2024-02-20T11:50:55-06:00 2023-06-30 FORVIS LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2022-07-01 421478832 CHILDSERVE HOMECARE INC % ROD WILDRICK CHIL 5157278750 PO BOX 707 JOHNSTON IA 50131 DAVID MCKENZIE PRESIDENT/COO 5157278750 2023-11-15 true DAVID MCKENZIE 999009999 SHAWNELL LINOT P01663908 3162652811 2022 2023-04-26 12:10:37Z DAVID MCKENZIE PO BOX 707 JOHNSTON IA 50131 1310132 false X WWW.CHILDSERVE.ORG X 1998 IA TO ENHANCE THE WELL-BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS BY PROVIDING SPECIALTY HOME HEALTH CARE. 6 5 28 11 0 57780 68244 1378933 1240250 0 0 0 1638 1436713 1310132 0 3901 0 0 1334502 1428148 0 0 0 225418 203158 1559920 1635207 -123207 -325075 428227 476441 34665 407954 393562 68487 WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. false false 993881 0 1240250 CHILDSERVE HOMECARE PROVIDES IN-HOME, SPECIALIZED SKILLED NURSING, OCCUPATIONAL THERAPY, PHYSICAL THERAPY AND SPEECH-LANGUAGE PATHOLOGY SERVICES FOR INDIVIDUALS, UP TO AGE 22, WITH COMPLEX MEDICAL NEEDS WITHIN A 35-MILE RADIUS OF JOHNSTON, IOWA. IN THIS FISCAL YEAR HOMECARE PROVIDED 22,287.81 HOURS OF SERVICE TO 18 CHILDREN. 993881 true true false false false false false false false false false false false false false false false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 0 0 28 true false false false false false false false false false false false false X 6 5 false false false false true true true true true false false true true true true true true true true false X ROD WILDRICK 5157278750 PO BOX 707 JOHNSTON IA 50131 TERI WAHLIG CEO 1.0 39.0 X X 0 901039 90080 DAVID MCKENZIE PRESIDENT/COO 1.0 39.0 X 0 375687 75235 BRIAN GENTRY CHAIR 0.25 3.75 X X 0 0 0 EMILY WILLITS VICE CHAIR 0.25 3.75 X X 0 0 0 MIKE WEGNER TREASURER 0.25 3.75 X X 0 0 0 MONDALE SMITH SECRETARY 0.25 3.75 X X 0 0 0 MIKE MCCOY PAST CHAIR 0.25 3.75 X X 0 0 0 0 1276726 165315 0 false true false 0 10613 57631 68244 NURSING SERVICES 621610 1240250 1240250 1240250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS REVENUE 900099 1638 1638 1638 1310132 1240250 1638 3901 3901 0 0 0 0 0 1227294 852146 375148 25546 16930 8616 86445 57645 28800 88863 62060 26803 0 0 0 0 0 0 9629 301 9328 0 0 4210 4210 0 0 6862 23 6839 3865 474 3391 0 1753 1753 0 0 550 135 415 0 ADMINISTRATION SUPPORT 162415 162415 EQUIPMENT RENTAL & MAINT 10729 266 10463 MEDICAL SUPPLIES 2418 2418 DUES & SUBSCRIPTIONS 727 727 1635207 993881 641326 0 9173 31925 0 0 0 0 373785 444516 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45269 0 428227 476441 34665 407954 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34665 407954 X 393562 68487 0 0 393562 68487 428227 476441 -325075 X false true X true true true X 170 0 314677 57780 68244 440871 0 0 170 0 314677 57780 68244 440871 0 440871 2118 26 0 0 0 2144 0 13800 0 0 0 1638 15438 458453 7307853 0.96165 0.00000 X 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true true false false TERI WAHLIG CEO 0 807061 0 93978 0 0 0 84428 0 5652 0 991119 0 0 DAVID MCKENZIE PRESIDENT/COO 0 302816 0 72871 0 0 0 69159 0 6076 0 450922 0 0 SCHEDULE J, PART I, LINE 3 THE EXECUTIVE COMMITTEE OF CHILDSERVE, INC. (A RELATED ORGANIZATION) HAS THE RESPONSIBILITY TO OVERSEE THE IMPLEMENTATION OF THE EXECUTIVE COMPENSATION POLICY FOR THE EXECUTIVE POSITIONS AND KEY EMPLOYEES AS DEFINED BY THE IRS. 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. SCHEDULE J, PART I, LINE 4B TERI WAHLIG - $69,576 DAVID MCKENZIE - $55,805 SCHEDULE J, PART I, LINE 6A & 6B INCENTIVE PAY IS BASED ON MEETING BUDGETED ORGANIZATIONAL PERFORMANCE METRICS. FORM 990, PART VI, SECTION A, LINE 6 CHILDSERVE, INC. IS THE SOLE MEMBER OF CHILDSERVE HOMECARE, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, CHILDSERVE, INC. HAS THE RIGHT TO ELECT ALL MEMBERS OF THE ORGANIZATION'S BOARD AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER, CHILDSERVE, INC. HAS THE RIGHT TO VOTE ON ALL PROPOSED AMENDMENTS OR RESTATEMENTS OF THE ARTICLES OF INCORPORATION AND, IF NECESSARY, THE ARTICLES OF DISSOLUTION OR MERGER. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE FORM 990 IS THEN REVIEWED BY THE INDEPENDENT AUDIT SUBCOMITTEE OF THE FINANCE COMMITTEE. THE SUBCOMMITTEE REVIEWS THE FORM 990 WITH THE FULL BOARD. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. 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 15A & 15B THE EXECUTIVE COMMITTEE OF CHILDSERVE, INC. (A RELATED ORGANIZATION) HAS THE RESPONSIBILITY TO OVERSEE THE IMPLEMENTATION OF THE EXECUTIVE COMPENSATION POLICY FOR THE EXECUTIVE POSITIONS AND KEY EMPLOYEES AS DEFINED BY THE IRS. 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, CONFICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINES 5-10 CHILDSERVE HOMECARE, INC. REPORTS COSTS RELATING TO COMPENSATION, SALARIES, WAGES, EMPLOYEE BENEFITS, AND PAYROLL TAXES ON SCHEDULE IX, LINES 5-10. CHILDSERVE, INC. (A RELATED ORGANIZATION) SERVES AS A COMMON PAYMASTER FOR THE ORGANIZATION. AS SUCH, CHILDSERVE, INC. IS RESPONSIBLE FOR FILING FORMS 941 AND W-2'S UNDER ITS TAX IDENTIFICATION NUMBER, NOT THE ORGANIZATION'S TAX IDENTIFICATION NUMBER. CHILDSERVE HOMES INC PO BOX 707 JOHNSTON IA 50131 421264664 SEE PART VII IA 501(C)(3) 10 CSI true CHILDSERVE MEDICAL EQUIPMENT & SUPPLY PO BOX 707 JOHNSTON IA 50131 421264666 SEE PART VII IA 501(C)(3) 10 CSI true CHILDSERVE HABILITATION CENTER PO BOX 707 JOHNSTON IA 50131 420680245 SEE PART VII IA 501(C)(3) 10 CSI true CHILDSERVE INC PO BOX 707 JOHNSTON IA 50131 421271420 SEE PART VII IA 501(C)(3) 12B NA true CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 50131 420680420 SEE PART VII IA 501(C)(3) 10 CSI true CHILDSERVE FOUNDATION INC PO BOX 707 JOHNSTON IA 50131 421157665 SEE PART VII IA 501(C)(3) 7 CSI true CHILDSERVE CLINIC INC PO BOX 707 JOHNSTON IA 50131 455327981 SEE PART VII IA 501(C)(3) 10 CSI true CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 50131 421390033 SEE PART VII IA 501(C)(3) 10 CSI true false true true false false false false false false false true false false false false true false false true CHILDSERVE HABILITATION CENTER P 161846 REVENUE CHILDSERVE INC S 418580 CASH TRANSFER PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: CHILDSERVE HOMES, INC. PRIMARY ACTIVITY: PROVIDES AROUND-THE-CLOCK CARE IN A HOMELIKE ENVIRONMENT FOR CHILDREN AND YOUNG ADULTS WHO REQUIRE NURSING CARE, BEHAVIOR SUPPORT, SKILL DEVELOPMENT AND THERAPY SERVICES. NAME OF RELATED ORGANIZATION: CHILDSERVE MEDICAL EQUIPMENT & SUPPLY, INC. PRIMARY ACTIVITY: PROVIDES PEDIATRIC SEATING AND MOBILITY FITTING, PEDIATRIC WHEELCHAIRS AND ADAPTIVE DEVICES, AUGMENTATIVE COMMUNICATION DEVICES, MEDICAL SUPPLIES, ORTHOPEDIC DEVICES USED TO SUPPORT, ALIGN, PREVENT, CORRECT AND/OR IMPROVE FUNCTION OF MOVABLE PARTS OF THE CHILD'S BODY. NAME OF RELATED ORGANIZATION: CHILDSERVE HABILITATION CENTER PROVIDE PEDIATRIC SKILLED NURSING AND SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND CHRONIC HEALTH CONDITIONS NAME OF RELATED ORGANIZATION: CHILDSERVE, INC. PRIMARY ACTIVITY: PARENT COMPANY FOR BENEFIT & SUPPORT OF PROGRAMS/SERVICES OF CHILDSERVE NAME OF RELATED ORGANIZATION: CHILDSERVE THERAPY, INC. PRIMARY ACTIVITY: PROVIDES OCCUPATIONAL, PHYSICAL AND SPEECH THERAPIES IN INDIVIDUAL AND GROUP SETTINGS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. NAME OF RELATED ORGANIZATION: CHILDSERVE FOUNDATION, INC. PRIMARY ACTIVITY: ENHANCES THE WELL-BEING OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS BY DEVELOPING, RECEIVING AND GRANTING FINANCIAL ASSISTANCE TO CHILDSERVE ORGANIZATIONS. NAME OF RELATED ORGANIZATION: CHILDSERVE CLINIC, INC. PRIMARY ACTIVITY: ENHANCES THE HEALTH AND WELLBEING OF CHILDREN BY IMPROVING ACCESS TO PEDIATRIC SUBSPECIALTY MEDICAL SERVICES, PEDIATRIC REHABILITATION SERVICES AND IN-HOME FAMILY SUPPORT SERVICES. NAME OF RELATED ORGANIZATION: CHILDSERVE COMMUNITY OPTIONS PRIMARY ACTIVITY: PROVIDE INTEGRATED SERVICES AND COMMUNITY CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS