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 420680245 CHILDSERVE HABILITATION CENTER 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 15431782 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 5 233 234 0 0 110555 457961 12678639 12933242 70840 15272 2055352 2025307 14915386 15431782 110273 0 0 0 7939875 8311461 0 0 0 6647982 6442861 14698130 14754322 217256 677460 27252323 27437772 20607856 20111980 6644467 7325792 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 9494488 14958549 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 89.18% 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. 9494488 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 0 1 13 0 1 233 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 LINDA KADING 2.00 X X 0 0 0 LLOYD VANDER KWAAK 19.00 X X 125911 136403 16376 DR WILLIAM LEPLEY 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 TERESA WAHLIG 40.00 X 188639 0 6814 314550 136403 23190 2 0 1 0 0 457961 457961 SKILLED NURSING CARE 621300 12723797 12723797 THERAPY SERVICES (INCL 621300 209445 209445 12933242 15272 15272 FACILITY SUPPORT REVEN 621300 1233411 1233411 LEASE REVENUE 532420 672424 672424 DIETARY REVENUE 621300 101531 101531 17941 17941 2025307 15431782 14958549 0 15272 314550 314550 6634996 6200563 434433 119743 111052 8691 746676 656357 90319 495496 441459 54037 329842 313334 16508 671441 661696 9745 1137108 127690 1009418 166312 67570 98742 16209 15270 939 841186 841186 813054 288124 524930 64925 57637 7288 ADMINISTRATION SUPPORT 1749596 1749596 EQUIPMENT RENTAL & MAIN 253757 248145 5612 BAD DEBT EXPENSE 141346 141346 WORKERS COMPENSATION 136095 120296 15799 121990 43949 78041 14754322 9494488 5259834 0 1582533 1403814 109092 72695 1347548 2116946 58806 49044 75720 58897 26825280 11002167 15894052 15823113 1299110 1297975 6885462 6615288 27252323 27437772 2219238 2059993 18383552 18051987 5066 20607856 20111980 X 6644467 7325792 6644467 7325792 27252323 27437772 X 677460 3865 X X 0 1 1 X 0 X 1715692 1023817 694342 110555 457961 4002367 10853119 13758415 13274426 14733991 14958549 67578500 12568811 14782232 13968768 14844546 15416510 71580867 0 0 0 71580867 85240 74622 74975 70785 15272 320894 85240 74622 74975 70785 15272 320894 12654051 14856854 14043743 14915331 15431782 71901761 0.99550 0.99120 0.00450 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2640249 2640249 21477801 8844535 12633266 2242273 1825670 416603 464957 331962 132995 15823113 INTEREST RECEIVABLE 522 LIFE INSURANCE PROCEEDS RECEIVABLE 115898 DUE FROM AFFILIATES 6498868 6615288 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 100533 108911 11702 12677 13676 14815 3435 3722 4425 4794 133771 144919 0 0 TERESA WAHLIG 176749 0 0 0 11890 0 3169 0 3645 0 195453 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 6 INCENTIVE PAY IS BASED ON MEETING A COMPREHENSIVE SET OF RESULTS WHICH INCLUDES NET EARNINGS. IOWA FINANCE AUTHORITY 521699886 46246UBQ2 2006-03-30 19663662 FACILITY CONSTRUCTION AND RENOVATION AND REFUND PRIOR ISSUE (8/1/2002) 0 0 0 1335000 22109364 1372692 557142 392979 68651 6821889 13926707 2007 1 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 1 CITIGROUP 5.200000000000 1 0 1 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN/LOSS ON INVESTMENTS 3,865. TOTAL TO FORM 990, PART XI, LINE 5: 3,865. 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 501310707 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 501310707 421264666 PROVIDE MOBILITY EQUIPMENT & SERVICES FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 0 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 501310707 420680420 PROVIDE THERAPY & AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL NEEDS 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 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 501310707 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 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 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 1 0 1 0 0 0 1 0 1 1 CHILDSERVE HOMES INC I 16862 BASED ON SQUARE FOOTAGE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC I 61400 BASED ON SQUARE FOOTAGE CHILDSERVE THERAPY INC I 294916 BASED ON SQUARE FOOTAGE CHILDSERVE FOUNDATION INC I 10006 BASED ON SQUARE FOOTAGE CHILDSERVE INC I 151851 BASED ON SQUARE FOOTAGE CHILDSERVE COMMUNITY OPTIONS I 129726 BASED ON SQUARE FOOTAGE CHILDSERVE HOMECARE INC I 7663 BASED ON SQUARE FOOTAGE CHILDSERVE HOMES INC K 11040 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE HOMES INC Q 29851 ACTUAL CASH TRANSFERRED CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC R 199585 ACTUAL CASH TRANSFERRED CHILDSERVE THERAPY INC R 137796 ACTUAL CASH TRANSFERRED CHILDSERVE FOUNDATION INC R 54233 ACTUAL CASH TRANSFERRED CHILDSERVE COMMUNITY OPTIONS Q 138220 ACTUAL CASH TRANSFERRED CHILDSERVE FOUNDATION INC C 457961 BASED ON APPROVED NEEDS CHILDSERVE HOMES INC K 1422 TRANSPORTATION BASED ON HOURS USE CHILDSERVE INC K 5275 TRANSPORTATION BASED ON HOURS USE CHILDSERVE COMMUNITY OPTIONS K 13161 TRANSPORTATION BASED ON HOURS USE CHILDSERVE INC O 1749596 BASED ON PROPORTIONATE REVENUE CHILDSERVE FOUNDATION INC O 65788 BASED ON HISTORICAL SUPPORT % CHILDSERVE HOMES INC K 136779 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE COMMUNITY OPTIONS K 103959 MAINT & HSKPG BASED ON HOURS USED CHILDSERVE HOMECARE INC R 47067 ACTUAL CASH TRANSFERRED