGRATED SERVICES AND COMMUNITY CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE HOMECARE, INC. PRIMARY ACTIVITY: PROVIDE SPECIALTY HOME HEALTH CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE HOMES, INC. PRIMARY ACTIVITY: PROVIDE COMMUNITY BASED GROUP HOME LIVING FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: THE CHILDSERVE CLINIC, INC. PRIMARY ACTIVITY: IMPROVE ACCESS TO PEDIATRIC SUBSPECIALTY MEDICAL SERVICES, PEDIATRIC REHABILITATION SERVICES, AND IN-HOME FAMILY SUPPORT SERVICES