2023-02-03T15:37:34-06:00 2022-06-30 411431613 BERGANKDV LTD 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2021-07-01 420680245 CHILDSERVE HABILITATION CENTER CHIL 5157278750 PO BOX 707 JOHNSTON IA 501310707 DAVID MCKENZIE PRESIDENT/COO 5157278750 2023-01-31 1 DAVID MCKENZIE 999009999 BRENT L ALEXANDER CPA P00075113 5157275700 2023-01-31 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z DAVID MCKENZIE PO BOX 707 JOHNSTON IA 501310707 29790781 0 X WWW.CHILDSERVE.ORG X 1928 IA TO ENHANCE THE WELL-BEING OF CHILDREN, TEENS, AND YOUNG ADULTS WITH SPECIAL HEALTH CARE NEEDS AND CHRONIC HEALTH CONDITIONS BY PROVIDING PEDIATRIC SKILLED NURSING CARE AND SPECIALTY SERVICES. 6 5 0 80 0 0 3551457 5818187 19998254 22747161 71037 75681 710307 1120796 24331055 29761825 0 0 0 0 13043594 14997390 0 0 0 9293980 11124632 22337574 26122022 1993481 3639803 45668883 49396260 30192699 30453951 15476184 18942309 WE PARTNER WITH FAMILIES TO HELP CHILDREN WITH SPECIAL HEALTH CARE NEEDS LIVE A GREAT LIFE. 0 0 17212394 23867957 THE CHILDSERVE HABILITATION CENTER HOUSES THREE CARE UNITS PROVIDING TWO LEVELS OF SPECIALIZED, 24-HOUR CARE. THIS INCLUDES LONG-TERM CARE FOR INDIVIDUALS WITH COMPLEX MEDICAL NEEDS UP TO AGE 30 AND POST-ACUTE REHABILITATION CARE FOR INDIVIDUALS FROM BIRTH TO 22 YEARS OLD WHO ARE RECOVERING FROM INJURY OR ILLNESS INCLUDING BRAIN OR SPINAL CORD INJURIES, COMPLEX RESPIRATORY CONDITIONS, ORTHOPEDIC SURGERY, BURN AND WOUNDS, AND COMPLICATIONS FROM PREMATURE BIRTH. IN 2021-22, CARE WAS PROVIDED TO 114 INDIVIDUALS. ALONG WITH 24/7 NURSING CARE, THIS INCLUDED A WIDE RANGE OF THERAPY SUPPORTS, ACCESS TO CUTTING EDGE TECHNOLOGY TO HELP SUPPORT INDEPENDENCE AND DAILY LIVING SKILLS. 17212394 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 X 15 0 1 0 0 0 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 TERI WAHLIG CEO 23.00 17.00 X X 0 447117 84595 MIKE MCCOY CHAIR 0.25 3.75 X X 0 0 0 BRIAN GENTRY VICE CHAIR 0.25 3.75 X X 0 0 0 EMILY WILLITS SECRETARY 0.25 3.75 X X 0 0 0 MIKE WEGNER TREASURER 0.25 3.75 X X 0 0 0 BRIAN LAURENZO PAST CHAIR 0.25 3.75 X X 0 0 0 DAVID MCKENZIE PRESIDENT/COO 23.00 17.00 X 0 362922 75124 TRACEY PAGE VP OF CLINICAL SERVICES 40.00 X 218255 0 28492 FREDERICK KLINGBEIL MED. DIR. OF PEDIATRIC REHAB 20.00 20.00 X 163525 163525 17554 LEAH BRANDON MED. DIR. OF MEDICINE & PEDIATRICS 36.00 4.00 X 183464 20385 4437 KELLY EASTIN VP OF INPATIENT SERVICES 40.00 X 110406 0 19698 DAWN SCHWARTZ VP OF QUALITY CARE 40.00 X 109231 0 16805 CARRIE VANQUATHAM DIRECTOR OF PEDIATRIC REHAB 40.00 X 102961 0 21990 887842 993949 268695 6 0 1 0 THE WEITZ COMPANY INC PO BOX 310474 DES MOINES IA 50331 CONSTRUCTION SERVICES/MATERIALS 5140990 STRATUS BLDG SOLUTIONS OF IOWA 7010 BROADWAY STE 315 DENVER CO 80221 CLEANING SERVICES 295322 RSM US LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 IT PROGRAMMING OF BI SOFTWARE 250528 MIKES CLEANING SERVICE PO BOX 41688 DES MOINES IA 50312 CLEANING SERVICES 242725 4 5551315 266872 5818187 SKILLED NURSING CARE 621300 22747161 22747161 22747161 74949 74949 29688 28956 732 732 732 LEASE REVENUE 532420 848495 848495 FACILITY SUPPORT REVENUE 621300 188007 188007 DIETARY REVENUE 621300 74919 74919 9375 9375 1120796 29761825 23867957 0 75681 222154 222154 12555013 11416542 1138471 259454 222506 36948 1032079 928539 103540 928690 829004 99686 672876 596860 76016 455875 335778 120097 1297356 561473 735883 109987 90686 19301 96911 24670 72241 872318 872318 1371883 267420 1104463 196334 47560 148774 ADMINISTRATION SUPPORT 3051493 3051493 MEDICAL & DIETARY SUPPL 1299198 1292942 6256 FOUNDATION SUPPORT 974973 974973 EQUIPMENT RENTAL & MAIN 453465 389149 64316 271963 209265 62698 26122022 17212394 8909628 0 969319 1023977 409201 431578 1788321 4629769 206924 189176 327848 424599 57545828 23698808 24614063 33847020 2664263 2395492 14688944 6454649 45668883 49396260 4568286 5265012 23685862 23190265 215104 1938551 1783570 30192699 30453951 X 15476184 18942309 15476184 18942309 45668883 49396260 3639803 -173678 0 X 0 1 X 1 1 1 X 287351 152457 492825 3551457 5818187 10302277 19034136 20021343 21194536 20708561 23867957 104826533 19321487 20173800 21687361 24260018 29686144 115128810 0 0 0 115128810 83707 57350 79809 68755 74949 364570 83707 57350 79809 68755 74949 364570 19405194 20231150 21767170 24328773 29761093 115493380 0.99680 0.99620 0.00320 0.00380 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3386878 3386878 49184523 20400574 28783949 4974427 3298234 1676193 33847020 DUE FROM AFFILIATES 6441475 ACCRUED INTEREST RECEIVABLE 13174 6454649 DEFERRED COMPENSATION 1783570 1783570 1 0 1 0 0 0 1 1 0 0 TERI WAHLIG CEO 0 359975 0 87142 0 0 0 79061 0 5534 0 531712 0 0 DAVID MCKENZIE PRESIDENT/COO 0 291239 0 71683 0 0 0 67038 0 8086 0 438046 0 0 FREDERICK KLINGBEIL MED. DIR. OF PEDIATRIC REHAB 142790 142790 20735 20735 0 0 4025 4025 4752 4752 172302 172302 0 0 TRACEY PAGE VP OF CLINICAL SERVICES 183470 0 34785 0 0 0 28492 0 0 0 246747 0 0 0 LEAH BRANDON MED. DIR. OF MEDICINE & PEDIATRICS 169311 18812 14153 1573 0 0 2818 313 1175 131 187457 20829 0 0 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. PART I, LINE 6 INCENTIVE PAY IS BASED ON MEETING BUDGETED ORGANIZATIONAL PERFORMANCE METRICS. A CITY OF WINDSOR HEIGHTS IOWA 421271420 973605AM0 2015-04-24 7996556 REFUND PRIOR ISSUE (03/30/06) 0 0 0 B IOWA FINANCE AUTHORITY 521699886 46246K2S0 2015-04-24 10335677 REFUND PRIOR ISSUE (03/30/06) 0 0 0 C IOWA FINANCE AUTHORITY 521699886 2022-03-09 18400000 SEE PART VI 0 0 0 A 4005000 7968373 751279 159931 7057163 2007 1 0 1 1 B 10271539 983313 206713 9081513 2007 1 0 1 1 C 9298516 203250 240100 8852690 2476 1 1 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: (A) ISSUER NAME: CITY OF WINDSOR HEIGHTS, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 03/31/2020 (A) ISSUE NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/31/2020 PART I, LINE C, COLUMN (F) - CONSTRUCT FACILITY AND REFUND ISSUES (3/13/13 & 5/23/19). PART II, LINE 3, COLUMNS A & B - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS / MARKET VALUE FLUCTUATIONS. PART II, LINE 3, COLUMN C - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL AVAILABLE HAS NOT YET BEEN DRAWN. MIKE WILSON MEMBER OF CHILDSERVE INC BOD AND AN OFFICER AT BANKERS TRUST 197250 INTEREST ON LOAN 0 JEFF RUSSELL MEMBER OF CHILDSERVE INC BOD AND AN OFFICER AT DELTA DENTAL 248380 DENTAL INSURANCE 0 MIKE WEGNER MEMBER OF CHILDSERVE INC BOD AND AN OFFICER AT MERCYONE 43609 MEDICAL TESTING 0 AARON KENNEDY MEMBER OF CHILDSERVE INC BOD AND AN OFFICER AT FLYNN WRIGHT 26518 VIDEOGRAPHY AND DEVELOPMENT OF PUBLICATIONS 0 FORM 990, PART V, LINE 13A CHILDSERVE HABILITATION CENTER 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 ORGANIZATIONS TAX IDENTIFICATION NUMBER. FORM 990, PART VI, SECTION B, LINE 11B 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 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, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINES 5-10 CHILDSERVE HABILITATION CENTER 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 501310707 421264664 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE MEDICAL EQUIPMENT & SUPPLY INC PO BOX 707 JOHNSTON IA 501310707 421264666 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE THERAPY INC PO BOX 707 JOHNSTON IA 501310707 420680420 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 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 10 0 CHILDSERVE COMMUNITY OPTIONS PO BOX 707 JOHNSTON IA 501310707 421390033 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 CHILDSERVE HOMECARE INC PO BOX 707 JOHNSTON IA 501310707 421478832 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 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 12A, I CHILDSERVE INC 0 THE CHILDSERVE CLINIC INC PO BOX 707 JOHNSTON IA 501310707 455327981 SEE PART VII - SUPPLEMENTAL INFORMATION IA 501(C)(3) LINE 10 CHILDSERVE INC 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 1 1 CHILDSERVE FOUNDATION INC C 5551315 BASED ON APPROVED NEEDS CHILDSERVE CLINIC INC J 104775 BASED ON SQUARE FOOTAGE CHILDSERVE COMMUNITY OPTIONS J 306738 BASED ON SQUARE FOOTAGE CHILDSERVE HOMES INC L 83000 MAINTENANCE BASED ON HOURS USED CHILDSERVE FOUNDATION INC P 974973 BASED ON PROPORTIONATE REVENUE CHILDSERVE INC P 3051493 BASED ON HISTORICAL SUPPORT % CHILDSERVE CLINIC INC R 885294 ACTUAL CASH TRANSFERRED CHILDSERVE MEDICAL EQUIPMENT & SUPPLY R 87288 ACTUAL CASH TRANSFERRED CHILDSERVE COMMUNITY OPTIONS L 99159 MAINTENANCE BASED ON HOURS USED CHILDSERVE THERAPY INC R 211081 ACTUAL CASH TRANSFERRED CHILDSERVE FOUNDATION INC S 5724516 ACTUAL CASH TRANSFERRED CHILDSERVE COMMUNITY OPTIONS S 3748039 ACTUAL CASH TRANSFERRED CHILDSERVE INC J 107177 BASED ON SQUARE FOOTAGE CHILDSERVE THERAPY INC J 270419 BASED ON SQUARE FOOTAGE PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: CHILDSERVE HOMES, INC. PRIMARY ACTIVITY: PROVIDE COMMUNITY BASED GROUP HOME LIVING FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE MEDICAL EQUIPMENT & SUPPLY, INC. PRIMARY ACTIVITY: PROVIDE MOBILITY EQUIPMENT, SPECIALTY MEDICAL SUPPLIES, AND SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE THERAPY, INC. PRIMARY ACTIVITY: PROVIDE SKILLED THERAPY AND AUDIOLOGY SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE COMMUNITY OPTIONS PRIMARY ACTIVITY: PROVIDE INTEGRATED SERVICES AND COMMUNITY CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: CHILDSERVE HOMECARE, INC. PRIMARY ACTIVITY: PROVIDE SPECIALTY HOME HEALTH CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS NAME OF RELATED ORGANIZATION: THE CHILDSERVE CLINIC, INC. PRIMARY ACTIVITY: IMPROVE ACCESS TO PEDIATRIC SUBSPECIALTY MEDICAL SERVICES, PEDIATRIC REHABILITATION SERVICES, AND IN-HOME FAMILY SUPPORT SERVICES