2016-12-13T11:51:33-06:00 2016-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2015-07-01 421271420 CHILDSERVE INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK PRESIDENT/CEO 5157278750 2016-12-08 1 BRENT L ALEXANDER P00075113 5152237300 2015 2017-02-10 21:41:12Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 4862767 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 47 16 0 0 14911 70 0 0 1672 1195 4543164 4861502 4559747 4862767 0 0 0 0 3621459 3882100 0 0 0 938288 980667 4559747 4862767 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 OPERATE 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 8 0 1 47 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 2.00 X X 0 0 0 PAUL NAGEL DIRECTOR 2.00 X 0 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 0.00 40.00 X X 0 395869 93673 DOUG DORNACKER CHAIR 2.00 X X 0 0 0 JOEL NELSON DIRECTOR 2.00 X 0 0 0 DAVID MACKAMAN VICE CHAIR 2.00 X X 0 0 0 SALLY STUDER DIRECTOR 2.00 X 0 0 0 SHIRLEY POERTNER SECRETARY 2.00 X X 0 0 0 RANDY VON FUMETTI 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 PAST CHAIR 2.00 X X 0 0 0 LOREN BROCKHOUSE DIRECTOR 2.00 X 0 0 0 DOUG CRETSINGER DIRECTOR 2.00 X 0 0 0 EMILY WILLITS DIRECTOR 2.00 X 0 0 0 MIKE WEGNER DIRECTOR 2.00 X 0 0 0 DAVID MCKENZIE SENIOR VICE PRESIDENT & CF 40.00 X 254157 0 39078 GEORGE EICHORN DIRECTOR OF COMPLIANCE/IN-HOUSE COUNSEL 40.00 X 109166 0 13536 ROD WILDRICK DIRECTOR OF ACCOUNTING 40.00 X 100480 0 8097 JAY WINGER DIRECTOR OF HUMAN RESOURCES 40.00 X 102836 0 5879 566639 395869 160263 4 0 1 0 0 70 70 1195 1195 ADMINISTRATION SUPPORT 561000 4842666 4842666 COMPANY STORE 453000 14075 14075 MISCELLANEOUS 900099 4761 4761 4861502 4862767 4861502 0 1195 295741 295741 2906992 2906992 110836 110836 395102 395102 173429 173429 11605 11605 66577 66577 214776 214776 49471 49471 104031 104031 201042 201042 29672 29672 15067 15067 46182 46182 RECRUITMENT EXPENSE 127716 127716 EQUIPMENT RENTAL AND MA 41880 41880 DUES AND SUBSCRIPTIONS 23420 23420 MISCELLANEOUS OPERATING 20325 20325 28903 28903 4862767 0 4862767 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 5500 5000 14911 70 25481 3617893 3834625 4272286 4543164 4861502 21129470 3623393 3834625 4277286 4558075 4861572 21154951 0 0 0 21154951 2687 13294 18864 1672 1195 37712 2687 13294 18864 1672 1195 37712 3626080 3847919 4296150 4559747 4862767 21192663 0.99820 0.99790 0.00180 0.00210 X 1 X X X X X X 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 0 350223 0 38646 0 7000 0 85439 0 8234 0 489542 0 0 DAVID MCKENZIE SENIOR VICE PRESIDENT & CF 233539 0 20618 0 0 0 32201 0 6877 0 293235 0 0 0 PART I, LINE 3 CHILDSERVE INC. OBTAINS A COMPREHENSIVE MARKET BASED STUDY TO OBTAIN COMPENSATION DATA FOR EACH KEY EMPLOYEE FROM SIMILAR TYPE AGENCIES AND ORGANIZATIONS EVERY THREE YEARS. DURING THE YEARS WHEN THE STUDY IS NOT CONDUCTED, MARKET BASED INFORMATION SUCH AS CPI OR COMPARABLE DATA WILL BE USED ANNUALLY TO MAKE ADJUSTMENTS TO THE MIDPOINT. THE EXECUTIVE COMMITTEE OF CHILDSERVE INC.'S BOARD OF DIRECTORS HAS THE RESPONSIBILITY TO OVERSEE THE IMPLEMENTATION OF THE EXECUTIVE COMPENSATION POLICY. THE EXECUTIVE COMMITTEE WILL APPROVE THE COMPENSATION ARRANGEMENTS FOR THE PRESIDENT/CEO WITHOUT DISCUSSION OR VOTING PARTICIPATION OF THE PRESIDENT/CEO. PART I, LINE 6 INCENTIVE PAY IS BASED ON MEETING BUDGETED ORGANIZATIONAL NET EARNINGS. FORM 990, PART VI, SECTION B, LINE 11 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 THREE KEY EMPLOYEES: PRESIDENT/CEO, VICE PRESIDENT OF ADMINISTRATION, AND VICE PRESIDENT OF PROGRAMS. 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. CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 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 9 CHILDSERVE INC 1 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 1 CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 1 CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 50131 421390033 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 1 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 50131 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 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 11A, 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 9 CHILDSERVE INC 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 CHILDSERVE HABILITATION CENTER Q 2945488 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMES INC Q 693209 BASED ON PROPORTIONATE REVENUE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC Q 137784 BASED ON PROPORTIONATE REVENUE CHILDSERVE THERAPY INC Q 490110 BASED ON PROPORTIONATE REVENUE CHILDSERVE COMMUNITY OPTIONS Q 387606 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMECARE INC Q 113469 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER K 181056 BASED ON SQUARE FOOTAGE 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