2015-01-14T08:40:05-06:00 2014-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2013-07-01 421271420 CHILDSERVE INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK PRESIDENT/CEO 5157278750 2015-01-13 1 BRENT L ALEXANDER P00075113 5152237300 2013 2016-03-07 17:11:31Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 4296150 0 X WWW.CHILDSERVE.ORG X 1985 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 18 17 39 0 0 0 0 5000 0 0 13294 18864 3858210 4272286 3871504 4296150 0 0 0 0 2996412 3245942 0 0 0 875092 1050208 3871504 4296150 0 0 0 0 0 0 0 0 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. 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 6 0 1 39 1 0 0 0 0 0 0 0 0 0 0 X 18 17 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 LINDA KADING DIRECTOR 2.00 X 0 0 0 DAVID MACKAMAN DIRECTOR 2.00 X 0 0 0 PAUL NAGEL PAST CHAIR 2.00 X X 0 0 0 MICHAEL GUMINA DIRECTOR 2.00 X 0 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 0.00 40.00 X X 0 334339 29807 KIP ALBERTSON VICE CHAIR 2.00 0.00 X X 0 0 0 JAY BYERS DIRECTOR 2.00 X 0 0 0 DOUG DORNACKER TREASURER 2.00 X X 0 0 0 JIM SANDERS DIRECTOR 2.00 X 0 0 0 DR WILLIAM LEPLEY DIRECTOR 2.00 X 0 0 0 SALLY STUDER DIRECTOR 2.00 X 0 0 0 JOHN TEMPLE DIRECTOR 2.00 X 0 0 0 SHIRLEY POERTNER DIRECTOR 2.00 X 0 0 0 RANDY VON FUMETTI DIRECTOR 2.00 X 0 0 0 MARIA WOOD DIRECTOR 2.00 X 0 0 0 FRANK STORK SECRETARY 2.00 X X 0 0 0 JOEL NELSON CHAIR 2.00 X X 0 0 0 DAVID MCKENZIE SENIOR VICE PRESIDENT & CHIEF FINANCIAL OFFICER 40.00 X 213659 0 13793 213659 334339 43600 1 0 1 0 0 5000 5000 18864 18864 ADMINISTRATION SUPPORT 561000 4237186 4237186 COMPANY STORE 453000 17933 17933 MISCELLANEOUS 900099 17167 17167 4272286 4296150 4272286 0 18864 223631 223631 2464836 2464836 89284 89284 311720 311720 156471 156471 20877 20877 55800 55800 290375 290375 33099 33099 130294 130294 213375 213375 20209 20209 20450 20450 30972 30972 RECRUITMENT EXPENSE 108582 108582 EQUIPMENT RENTAL AND MA 42262 42262 DUES AND SUBSCRIPTIONS 27684 27684 MISCELLANEOUS OPERATING 26667 26667 29562 29562 4296150 0 4296150 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 10938 2151 5500 5000 23589 3378310 3582644 3617893 3834625 4272286 18685758 3389248 3584795 3623393 3834625 4277286 18709347 0 0 0 18709347 5312 2687 13294 18864 40157 5312 2687 13294 18864 40157 3389248 3590107 3626080 3847919 4296150 18749504 0.99790 0.99880 0.00210 0.00120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 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, 2011 THROUGH JUNE 30, 2014. X 1 1 X X X X X X 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK PRESIDENT/CEO 0 252293 0 54043 0 28003 0 20606 0 9201 0 364146 0 0 DAVID MCKENZIE SENIOR VICE PRESIDENT & CHIEF FINANC 167324 0 28835 0 17500 0 9106 0 4687 0 227452 0 0 0 PART I, LINE 1A THE TAX INDEMNIFICATION AND GROSS-UP PAYMENTS ARE RELATED TO TAXABLE FRINGE BENEFITS INCLUDED AS COMPENSATION FOR THE PRESIDENT/CEO OF THE ORGANIZATION. PART I, LINE 6 INCENTIVE PAY IS BASED ON MEETING A COMPREHENSIVE SET OF RESULTS WHICH INCLUDES NET EARNINGS. FRANK STORK MEMBER OF THE CHILDSERVE INC. BOARD OF DIRECTORS AND AN OFFICER AT WELLMARK 311401 ADMINISTRATIVE FEES FOR SELF-INSURED HEALTH PLAN PAID TO WELLMARK. 0 0 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 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 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 CHILDSERVE HABILITATION CENTER Q 2681948 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMES INC Q 663674 BASED ON PROPORTIONATE REVENUE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC Q 93246 BASED ON PROPORTIONATE REVENUE CHILDSERVE THERAPY INC Q 282781 BASED ON PROPORTIONATE REVENUE CHILDSERVE FOUNDATION INC Q 50000 BASED ON PROPORTIONATE REVENUE CHILDSERVE COMMUNITY OPTIONS Q 268452 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMECARE INC Q 147085 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER K 196677 BASED ON SQUARE FOOTAGE 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