2012-11-12T17:53:00-06:00 2012-06-30 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2011-07-01 420680420 CHILDSERVE THERAPY INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK 5157278750 2012-11-07 1 BRENT L ALEXANDER P00075113 5152237300 2011 2016-02-24 21:20:13Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 4394225 0 X WWW.CHILDSERVE.ORG X 1938 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 6 5 87 74 0 0 307629 322107 4211906 4069400 59 49 4126 2669 4523720 4394225 0 0 0 0 3045844 3051085 0 0 0 1173922 1232345 4219766 4283430 303954 110795 3118505 3230733 105815 107248 3012690 3123485 TO ENHANCE THE WELL BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS BY PROVIDING SKILLED THERAPY, SPECIALTY CLINICS AND SERVICES. 0 0 2534498 4072069 THERAPY SERVICES PROVIDED INCLUDE SPEECH-LANGUAGE PATHOLOGY, OCCUPATIONAL THERAPY AND PHYSICAL THERAPY. A TOTAL OF 1,219 CHILDREN RECEIVED SERVICES. 2534498 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 3 0 1 87 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 2.00 X X 0 0 0 DR WILLIAM LEPLEY 2.00 X X 0 0 0 LLOYD VANDER KWAAK 2.00 X X 15739 246575 16376 LINDA KADING 2.00 X X 0 0 0 JOHN TEMPLE 2.00 X X 0 0 0 PAUL NAGEL 2.00 X X 0 0 0 15739 246575 16376 0 0 1 0 0 123982 198125 322107 THERAPY SERVICES 621300 4069400 4069400 4069400 49 49 IN-HOUSE TRAINING CONF 900099 2669 2669 2669 4394225 4072069 0 49 15739 15739 2704141 2160619 543522 54496 46010 8486 82518 44879 37639 194191 156504 37687 12093 409 11684 17999 17999 83134 33067 50067 316069 316069 19345 11577 7768 41983 1174 40809 42476 28139 14337 23861 18320 5541 ADMINISTRATION SUPPORT 581913 581913 EQUIPMENT RENTAL AND MA 29881 133 29748 BAD DEBT EXPENSE 19700 19700 WORKERS COMPENSATION EX 15175 12522 2653 28716 1445 27271 4283430 2534498 1748932 0 138595 41991 448528 373431 394792 194624 54035 200168 2477347 2615143 3118505 3230733 105815 107248 105815 107248 X 3012690 3123485 3012690 3123485 3118505 3230733 110795 0 X X 0 1 1 X 0 X 253731 287078 256022 307629 322107 1426567 2420480 3140595 3432750 4216032 4072069 17281926 2674211 3427673 3688772 4523661 4394176 18708493 0 0 0 18708493 195 162 142 59 49 607 195 162 142 59 49 607 2674406 3427835 3688914 4523720 4394225 18709100 1.00000 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 394792 194624 200168 200168 DUE FROM AFFILIATES 2615143 2615143 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 (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. X 1 1 X X X X X X 0 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK 12567 196877 1463 22916 1709 26782 429 6728 553 8666 16721 261969 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. 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. FORM 990, PART XII, LINE 2C THE 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. CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 PROVIDE COMMUNITY BASED GROUP HOME LIVING FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC PO BOX 707 JOHNSTON IA 50131 421264666 PROVIDE MOBILITY EQUIPMENT & SERVICES FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 PROVIDE PEDIATRIC NURSING & SERVICES FOR CHILDREN WITH SPECIAL NEEDS 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 PROVIDE INTEGRATED SERVICES & COMMUNITY CARE FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 50131 421478832 PROVIDE SPECIALTY HOME HEALTH CARE FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 0 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 IMPROVE ACCESS TO PEDIATRIC MEDICAL, REHABILITATION, FAMILY SUPPORT SERVICES IA 501(C)(3) LINE 9 CHILDSERVE INC 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 CHILDSERVE HABILITATION CENTER Q 137796 ACTUAL CASH TRANSFERRED CHILDSERVE INC O 581913 BASED ON PROPORTIONATE REVENUE CHILDSERVE FOUNDATION INC C 123982 BASED ON APPROVED NEEDS CHILDSERVE FOUNDATION INC O 9995 BASED ON HISTORICAL SUPPORT % CHILDSERVE HABILITATION CENTER J 294916 BASED ON SQUARE FOOTAGE