2021-11-12T10:33:52-06:00 2021-06-30 411431613 BERGANKDV LTD 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2020-07-01 421157665 CHILDSERVE FOUNDATION INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 DAVID MCKENZIE PRESIDENT/COO 5157278750 2021-11-10 1 DAVID MCKENZIE 999009999 BRENT L ALEXANDER CPA P00075113 5157275700 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID MCKENZIE PO BOX 707 JOHNSTON IA 501310707 9531125 0 X WWW.CHILDSERVE.ORG X 1981 IA OPERATING AS A FOUNDATION TO DEVELOP, RECEIVE AND GRANT FINANCIAL ASSISTANCE TO THE CHILDSERVE ORGANIZATIONS. 21 20 0 173 0 0 3564763 1730852 0 0 200852 621824 596711 627412 4362326 2980088 643166 2628045 0 0 368168 444083 0 0 621593 351730 578705 1363064 3650833 2999262 -670745 17361920 20989785 266282 3878231 17095638 17111554 WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 0 0 2628045 2628045 200000 CHILDSERVE FOUNDATION ENHANCES THE WELL-BEING OF CHILDREN WITH SPECIAL HEALTHCARE NEEDS BY DEVELOPING, RECEIVING AND FACILITATING CHARITABLE GIVING TO CHILDSERVE. CHILDSERVE FOUNDATION DISTRIBUTED $2,631,045 TO CHILDSERVE ORGANIZATIONS AND PROGRAMS. 2628045 1 1 0 0 0 0 0 0 0 1 1 1 0 0 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 3 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 20 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 407196 77715 TOM STEWART PAST CHAIR 2.00 X 0 0 0 NICK GERHART CHAIR 2.00 X X 0 0 0 CHRIS LITTLEFIELD VICE CHAIR 2.00 X X 0 0 0 KIM WILLIS TRUSTEE 2.00 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 REYNOLDS CRAMER TRUSTEE 2.00 X 0 0 0 JERRY DEEGAN TRUSTEE 2.00 X 0 0 0 JOANIE HOUSTON SECRETARY/TREASURER 2.00 X 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 JOEL NELSON 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 325502 70065 MARK GAMBAIANA VP OF DEVELOPMENT 40.00 X 0 103465 17491 0 836163 165271 0 0 1 0 0 3000 299060 1428792 3000 1730852 196567 196567 6849942 6424685 425257 425257 425257 553764 3000 126352 427412 427412 FOUNDATION SUPPORT 561000 200000 200000 200000 2980088 200000 0 1049236 2628045 2628045 381037 381037 11530 11530 23089 23089 28427 28427 11897 11897 92114 92114 7542 7542 1138 1138 4799 4799 9772 9772 6340 6340 927 927 ADMINISTRATION SUPPORT 320724 320724 MISCELLANEOUS OPERATING 64359 64359 PLEDGE RECEIVABLE BAD D 50000 50000 EQUIPMENT RENTAL AND MA 3533 3533 5560 5560 3650833 2628045 401195 621593 292119 425175 5766008 5927741 3848914 2022306 3215 122272 11495 11495 3826698 1579274 2296872 2247424 3695662 8564296 1276376 1519128 171259 149948 17361920 20989785 21488 31064 244794 3847167 266282 3878231 X 5252263 6129211 11843375 10982343 17095638 17111554 17361920 20989785 X -670745 473088 213573 X 0 1 X 1 0 X X 8 CHILDSERVE HABILITATION CENTER 420680245 10 1 1919456 0 CHILDSERVE HOMES INC 421264664 10 1 96028 0 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC 421264666 10 1 4118 0 CHILDSERVE THERAPY INC 420680420 10 1 133066 0 CHILDSERVE HOMECARE INC 421478832 10 1 500 0 CHILDSERVE INC 421271420 10 1 0 0 CHILDSERVE COMMUNITY OPTIONS 421390033 10 1 256456 0 CHILDSERVE CLINIC INC 455327981 10 1 218422 0 8 2628046 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 3889333 393366 1012394 144986 5150107 3894669 10000 112807 128143 3889333 3797979 1104 235110 139524 3894669 3751917 192097 146035 3797979 3184324 10000 701809 144216 3751917 0.43160 0.33880 0.22960 0 0 414629 414629 3387352 1579172 1808180 24717 102 24615 2247424 BENEFICIAL INTEREST IN PERPETUAL TRUST 248257 F BENEFICIAL INETEREST IN COMMUNITY TRUST 147998 F BENEFICIAL INTEREST IN TRUST 1122873 F 1519128 ANNUITY PAYABLE 75072 DUE TO AFFILIATES 3772095 3847167 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 48863 48863 1648 12792 165 323 BUBBLE BALL 507901 3000 504901 232 1138 41096 12614 56344 556764 3000 553764 1880 13930 41261 12614 56667 126352 427412 1 CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 501310707 420680245 501(C)(3) 1919456 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) 96028 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) 133066 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) 256456 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) 218422 PROVIDING PEDIATRIC SUB-SPECIALTY MEDICAL SERVICES AND PEDIATRIC REHABILITATION SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS 5 1 0 1 0 0 0 1 1 0 0 TERI WAHLIG CEO 0 366983 0 40213 0 0 0 72569 0 5146 0 484911 0 0 DAVID MCKENZIE PRESIDENT/COO 0 290769 0 34733 0 0 0 60950 0 9115 0 395567 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 59912 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 CHANGE IN VALUE OF BENEFICIAL INTEREST IN TRUSTS 213,573. 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 0 1 CHILDSERVE HABILITATION CENTER B 1919456 BASED ON APPROVED NEEDS CHILDSERVE HOMES INC B 96028 BASED ON APPROVED NEEDS CHILDSERVE THERAPY INC B 133066 BASED ON APPROVED NEEDS CHILDSERVE HABILITATION CENTER Q 98080 BASED ON HISTORICAL SUPPORT % CHILDSERVE INC P 320724 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER S 3604631 ACTUAL CASH TRANSFERED CHILDSERVE COMMUNITY OPTIONS B 256456 BASED ON APPROVED NEEDS CHILDSERVE CLINICS B 218422 BASED ON APPROVED NEEDS 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