CHILDSERVE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CHILDSERVE INC (EIN 42-1271420)
Tax period
2012-07-01 to 2013-06-30
Filed
2013-11-08
IRS object ID
201313129349301051
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-08T08:22:52-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN421229486EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BROOKS LODDEN PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11441 29TH STREET STE 305AddressLine1
CityWEST DES MOINESCity
StateIAState
ZIP Code502661357ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421271420EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHILDSERVE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHILNameControl
Phone5157278750Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 707AddressLine1
CityJOHNSTONCity
StateIAState
ZIP Code501310707ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLLOYD VANDER KWAAKName
TitlePRESIDENT/CEOTitle
Phone5157278750Phone
Date Signed2013-10-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBRENT L ALEXANDERName
PTINP00075113PTIN
Phone5152237300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLLOYD VANDER KWAAKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 707AddressLine1
CityJOHNSTONCity
StateIAState
ZIP Code501310707ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3871504GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHILDSERVE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionWE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees47TotalNbrEmployees
Total Nbr Volunteers3TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5500ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year9073InvestmentIncomePriorYear
Investment Income Current Year13294InvestmentIncomeCurrentYear
Other Revenue Prior Year3631640OtherRevenuePriorYear
Other Revenue Current Year3858210OtherRevenueCurrentYear
Total Revenue Prior Year3646213TotalRevenuePriorYear
Total Revenue Current Year3871504TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2785134SalariesEtcPriorYear
Salaries Etc Current Year2996412SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year861079OtherExpensePriorYear
Other Expenses Current Year875092OtherExpensesCurrentYear
Total Expenses Prior Year3646213TotalExpensesPriorYear
Total Expenses Current Year3871504TotalExpensesCurrentYear
Revenues Less Expenses Prior Year0RevenuesLessExpensesPriorYear
Revenues Less Expenses CY0RevenuesLessExpensesCY
Total Assets BOY0TotalAssetsBOY
Total Assets EOY0TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY0NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Mission DescriptionTO 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionOPERATE AS PARENT COMPANY AND CORPORATE FRAMEWORK FOR THE BENEFIT AND SUPPORT OF THE PROGRAMS OFFERED BY THE CHILDSERVE NONPROFIT TAX-EXEMPT ORGANIZATIONS.Description
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees47NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums1FundsToPayPremiums
Premiums Paid1PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHILDSERVEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5157278750TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 707AddressLine1
CityJOHNSTONCity
StateIAState
ZIP Code501310707ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedOfficerOfficer
JOHN BRUNTZ
DIRECTOR2.00X000
LINDA KADING
DIRECTOR2.00X000
DAVID MACKAMAN
DIRECTOR2.00X000
PAUL NAGEL
CHAIR0.30X0002.10X
MICHAEL GUMINA
DIRECTOR2.00X000
LLOYD VANDER KWAAK
PRESIDENT/CEO1.00X02919462726739.00X
KIP ALBERTSON
TREASURER0.30X0002.10X
JAY BYERS
DIRECTOR2.00X000
DOUG DORNACKER
DIRECTOR2.00X000
JIM SANDERS
DIRECTOR2.00X000
DR WILLIAM LEPLEY
DIRECTOR2.00X000
KAREN GERDES MD
DIRECTOR2.00X000
JOHN TEMPLE
PAST CHAIR0.30X0002.10X
SHIRLEY POERTNER
DIRECTOR2.00X000
RANDY VON FUMETTI
DIRECTOR2.00X000
MARIA WOOD
DIRECTOR2.00X000
FRANK STORK
SECRETARY0.30X0002.10X
JOEL NELSON
VICE CHAIR0.30X0002.40X
DAVID MCKENZIE
VP BUSINESS40.00194473014936X
FieldValueIRS element (for citing)
Total Reportable Comp From Org194473TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs291946TotalReportableCompFrmRltdOrgs
Total Other Compensation42203TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column13294TotalRevenueColumn
Exclusion$13,294ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADMINISTRATION SUPPORT56100038346253834625
COMPANY STORE4530001887618876
MISCELLANEOUS90009947094709
FieldValueIRS element (for citing)
Total Other Revenue3858210TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3871504TotalRevenueColumn
Related Or Exempt Function Income3858210RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$13,294ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total218190Total
Management And General218190ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2326827Total
Management And General2326827ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total86870Total
Management And General86870ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total213884Total
Management And General213884ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total150641Total
Management And General150641ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total9765Total
Management And General9765ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total63190Total
Management And General63190ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total189953Total
Management And General189953ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total22027Total
Management And General22027ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total113759Total
Management And General113759ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total168440Total
Management And General168440ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total25131Total
Management And General25131ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total17520Total
Management And General17520ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total28713Total
Management And General28713ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
RECRUITMENT EXPENSE103296103296
EQUIPMENT RENTAL AND MA6430064300
DUES AND SUBSCRIPTIONS1739417394
MISCELLANEOUS OPERATING1528715287

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total36317Total
Management And General36317ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3871504Total
Program Services0ProgramServices
Management And General3871504ManagementAndGeneral
Fundraising0Fundraising

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses0ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years20745CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10938CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2151CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5500CurrentTaxYearMinus1Year
Total39334Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3528459CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3378310CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3582644CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3617893CurrentTaxYearMinus1Year
Current Tax Year3834625CurrentTaxYear
Total17941931Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3549204CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3389248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3584795CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3623393CurrentTaxYearMinus1Year
Current Tax Year3834625CurrentTaxYear
Total17981265Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50917981265PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years5312CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2687CurrentTaxYearMinus1Year
Current Tax Year13294CurrentTaxYear
Total21293Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years5312CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2687CurrentTaxYearMinus1Year
Current Tax Year13294CurrentTaxYear
Total21293Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3549204CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3389248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3590107CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3626080CurrentTaxYearMinus1Year
Current Tax Year3847919CurrentTaxYear
Total18002558Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99880PublicSupportPercentage509
Prior Year Support Percentage0.99950PriorYearSupportPercentage
Investment Income Percentage0.00120InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00050PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationACCOUNTING 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LLOYD VANDER KWAAK
PRESIDENT/CEO0233560031021027365017113010154031921300
DAVID MCKENZIE
VP BUSINESS15388102359201700007580073560209409000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE 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 6INCENTIVE PAY IS BASED ON MEETING A COMPREHENSIVE SET OF RESULTS WHICH INCLUDES NET EARNINGS.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonFRANK STORKNamePerson
FieldValueIRS element (for citing)
RelationshipMEMBER OF THE CHILDSERVE INC. BOARD OF DIRECTORS AND AN OFFICER AT WELLMARKRelationship
Amount Of Transaction340721AmountOfTransaction
Description Of TransactionADMINISTRATIVE FEES FOR SELF-INSURED HEALTH PLAN PAID TO WELLMARK.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CMEMBERS 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 15THE 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CHILDSERVE HABILITATION CENTER
PO BOX 707JOHNSTONIA50131420680245SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC
PO BOX 707JOHNSTONIA50131421264666SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE THERAPY INC
PO BOX 707JOHNSTONIA50131420680420SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE HOMES INC
PO BOX 707JOHNSTONIA50131421264664SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE COMMUNITY OPTIONS
PO BOX 707JOHNSTONIA50131421390033SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE HOMECARE INC
PO BOX 707JOHNSTONIA50131421478832SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
CHILDSERVE FOUNDATION INC
PO BOX 707JOHNSTONIA50131421157665DEVELOP, RECEIVE AND GRANT FINANCIAL ASSISTANCE TO CHILDSERVE ORGANIZATIONSIA501(C)(3)LINE 11A, I0
THE CHILDSERVE CLINIC INC
PO BOX 707JOHNSTONIA50131455327981SEE PART VII - SUPPLEMENTAL INFORMATIONIA501(C)(3)LINE 9CHILDSERVE INC1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHILDSERVE HABILITATION CENTER
Q1855980BASED ON PROPORTIONATE REVENUE
CHILDSERVE HOMES INC
Q701670BASED ON PROPORTIONATE REVENUE
CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC
Q108619BASED ON PROPORTIONATE REVENUE
CHILDSERVE THERAPY INC
Q617272BASED ON PROPORTIONATE REVENUE
CHILDSERVE FOUNDATION INC
Q50000BASED ON PROPORTIONATE REVENUE
CHILDSERVE COMMUNITY OPTIONS
Q368623BASED ON PROPORTIONATE REVENUE
CHILDSERVE HOMECARE INC
Q132462BASED ON PROPORTIONATE REVENUE
CHILDSERVE HABILITATION CENTER
M4677TRANSPORTATION BASED ON HOURS USE
CHILDSERVE HABILITATION CENTER
K151851BASED ON SQUARE FOOTAGE

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferencePART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS:ReturnReference
ExplanationNAME 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 SERVICESExplanation

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