2015-12-04T08:56:59-06:00 2015-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2014-07-01 421390033 CHILDSERVE COMMUNITY OPTIONS CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK PRESIDENT/CEO 5157278750 2015-12-03 1 BRENT L ALEXANDER P00075113 5152237300 2014 2016-03-07 17:11:31Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 9396916 0 X WWW.CHILDSERVE.ORG X 1992 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 6 5 523 18 0 0 39228 113446 8848993 9280707 0 0 3183 2763 8891404 9396916 0 0 0 0 7466808 8000883 0 0 0 1729141 2174427 9195949 10175310 -304545 -778394 2769388 2788478 6289091 7086575 -3519703 -4298097 X TO ENHANCE THE WELL BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS BY PROVIDING INTEGRATED COMMUNITY CARE AND SERVICES. 0 0 1680759 1801777 CHILDSERVE CASE MANAGEMENT - ASSESSES THE NEEDS OF POLK COUNTY CHILDREN WITH SPECIAL HEALTH CARE NEEDS FOR THE PURPOSE OF ASSISTING THEM IN OBTAINING SERVICES, FUNDING AND DEVELOPING AN INDIVIDUALIZED CARE PLAN, AND THEN MONITORING THE IMPLEMENTATION OF THAT PLAN. DURING THE CURRENT FISCAL YEAR, CHILDSERVE CASE MANAGEMENT SERVED 527 CHILDREN AGES BIRTH TO 22 YEARS. 2142915 2255365 CHILDSERVE CHILDCARE PROVIDES A UNIQUE CHILDCARE EXPERIENCE FOR AMES AND DES MOINES AREA CHILDREN WITH AND WITHOUT SPECIAL HEALTH CARE NEEDS. IN THE CURRENT FISCAL YEAR, CHILDSERVE CHILDCARE SERVED 241 CHILDREN. 2254000 2411024 CHILDSERVE RESPITE GIVES FAMILIES A BREAK FROM DAILY DEMANDS OF CARING FOR A CHILD WITH SPECIAL HEALTH CARE NEEDS. RESPITE IS PROVIDED IN THE CHILDREN'S HOMES AND IN THE COMMUNITY. IN THE CURRENT FISCAL YEAR, CHILDSERVE RESPITE PROVIDED SERVICES FOR 610 CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND PROVIDED AN AVERAGE OF 11,837 HOURS OF RESPITE SERVICE EACH MONTH. 1292877 1336907 CHILDSERVE SUPPORTED COMMUNITY LIVING (SCL) ASSISTS CHILDREN AND YOUNG ADULTS IN DEVELOPING AND MAINTAINING SOCIALIZATION, COMMUNICATION, AND PERSONAL MANAGEMENT SKILLS. IN THE CURRENT FISCAL YEAR, CHILDSERVE SCL PROVIDED INDIVIDUAL SERVICES TO 254 CHILDREN, AVERAGING 3,103 HOURS OF SERVICE PER MONTH. 1306552 1475634 CHILDSERVE DAY HABILITATION PROVIDES A UNIQUE CHILDCARE EXPERIENCE FOR AMES AND DES MOINES AREA CHILDREN WITH AND WITHOUT SPECIAL HEALTH CARE NEEDS. IN THE CURRENT FISCAL YEAR, CHILDSERVE CHILDCARE PROVIDED 68,273 HOURS OF SERVICE TO 148 CHILDREN. 2599429 2812541 8677103 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 0 0 0 1 3 0 1 523 1 0 0 0 0 0 0 0 0 0 0 X 6 5 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 JOEL NELSON PAST CHAIR 2.00 X X 0 0 0 KIP ALBERTSON CHAIR 2.00 X X 0 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 2.50 37.50 X X 23223 343074 57627 SHIRLEY POERTNER SECRETARY 2.00 X X 0 0 0 DOUG DORNACKER VICE CHAIR 2.00 X X 0 0 0 DAVID MACKAMAN TREASURER 2.00 X X 0 0 0 DAVE COMSTOCK VICE PRESIDENT HOME & COMMUNITY SERVICES 40.00 X 133410 0 13106 156633 343074 70733 1 0 1 0 0 109993 3453 113446 RESPITE 621300 2411024 2411024 CHILD CARE 621300 2255365 2255365 CASE MANAGEMENT 621300 1801777 1801777 DAY HEALTH/DAY HABILIT 621300 1475634 1475634 SCL 621300 1336907 1336907 9280707 MISCELLANEOUS INCOME 900099 2763 2763 2763 9396916 9283470 0 0 210374 164337 46037 6717712 6114750 602962 57709 32398 25311 507153 474635 32518 507935 461727 46208 79424 55151 24273 175 50 125 341530 303349 38181 610388 601857 8531 65244 51930 13314 18551 15539 3012 150771 150771 58717 58011 706 ADMINISTRATION SUPPORT 615154 615154 WORKERS COMPENSATION EX 76240 74235 2005 EQUIPMENT RENTAL AND MA 53033 41125 11908 BAD DEBT EXPENSE 37829 37829 67371 39409 27962 10175310 8677103 1498207 0 38714 49367 899321 968395 909 0 2571223 800507 1830444 1770716 2769388 2788478 180970 476890 6108121 6609685 6289091 7086575 X -3519703 -4298097 -3519703 -4298097 2769388 2788478 -778394 0 X 0 1 X 1 0 X 208904 58394 94734 39228 113446 514706 7359259 7782476 8240514 8848993 9280707 41511949 7568163 7840870 8335248 8888221 9394153 42026655 0 0 0 42026655 20 21 10 51 20 21 10 51 2763 2763 7568183 7840891 8335258 8888221 9396916 42029469 0.99990 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 332000 332000 1722291 474548 1247743 516932 325959 190973 1770716 DUE TO AFFILIATES 6609685 6609685 X PART X, LINE 2: ACCOUNTING FOR UNCERTAIN TAX POSITIONS: CHILDSERVE, INC. AND SUBSIDIARIES HAVE DETERMINATION LETTERS FROM THE IRS WITH VARIOUS DATES STATING THE ORGANIZATION AND ITS SUBSIDIARIES ARE EXEMPT FROM INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHILDSERVE, INC. AND SUBSIDIARIES FILES FORM 990 TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. MANAGEMENT OF THE ORGANIZATION BELIEVES IT HAS NO MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, WILL NOT RECOGNIZE ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. ANY INTEREST AND PENALTY PAYMENTS WOULD BE RECORDED IN SEPARATE ACCOUNTS IN THE OPERATING EXPENSES. THE ORGANIZATION'S REMAINING OPEN YEARS SUBJECT TO EXAMINATION INCLUDE THE YEARS ENDED JUNE 30, 2012 THROUGH JUNE 30, 2015. 1 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 18412 272004 3258 48123 1553 22947 3133 46283 521 7690 26877 397047 0 0 PART I, LINE 3 CHILDSERVE INC. (A RELATED ORGANIZATION) 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 HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 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 9 CHILDSERVE INC 0 CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 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 9 0 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 50131 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 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 0 THE CHILDSERVE CLINIC INC PO BOX 707 JOHNSTON IA 50131 455327981 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1 CHILDSERVE HABILITATION CENTER S 501564 ACTUAL CASH TRANSFERRED CHILDSERVE HABILITATION CENTER K 146966 BASED ON SQUARE FOOTAGE CHILDSERVE INC P 615155 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER M 136875 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE FOUNDATION C 109993 BASED ON APPROVED NEEDS PART II, IDENTIFICATION OF RELATED TAX - EXEMPT ORGANIZATIONS: 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 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 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 THERAPY, INC. PRIMARY ACTIVITY: PROVIDE SKILLED THERAPY AND AUDIOLOGY SERVICES 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