CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC (EIN 42-1264666)
Tax period
2011-07-01 to 2012-06-30
Filed
2012-11-12
IRS object ID
201223189349300347
Schema version
2011v1.2
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)
Timestamp2012-11-12T17:53:00-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421264666EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHILDSERVE MEDICAL EQUIPMENT & SUPPLY 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 Signed2012-11-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBRENT L ALEXANDERName
PTINP00075113PTIN
Phone5152237300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
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 Receipts1162245GrossReceipts
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 Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees4TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year19544ContributionsGrantsPriorYear
Contributions Grants Current Year78244ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1065292ProgramServiceRevenuePriorYear
Program Service Revenue CY1083758ProgramServiceRevenueCY
Investment Income Prior Year17InvestmentIncomePriorYear
Investment Income Current Year243InvestmentIncomeCurrentYear
Other Revenue Prior Year2OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year1084855TotalRevenuePriorYear
Total Revenue Current Year1162245TotalRevenueCurrentYear
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 Year223392SalariesEtcPriorYear
Salaries Etc Current Year162567SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year822270OtherExpensePriorYear
Other Expenses Current Year839337OtherExpensesCurrentYear
Total Expenses Prior Year1045662TotalExpensesPriorYear
Total Expenses Current Year1001904TotalExpensesCurrentYear
Revenues Less Expenses Prior Year39193RevenuesLessExpensesPriorYear
Revenues Less Expenses CY160341RevenuesLessExpensesCY
Total Assets BOY889275TotalAssetsBOY
Total Assets EOY1062218TotalAssetsEOY
Total Liabilities BOY41878TotalLiabilitiesBOY
Total Liabilities EOY54480TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY847397NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1007738NetAssetsOrFundBalancesEOY
Mission DescriptionTO ENHANCE THE WELL BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS BY PROVIDING MOBILITY EQUIPMENT, SPECIALTY SUPPLIES AND SERVICES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense761635Expense
Revenue1083758Revenue
DescriptionPROVIDES MEDICAL SUPPLIES AND ADAPTS EQUIPMENT FOR USE BY PERSONS WITH PHYSICAL DISABILITIES IN THE COMMUNITY AND WITHIN THE CHILDSERVE RESIDENTIAL FACILITIES.Description
Total Program Service Expense761635TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
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 Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
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 Organization0BsnssRltnshpWithOrganization
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 Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees4NumberOfEmployees
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 Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
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 (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOEL NELSON
TREASURER2.00XX000
LINDA KADING
SECRETARY2.00XX000
LLOYD VANDER KWAAK
PRESIDENT/CEO2.00XX1311624919816376
DR WILLIAM LEPLEY
PAST CHAIR2.00XX000
JOHN TEMPLE
CHAIR2.00XX000
PAUL NAGEL
VICE CHAIR2.00XX000
FieldValueIRS element (for citing)
Total Reportable Comp From Org13116TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs249198TotalReportableCompFrmRltdOrgs
Total Other Compensation16376TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns11394FederatedCampaigns
Related Organizations66850RelatedOrganizations
Total Contributions78244TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADAPTIVE EQUIPMENT621300694505694505
MEDICAL SUPPLIES621300389253389253
FieldValueIRS element (for citing)
Total Program Service Revenue1083758TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column243TotalRevenueColumn
Exclusion$243ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1162245TotalRevenueColumn
Related Or Exempt Function Income1083758RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$243ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total13116Total
Management And General13116ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total129015Total
Program Services108847ProgramServices
Management And General20168ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3579Total
Program Services2483ProgramServices
Management And General1096ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6476Total
Program Services1252ProgramServices
Management And General5224ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total10381Total
Program Services8022ProgramServices
Management And General2359ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total626960Total
Program Services621608ProgramServices
Management And General5352ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total65700Total
Management And General65700ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total5849Total
Program Services5027ProgramServices
Management And General822ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total230Total
Program Services230ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1142Total
Program Services1142ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1788Total
Program Services1165ProgramServices
Management And General623ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
ADMINISTRATION SUPPORT102397102397
OTHER MISCELLANEOUS EXP1236612366
BAD DEBT EXPENSE75117511
DUES AND SUBSCRIPTIONS54674871596

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total9927Total
Program Services3752ProgramServices
Management And General6175ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1001904Total
Program Services761635ProgramServices
Management And General240269ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY75640BOY
EOY56810EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY157233BOY
EOY164965EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY84517BOY
EOY70115EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis50056LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec44452LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6746BOY
EOY5604EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY565139BOY
EOY764724EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY889275BOY
EOY1062218EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY41878BOY
EOY54480EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY41878BOY
EOY54480EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY847397BOY
EOY1007738EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY847397BOY
EOY1007738EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY889275BOY
EOY1062218EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses160341ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years32084CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22893CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39378CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19544CurrentTaxYearMinus1Year
Current Tax Year78244CurrentTaxYear
Total192143Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1091387CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1223785CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1073601CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1065294CurrentTaxYearMinus1Year
Current Tax Year1083758CurrentTaxYear
Total5537825Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1123471CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1246678CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1112979CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1084838CurrentTaxYearMinus1Year
Current Tax Year1162002CurrentTaxYear
Total5729968Total

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 Total5095729968PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years252CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years251CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years177CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17CurrentTaxYearMinus1Year
Current Tax Year243CurrentTaxYear
Total940Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years252CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years251CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years177CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17CurrentTaxYearMinus1Year
Current Tax Year243CurrentTaxYear
Total940Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1123723CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1246929CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1113156CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1084855CurrentTaxYearMinus1Year
Current Tax Year1162245CurrentTaxYear
Total5730908Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99980PublicSupportPercentage509
Prior Year Support Percentage0.99980PriorYearSupportPercentage
Investment Income Percentage0.00020InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00020PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis25098InvestmentCostOrOtherBasis
Depreciation19494Depreciation
Book Value5604BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis24958InvestmentCostOrOtherBasis
Depreciation24958Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5604TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionDUE FROM AFFILIATEDescription
Book Value764724BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets764724TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X: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 (EXCEPT FOR CHILDSERVE CLINIC) ALL FILE 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 ORGANIZATIONS REMAINING OPEN YEARS SUBJECT TO EXAMINATION INCLUDE THE YEARS ENDED JUNE 30, 2009 THROUGH JUNE 30, 2012. CHILDSERVE CLINIC WAS INCORPORATED DURING THE YEAR ENDED JUNE 30, 2012 AND INTENDS TO APPLY 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

FieldValueIRS element (for citing)
Name PersonLLOYD VANDER KWAAKNamePerson
Base Compensation Filing Org10472BaseCompensationFilingOrg
Comp Based On Related Orgs198972CompBasedOnRelatedOrgs
Bonus Filing Org1219BonusFilingOrg
Bonus Related Orgs23160BonusRelatedOrgs
Other Compensation Filing Org1425OtherCompensationFilingOrg
Other Compensation Related Orgs27066OtherCompensationRelatedOrgs
Deferred Comp Filing Org358DeferredCompFilingOrg
Deferred Comp Related Orgs6799DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org461NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs8758NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org13935TotalCompensationFilingOrg
Total Compensation Related Orgs264755TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

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 O IRS990ScheduleO

General Explanation GeneralExplanation (5 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.
FORM 990, PART XII, LINE 2CTHE ORGANIZATION FORMED AN INDEPENDENT AUDIT SUBCOMMITTEE OF THE FINANCE COMMITTEE, WHICH NOW ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT.

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 HOMES INC
PO BOX 707JOHNSTONIA50131421264664PROVIDE COMMUNITY BASED HOME HEALTH CARE FOR CHILDREN WITH SPECIAL NEEDSIA501(C)(3)LINE 9CHILDSERVE INC0
CHILDSERVE HABILITATION CENTER
PO BOX 707JOHNSTONIA50131420680245PROVIDE PEDIATRIC NURSING & SERVICES FOR CHILDREN WITH SPECIAL NEEDSIA501(C)(3)LINE 9CHILDSERVE INC0
CHILDSERVE THERAPY INC
PO BOX 707JOHNSTONIA50131420680420PROVIDE THERAPY & AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL NEEDSIA501(C)(3)LINE 9CHILDSERVE INC0
CHILDSERVE INC
PO BOX 707JOHNSTONIA50131421271420PARENT COMPANY FOR BENEFIT & SUPPORT OF PROGRAMS/ SERVICES OF CHILDSERVEIA501(C)(3)LINE 90
CHILDSERVE COMMUNITY OPTIONS
PO BOX 707JOHNSTONIA50131421390033PROVIDE INTEGRATED SERVICES & COMMUNITY CARE FOR CHILDREN WITH SPECIAL NEEDSIA501(C)(3)LINE 9CHILDSERVE INC0
CHILDSERVE HOMECARE INC
PO BOX 707JOHNSTONIA50131421478832PROVIDE SPECIALTY HOME HEALTH CARE FOR CHILDREN WITH SPECIAL NEEDSIA501(C)(3)LINE 9CHILDSERVE INC0
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 707JOHNSTONIA50131455327981IMPROVE ACCESS TO PEDIATRIC MEDICAL, REHABILITATION, FAMILY SUPPORT SERVICESIA501(C)(3)LINE 9CHILDSERVE INC0
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 Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
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 Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHILDSERVE HABILITATION CENTER
Q199585ACTUAL CASH TRANSFERRED
CHILDSERVE INC
O102397BASED ON PROPORTIONATE REVENUE
CHILDSERVE FOUNDATION INC
O5090BASED ON HISTORICAL SUPPORT %
CHILDSERVE HABILITATION CENTER
J61400BASED ON SQUARE FOOTAGE
CHILDSERVE FOUNDATION INC
C66850BASED ON APPROVED NEEDS

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