2018-11-13T08:52:58-06:00 2018-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2017-07-01 421271420 CHILDSERVE INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 DAVID MCKENZIE PRESIDENT/COO 5157278750 2018-11-13 1 BRENT L ALEXANDER P00075113 5152237300 2018-11-06 38.87.33.4 2018-11-13 08:27:23 CS P 0796FCE7583AE90769CEF6CA2A629B61E6D445D2 0796FCE7583AE90769CEF6CA2A629B61E6D445D2 2017 2019-02-21 02:37:17Z DAVID MCKENZIE PO BOX 707 JOHNSTON IA 501310707 5428351 0 X WWW.CHILDSERVE.ORG X 1985 IA TO OPERATE EXCLUSIVELY AS THE PARENT COMPANY AND CORPORATE FRAMEWORK FOR THE BENEFIT AND SUPPORT OF THE PROGRAMS OFFERED BY THE CHILDSERVE NONPROFIT TAX-EXEMPT ORGANIZATIONS. 17 16 1862 16 0 0 750 337 0 0 2016 3185 5551054 5424829 5553820 5428351 0 0 0 0 4350741 4364058 0 0 0 1203079 1064293 5553820 5428351 0 0 0 0 0 0 0 0 WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 0 0 5424829 OPERATES AS PARENT COMPANY AND CORPORATE FRAMEWORK FOR THE BENEFIT AND SUPPORT OF THE PROGRAMS OFFERED BY THE CHILDSERVE NONPROFIT TAX-EXEMPT ORGANIZATIONS. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 13 0 1 1862 1 0 0 0 0 0 0 0 0 0 0 X 17 16 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 JOHN BRUNTZ DIRECTOR 2.00 X 0 0 0 JIM SANDERS TREASURER 2.25 1.75 X X 0 0 0 PAUL NAGEL DIRECTOR 2.00 X 0 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 1.00 39.00 X X 450410 0 105311 DOUG DORNACKER PAST CHAIR 2.25 1.75 X X 0 0 0 JOEL NELSON DIRECTOR 2.00 X 0 0 0 DAVID MACKAMAN CHAIR 2.25 1.75 X X 0 0 0 SALLY STUDER DIRECTOR 2.00 X 0 0 0 SHIRLEY POERTNER VICE CHAIR 2.25 1.75 X X 0 0 0 MATT GROTNES DIRECTOR 2.00 X 0 0 0 MARIA WOOD DIRECTOR 2.00 X 0 0 0 JULIE MCMILLIN DIRECTOR 2.00 X 0 0 0 KIP ALBERTSON DIRECTOR 2.00 X 0 0 0 DAVID MCKENZIE EXECUTIVE VP & CFO 1.00 39.00 X X 289289 0 47650 LOREN BROCKHOUSE DIRECTOR 2.00 X 0 0 0 DOUG CRETSINGER SECRETARY 2.25 1.75 X X 0 0 0 EMILY WILLITS DIRECTOR 2.00 X 0 0 0 MIKE WEGNER DIRECTOR 2.00 X 0 0 0 MINDY MOSS DIRECTOR 2.00 X 0 0 0 GEORGE EICHHORN DIRECTOR OF COMPLIANCE 40.00 X 133546 0 5858 JAY WINGER VP OF HUMAN RESOURCES 40.00 X 105945 0 8303 DAVID JAMES DIRECTOR OF INFORMATION SYSTEMS 40.00 X 105626 0 16507 1084816 0 183629 5 0 1 0 0 337 337 3185 3185 ADMINISTRATION SUPPORT 561000 5407403 5407403 COMPANY STORE 453000 12951 12951 MISCELLANEOUS 900099 4475 4475 5424829 5428351 5424829 0 3185 912078 912078 2753846 2753846 60141 60141 406661 406661 231332 231332 14331 14331 71620 71620 297790 297790 44313 44313 113869 113869 208947 208947 25560 25560 15023 15023 51954 51954 RECRUITMENT EXPENSE 96728 96728 EQUIPMENT RENTAL AND MA 44530 44530 DUES AND SUBSCRIPTIONS 34085 34085 EQUIPMENT SERVICE AGREE 19231 19231 26312 26312 5428351 0 5428351 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 X 0 1 X 1 0 X 5000 14911 70 750 337 21068 4272286 4543164 4861502 5551054 5424829 24652835 4277286 4558075 4861572 5551804 5425166 24673903 0 0 0 24673903 18864 1672 1195 2016 3185 26932 18864 1672 1195 2016 3185 26932 4296150 4559747 4862767 5553820 5428351 24700835 0.99890 0.99840 0.00110 0.00160 X 1 X X X X X X 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 360615 0 82795 0 7000 0 96780 0 8531 0 555721 0 0 0 DAVID MCKENZIE EXECUTIVE VP & CFO 245541 0 43748 0 0 0 39959 0 7691 0 336939 0 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF CHILDSERVE, INC. 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 NET EARNINGS. 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 THE ORGANIZATION'S BOARD OF DIRECTORS 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 IX, LINES 5-10 CHILDSERVE, INC. SERVES AS A COMMON PAYMASTER FOR ITS EIGHT RELATED ORGANIZATIONS; CHILDSERVE HABILITATION CENTER, CHILDSERVE HOMECARE INC., CHILDSERVE FOUNDATION INC., CHILDSERVE MEDICAL EQUIPMENT & SUPPLY, CHILDSERVE HOMES INC., CHILDSERVE THERAPY INC., CHILDSERVE COMMUNITY OPTIONS,AND CHILDSERVE CLINIC, INC. AS SUCH, CHILDSERVE, INC. IS RESPONSIBLE FOR FILING FORMS 941 AND W-2'S FOR ALL THE ORGANIZATIONS UNDER ITS TAX IDENTIFICATION NUMBER. CHILDSERVE, INC. REPORTS COSTS RELATING TO COMPENSATION, SALARIES WAGES, EMPLOYEE BENEFITS, AND PAYROLL TAXES FOR CERTAIN ADMINISTRATIVE DEPARTMENTS ON SCHEDULE IX, LINES 5-10. ALL OTHER COSTS RELATING TO COMPENSATION, SALARIES WAGES, EMPLOYEE BENEFITS, AND PAYROLL TAXES ARE REPORTED ON THE RELATED ORGANIZATIONS' RESPECTIVE FORMS 990, SCHEDULES IX, LINES 5-10. CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 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 1 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 50131 421390033 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 50131 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 CHILDSERVE FOUNDATION INC PO BOX 707 JOHNSTON IA 50131 421157665 DEVELOP, RECEIVE AND GRANT FINANCIAL ASSISTANCE TO CHILDSERVE ORGANIZATIONS IA 501(C)(3) LINE 12A, I CHILDSERVE INC 1 THE CHILDSERVE CLINIC INC PO BOX 707 JOHNSTON IA 50131 455327981 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 CHILDSERVE HABILITATION CENTER Q 3175957 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMES INC Q 881273 BASED ON PROPORTIONATE REVENUE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC Q 89303 BASED ON PROPORTIONATE REVENUE CHILDSERVE THERAPY INC Q 698694 BASED ON PROPORTIONATE REVENUE CHILDSERVE COMMUNITY OPTIONS Q 412177 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMECARE INC Q 50000 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER K 180284 BASED ON SQUARE FOOTAGE CHILDSERVE FOUNDATION Q 50000 BASED ON PROPORTIONATE REVENUE CHILDSERVE CLINICS Q 50000 BASED ON PROPORTIONATE REVENUE 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 HOMES, INC. PRIMARY ACTIVITY: PROVIDE COMMUNITY BASED GROUP HOME LIVING 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: THE CHILDSERVE CLINIC, INC. PRIMARY ACTIVITY: IMPROVE ACCESS TO PEDIATRIC SUBSPECIALTY MEDICAL SERVICES, PEDIATRIC REHABILITATION SERVICES, AND IN-HOME FAMILY SUPPORT SERVICES