2011-11-15T14:14:07-06:00 2011-06-30 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2010-07-01 421271420 CHILDSERVE INC CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 LLOYD VANDER KWAAK 5157278750 2011-11-11 1 BRENT L ALEXANDER 5152237300 2010 2016-03-07 17:11:31Z LLOYD VANDER KWAAK PO BOX 707 JOHNSTON IA 501310707 3603548 0 X WWW.CHILDSERVE.ORG X 1985 IA WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 18 17 41 0 0 0 10938 2151 0 0 0 5312 3388631 3596085 3399569 3603548 0 0 0 0 2611648 2767722 0 0 0 787921 835826 3399569 3603548 0 0 0 0 0 0 0 0 TO OPERATE EXCLUSIVELY AS THE PARENT COMPANY AND CORPORATE FRAMEWORK FOR THE BENEFIT AND SUPPORT OF THE PROGRAMS OFFERED BY CHILDSERVE COMPANIES. 0 0 OPERATE AS PARENT COMPANY AND CORPORATE FRAMEWORK FOR THE BENEFIT AND SUPPORT OF THE PROGRAMS OFFERED BY THE CHILDSERVE COMPANIES. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 4 0 1 41 1 0 0 0 0 0 0 0 0 0 0 X 18 17 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 NANCY ADLER 2.00 X 0 0 0 LINDA KADING 2.00 X X 0 0 0 WILLARD BOYD III 2.00 X X 0 0 0 PAUL NAGEL 2.00 X X 0 0 0 MICHAEL GUMINA 2.00 X 0 0 0 LLOYD VANDER KWAAK 1.00 X X 0 227506 18840 KIP ALBERTSON 2.00 X 0 0 0 JAY BYERS 2.00 X 0 0 0 DOUG DORNACKER 2.00 X 0 0 0 IVAN LYDDON 2.00 X 0 0 0 DR WILLIAM LEPLEY 2.00 X X 0 0 0 KAREN GERDES MD 2.00 X 0 0 0 JOHN TEMPLE 2.00 X X 0 0 0 SHIRLEY POERTNER 2.00 X 0 0 0 RANDY VON FUMETTI 2.00 X 0 0 0 MARIA WOOD 2.00 X 0 0 0 FRANK STORK 2.00 X 0 0 0 JOEL NELSON 2.00 X 0 0 0 DAVID MCKENZIE 40.00 X 154125 0 12048 TAMMY STAPP 40.00 X 149241 0 14319 303366 227506 45207 2 0 1 0 0 2151 2151 5312 5312 ADMINISTRATION SUPPORT 561000 3582640 3582640 COMPANY STORE 453000 13441 13441 TRAINING CLASS AND MIS 900099 4 4 3596085 3603548 3582644 0 18753 329733 329733 1971849 1971849 46084 46084 280110 280110 139946 139946 16919 16919 52600 52600 191740 191740 23573 23573 109392 109392 124431 124431 33728 33728 20139 20139 1090 1090 6565 6565 34592 34592 RECRUITMENT EXPENSE 84711 84711 MISCELLANEOUS OPERATING 40222 40222 EQUIPMENT RENTAL AND MA 28881 28881 DUES AND SUBSCRIPTIONS 28606 28606 EQUIPMENT SERVICE AGREE 15508 15508 23129 23129 3603548 0 3603548 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 X 0 1 1 X 0 X 105457 68086 20745 10938 2151 207377 2884288 3068442 3528459 3378310 3582644 16442143 2989745 3136528 3549204 3389248 3584795 16649520 0 0 0 16649520 5312 5312 5312 5312 2989745 3136528 3549204 3389248 3590107 16654832 0.99970 1.00000 0.00030 X 0 3603548 3603548 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING FOR UNCERTAIN TAX POSITIONS: CHILDSERVE, INC. AND SUBSIDIARIES 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 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, 2008 THROUGH JUNE 30, 2011. X 1 1 X X X X X X 1 0 0 0 0 1 1 0 0 LLOYD VANDER KWAAK 0 189533 0 22784 0 15189 0 7422 0 11418 0 246346 0 0 DAVID MCKENZIE 137462 0 16663 0 0 0 5907 0 6141 0 166173 0 0 0 TAMMY STAPP 137243 0 11998 0 0 0 5060 0 9259 0 163560 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 4A TAMMY STAPP, VP FOR PROGRAMS RECEIVED SEVERANCE PAYMENTS WHICH INCLUDED REPORTABLE COMPENSATION OF $50,467, RETIRMENT BENEFITS OF $1,362, AND HEALTH BENEFITS OF $3,281. PART I, LINE 6 INCENTIVE PAY IS BASED ON MEETING A COMPREHENSIVE SET OF RESULTS WHICH INCLUDES NET EARNINGS. FRANK STORK OFFICER WELLMARK MEMBER OF THE CHILDSERVE INC. BOARD OF DIRECTORS AND AN OFFICER AT WELLMARK 408318 ADMINISTRATIVE FEES FOR SELF-INSURED HEALTH PLAN PAID TO WELLMARK. 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S POLICY FOR REVIEW OF THE FORM 990 RETURN INCLUDES REVIEW BY 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. 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 1 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 1 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 PROVIDE THERAPY & AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 1 CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 PROVIDE HEALTH CARE IN HOMES & APARTMENTS FOR CHILDREN WITH SPECIAL NEEDS IA 501(C)(3) LINE 9 CHILDSERVE INC 1 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 1 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 1 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 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 CHILDSERVE HABILITATION CENTER P 1926754 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMES INC P 485598 BASED ON PROPORTIONATE REVENUE CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC P 105842 BASED ON PROPORTIONATE REVENUE CHILDSERVE THERAPY INC P 499452 BASED ON PROPORTIONATE REVENUE CHILDSERVE FOUNDATION INC P 49941 BASED ON PROPORTIONATE REVENUE CHILDSERVE COMMUNITY OPTIONS P 422932 BASED ON PROPORTIONATE REVENUE CHILDSERVE HOMECARE INC P 90420 BASED ON PROPORTIONATE REVENUE CHILDSERVE HABILITATION CENTER L 6453 TRANSPORTATION BASED ON HOURS USE CHILDSERVE HABILITATION CENTER J 112245 BASED ON SQUARE FOOTAGE CHILDSERVE FOUNDATION INC C 2151 BASED ON APPROVED NEEDS