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 421157665 CHILDSERVE FOUNDATION INC 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 4019332 0 X WWW.CHILDSERVE.ORG X 1981 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 14 13 4 688 0 0 669627 3043976 0 0 188251 85818 204649 267719 1062527 3397513 810793 491043 0 0 200018 216059 0 0 358265 160553 233649 1171364 940751 -108837 2456762 9270749 12121673 111880 105856 9158869 12015817 OPERATING AS A FOUNDATION TO DEVELOP, RECEIVE AND GRANT FINANCIAL ASSISTANCE TO THE CHILDSERVE ORGANIZATIONS. 0 0 491043 491043 GRANTED $491,043 TO OTHER CHILDSERVE ORGANIZATIONS TO HELP MEET THE NEEDS OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS. 491043 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 4 1 0 0 0 0 0 0 0 0 0 0 X 14 13 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 CATHY STJERNBERG 2.00 X 0 0 0 CHRIS RISEWICK 2.00 X 0 0 0 PETER CARTWRIGHT 2.00 X X 0 0 0 LLOYD VANDER KWAAK 1.00 39.00 X X 3795 288151 27267 STEVE GOODING 2.00 X X 0 0 0 AMANDA BRINK HULL 2.00 X 0 0 0 DAVID NELSON 2.00 X 0 0 0 LARRY STELTER 2.00 X 0 0 0 RALPH YOUNG 2.00 X 0 0 0 MARSHALL PORTER 2.00 X X 0 0 0 JOEL NELSON 0.30 2.40 X 0 0 0 PAT MCGOLDRICK 2.00 X 0 0 0 DAVID VAN AHN 2.00 X 0 0 0 BRIAN LAURENZO 2.00 X X 0 0 0 3795 288151 27267 0 0 1 0 0 17547 3026429 3043976 158366 158366 498833 571381 -72548 -72548 -72548 118157 17547 50438 67719 67719 FOUNDATION SUPPORT 561000 200000 200000 200000 3397513 200000 0 153537 488188 488188 2855 2855 4143 4143 184222 184222 3642 3642 11064 11064 12988 12988 12062 12062 40718 8 40710 41810 41810 10915 10915 7480 7480 90 90 4262 4262 2579 2579 802 802 ADMINISTRATION SUPPORT 50000 50000 TRUST EXPENSE 25041 25041 MISCELLANEOUS OPERATING 18873 9553 9320 PUBLIC RELATIONS 8990 8990 10027 10027 940751 491043 91443 358265 32696 12057 446214 492736 97621 1533113 3563988 808299 2804453 2755689 3869275 4081211 1179327 1249688 841163 1997179 9270749 12121673 13242 9961 98638 95895 111880 105856 X 5396181 6601016 2090953 3734063 1671735 1680738 9158869 12015817 9270749 12121673 X 2456762 329826 70360 X 0 1 X 1 0 X X 0 0 0 CHILDSERVE HABILITATION CENTER 420680245 9 1 177464 CHILDSERVE HOMES INC 421264664 9 1 96189 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC 421264666 9 1 0 CHILDSERVE THERAPY INC 420680420 9 1 42703 CHILDSERVE HOMECARE INC 421478832 9 1 1616 CHILDSERVE INC 421271420 9 1 0 CHILDSERVE COMMUNITY OPTIONS 421390033 9 1 71646 CHILDSERVE CLINICS 455327981 9 1 98570 8 488188 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2896740 0 321167 136999 3080908 3004092 1545 28298 137195 2896740 2693513 444768 134189 3004092 2465995 343187 115669 2693513 3176063 -548102 161966 2465995 0.21020 0.47850 0.31130 0 0 414629 414629 3139268 798208 2341060 10091 10091 0 2755689 BENEFICIAL INTEREST IN PERPETUAL TRUST 206347 F BENEFICIAL INTEREST IN COMMUNITY TRUST 109986 F BENEFICIAL INTEREST IN TRUST 933355 F 1249688 CASH SURRENDER VALUE OF LIFE INSURANCE 84477 ACCRUED INTEREST RECEIVABLE 11764 DUE FROM AFFILIATES - CHILDSERVE HABILITATION CENTER 1900938 1997179 ANNUITY PAYABLE 95895 95895 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE PRIMARY USE OF ENDOWMENT FUNDS IS FOR GRANTS TO OTHER RELATED CHILDSERVE ORGANIZATIONS FOR OPERATING NEEDS AS FURTHER DISCLOSED IN SCHEDULE I. THERE ARE TWO OTHER SMALL ENDOWMENTS FOR WHICH EARNINGS ARE USED FOR NURSING SCHOLARSHIPS AND STAFF EDUCATION. 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. GOLF OUTING 51023 5500 45523 477 5993 BUBBLE BALL 82081 12047 70034 31767 2250 7532 1 2600 2600 2419 135704 17547 118157 32244 8243 9951 50438 67719 1 CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 501310707 420680245 501(C)(3) 177464 PROVIDE PEDIATRIC NURSING & SERVICES FOR CHILDREN WITH SPECIAL NEEDS CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 501310707 421264664 501(C)(3) 96189 PROVIDE HEALTH CARE IN HOMES & APARTMENTS FOR CHILDREN WITH SPECIAL NEEDS CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 501310707 420680420 501(C)(3) 42703 PROVIDE THERAPY & AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL NEEDS PARENT COMPANY FOR BENEFIT & SUPPORT OF PROGRAMS/ SERVICES OF CHILDSERVE CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 501310707 421390033 501(C)(3) 71646 PROVIDE INTEGRATED SERVICES & COMMUNITY CARE FOR CHILDREN WITH SPECIAL NEEDS PROVIDE SPECIALTY MOBILITY EQUIPMENT, SPECIALTY MEDICAL SUPPLIES FOR CHILDREN WITH SPECIAL NEEDS CHILDSERVE HOMECARE PO BOX 707 JOHNSTON IA 501310707 421478832 501(C)(3) 1616 PROVIDE SPECIALTY HOME HEALTH CARE FOR CHILDREN WITH SPECIAL NEEDS CHILDSERVE CLINICS PO BOX 707 JOHNSTON IA 501310707 455327981 501(C)(3) 98570 PROVIDE PEDIATRIC SUBSPECIALTY MEDICAL SERVICES FOR CHILDREN WITH SPECIAL NEEDS 6 0 X 1 1 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK 3036 230524 403 30618 356 27009 222 16891 132 10022 4149 315064 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. LARRY STELTER TRUSTEE ON THE CHILDSERVE FOUNDATION BOARD & OFFICER OF THE STELTER COMPANY 30402 PAYMENTS TO THE STELTER COMPANY FOR WEBSITE MANAGEMENT, COMPANY NEWSLETTERS AND MAILING OF THOSE NEWSLETTERS. 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 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: CHANGE IN VALUE IN BENEFICIAL INTERESTS IN TRUSTS 70,360. 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 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 THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 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 COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 50131 421390033 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 HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 9 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 CHILDSERVE HABILITATION CENTER R 1144405 ACTUAL CASH TRANSFERRED CHILDSERVE INC P 50000 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER K 10006 BASED ON SQUARE FOOTAGE CHILDSERVE HABILITATION CENTER B 177464 BASED ON APPROVED NEEDS CHILDSERVE HABILITATION CENTER Q 98080 BASED ON HISTORICAL SUPPORT % CHILDSERVE HOMES INC Q 37080 BASED ON HISTORICAL SUPPORT % CHILDSERVE HOMES INC B 96189 BASED ON APPROVED NEEDS CHILDSERVE COMMUNITY OPTIONS Q 19480 BASED ON HISTORICAL SUPPORT % CHILDSERVE COMMUNITY OPTIONS B 71646 BASED ON APPROVED NEEDS CHILDSERVE HOMECARE INC Q 7000 BASED ON HISTORICAL SUPPORT % CHILDSERVE THERAPY INC Q 32620 BASED ON HISTORICAL SUPPORT % CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC Q 5740 BASED ON HISTORICAL SUPPORT % CHILDSERVE THERAPY INC B 42703 BASED ON APPROVED NEEDS CHILDSERVE HOMECARE INC B 1616 BASED ON APPROVED NEEDS CHILDSERVE CLINICS B 98570 BASED ON APPROVED NEEDS 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 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: CHILDSERVE HOMES, INC. PRIMARY ACTIVITY: PROVIDE COMMUNITY BASED GROUP HOME LIVING 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