2013-11-08T08:22:52-06:00 2013-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2012-07-01 420680245 CHILDSERVE HABILITATION CENTER CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK 5157278750 2013-10-31 1 BRENT L ALEXANDER P00075113 5152237300 2012 2016-02-24 21:20:13Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 16615467 0 X WWW.CHILDSERVE.ORG X 1928 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 6 5 232 349 0 0 457961 177464 12933242 14367043 15272 19332 2025307 2051628 15431782 16615467 0 0 0 0 8311461 8784588 0 0 0 6442861 7046020 14754322 15830608 677460 784859 27437772 36473981 20111980 28389592 7325792 8084389 TO ENHANCE THE WELL BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND CHRONIC HEALTH CONDITIONS BY PROVIDING PEDIATRIC SKILLED NURSING CARE AND SPECIALTY SERVICES. 0 0 10175721 16418671 TWO LEVELS OF SKILLED NURSING SERVICES ARE PROVIDED, CONTINUING CARE AND TRANSITIONAL CARE. CONTINUING CARE IS LONG TERM SKILLED NURSING SERVICE FOR CHILDREN WITH SPECIALTY HEALTH CARE AND SUPPORT NEEDS. THE CONTINUING CARE UNIT IS LICENSED FOR 37 BEDS AND HAD A 98.79% OCCUPANCY RATE SERVING 42 DIFFERENT CHILDREN. TRANSITIONAL CARE PROVIDES SUB-ACUTE LEVEL OF CARE FOR CHILDREN WHO REQUIRE SHORT TERM INTENSIVE NURSING CARE AND REHABILITATION SERVICES. THE TRANSITIONAL CARE UNIT IS LICENSED FOR 21 BEDS AND SERVED 59 DIFFERENT CHILDREN. SKILLED NURSING SERVICES INCLUDE: PHYSICAL, MEDICAL, EDUCATIONAL, SOCIAL, PSYCHOLOGICAL, OCCUPATIONAL, RECREATIONAL, DIETARY AND SPEECH SERVICES. 10175721 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 232 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 0.30 2.40 X X 0 0 0 FRANK STORK 0.30 2.10 X X 0 0 0 LLOYD VANDER KWAAK 19.00 21.00 X X 141333 150613 27267 KIP ALBERTSON 0.30 2.10 X X 0 0 0 JOHN TEMPLE 0.30 2.10 X X 0 0 0 PAUL NAGEL 0.30 2.10 X X 0 0 0 TERESA WAHLIG 40.00 X 225653 0 16014 TRACEY PAGE 40.00 X 103321 0 3196 470307 150613 46477 3 0 1 0 0 177464 177464 SKILLED NURSING CARE 621300 14187444 14187444 THERAPY SERVICES (INCLUDING AQUAT 621300 179599 179599 14367043 19332 19332 FACILITY SUPPORT REVENUE 621300 1252329 1252329 LEASE REVENUE 532420 672424 672424 DIETARY REVENUE 621300 110686 110686 16189 16189 2051628 16615467 16418671 0 19332 399490 245198 154292 7098832 6425030 673802 105920 102669 3251 646076 546638 99438 534270 469591 64679 1688 1163 525 466384 394470 71914 836531 814573 21958 1231862 149452 1082410 159795 75854 83941 35757 31691 4066 886885 886885 811124 299475 511649 62530 60082 2448 ADMINISTRATION SUPPORT 1855980 1855980 EQUIPMENT RENTAL & MAIN 338244 326889 11355 WORKERS COMPENSATION 139125 124398 14727 FOUNDATION SUPPORT 98080 98080 122035 108548 13487 15830608 10175721 5654887 0 1403814 104196 72695 10309152 2116946 1552355 49044 55900 58897 120723 28962470 11813291 15823113 17149179 1297975 1346713 6615288 5835763 27437772 36473981 2059993 3326406 18051987 25063186 20111980 28389592 X 7325792 8084389 7325792 8084389 27437772 36473981 X 784859 -26262 X 0 1 X 1 0 X 1023817 694342 110555 457961 177464 2464139 13758415 13274426 14733991 14958549 16418671 73144052 14782232 13968768 14844546 15416510 16596135 75608191 0 0 0 75608191 74622 74975 70785 15272 19332 254986 74622 74975 70785 15272 19332 254986 14856854 14043743 14915331 15431782 16615467 75863177 0.99660 0.99550 0.00340 0.00450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2640249 2640249 21531304 9535747 11995557 2337134 1932269 404865 2453783 345275 2108508 17149179 INTEREST RECEIVABLE 979 LIFE INSURANCE PROCEEDS RECEIVABLE 130050 DUE FROM AFFILIATES 5704734 5835763 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING FOR UNCERTAIN TAX POSITIONS: CHILDSERVE, INC. AND SUBSIDIARIES (EXCEPT FOR CHILDSERVE CLINIC) 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, 2010 THROUGH JUNE 30, 2013. CHILDSERVE CLINIC WAS INCORPORATED DURING THE YEAR ENDED JUNE 30, 2012 AND APPLIED FOR TAX-EXEMPT STATUS DURING THE YEAR ENDING JUNE 30, 2013. X 1 1 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK 113067 120493 15017 16004 13249 14116 8284 8829 4915 5239 154532 164681 0 0 TERESA WAHLIG 208653 0 0 0 17000 0 12239 0 3775 0 241667 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 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 A COMPREHENSIVE SET OF RESULTS WHICH INCLUDES NET EARNINGS. A IOWA FINANCE AUTHORITY 521699886 46246UBQ2 2006-03-30 19663662 FACILITY CONSTRUCTION AND REFUND PRIOR ISSUE (8/1/2002) 0 0 0 B CITY OF WINDSOR HEIGHTS IOWA 421271420 2013-03-14 7500000 CONSTRUCT, IMPROVE, & EQUIP FACILITIES 0 0 0 A 1710000 22091617 1354944 557142 392979 68651 6821889 13926707 2007 1 1 1 1 B 7506463 49729 147500 545008 6764226 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0 0 0 A 0 0 1 1 0 0 1 CITIGROUP 5.200000000000 1 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/28/2011 SCHEDULE K, PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 3: THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. 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 CHILDSERVE INC.(A RELATED ORGANIZATION) 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNREALIZED GAIN/LOSS ON INVESTMENTS -26,262. CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 501310707 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 501310707 421264666 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 501310707 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE INC PO BOX 707 JOHNSTON IA 501310707 421271420 PARENT COMPANY FOR BENEFIT & SUPPORT OF PROGRAMS/ SERVICES OF CHILDSERVE IA 501(C)(3) LINE 9 0 CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 501310707 421390033 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 501310707 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE FOUNDATION INC PO BOX 707 JOHNSTON IA 501310707 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 501310707 455327981 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 CHILDSERVE INC 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 1 CHILDSERVE HOMES INC J 16862 BASED ON SQUARE FOOTAGE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC J 61400 BASED ON SQUARE FOOTAGE CHILDSERVE THERAPY INC J 294916 BASED ON SQUARE FOOTAGE CHILDSERVE FOUNDATION INC J 10006 BASED ON SQUARE FOOTAGE CHILDSERVE INC J 151851 BASED ON SQUARE FOOTAGE CHILDSERVE COMMUNITY OPTIONS J 129726 BASED ON SQUARE FOOTAGE CHILDSERVE HOMECARE INC J 7664 BASED ON SQUARE FOOTAGE CHILDSERVE HOMES INC L 2976 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE FOUNDATION INC C 177464 BASED ON APPROVED NEEDS CHILDSERVE INC L 4677 TRANSPORTATION BASED ON HOURS USE CHILDSERVE COMMUNITY OPTIONS L 12609 TRANSPORTATION BASED ON HOURS USE CHILDSERVE HOMES INC L 122253 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE COMMUNITY OPTIONS L 159148 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE HOMES INC L 13589 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE INC P 1855980 BASED ON PROPORTIONATE REVENUE CHILDSERVE FOUNDATION INC P 98080 BASED ON HISTORICAL SUPPORT % CHILDSERVE HOMES INC S 38055 ACTUAL CASH TRANSFERED CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC S 115782 ACTUAL CASH TRANSFERED CHILDSERVE THERAPY INC R 335631 ACTUAL CASH TRANSFERED CHILDSERVE FOUNDATION INC S 1144405 ACTUAL CASH TRANSFERED CHILDSERVE COMMUNITY OPTIONS R 176022 ACTUAL CASH TRANSFERED CHILDSERVE HOMECARE INC S 80805 ACTUAL CASH TRANSFERED CHILDSERVE CLINIC INC R 73259 ACTUAL CASH TRANSFERED 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 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: THE CHILDSERVE CLINIC, INC. PRIMARY ACTIVITY: IMPROVE ACCESS TO PEDIATRIC SUBSPECIALTY MEDICAL SERVICES, PEDIATRIC REHABILITATION SERVICES, AND IN-HOME FAMILY SUPPORT SERVICES