2024-02-12T16:03:44-06:00 2023-03-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2022-04-01 237365138 JOHN KNOX VILLAGE JOHN 8163472859 400 NW MURRAY ROAD LEES SUMMIT MO 64081 RICHARD KIM KLOCKENGA VP OF FINANCE & TREASURER 8163472859 2024-02-12 1 RICHARD KIM KLOCKENGA 999009999 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2024-02-12 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z DANIEL REXROTH 400 NW MURRAY ROAD LEES SUMMIT MO 64081 93580640 0 X WWW.JKV.ORG X 1974 MO ENRICH THE LIVES OF OLDER ADULTS THROUGH COMMUNITY LIVING. "ENRICHING LIVES, BUILDING COMMUNITY" 9 9 1131 200 206205 0 7715338 233286 62592003 65070145 4260069 1573004 1434992 1543238 76002402 68419673 0 0 0 0 40696437 39782732 0 0 0 40024785 39601037 80721222 79383769 -4718820 -10964096 191307617 192698383 263022526 278230522 -71714909 -85532139 X TO ENRICH THE LIVES OF OLDER ADULTS THROUGH COMMUNITY LIVING, "ENRICHING LIVES, BUILDING COMMUNITY." 0 0 30953899 0 27025372 HEALTH SERVICES - SEE SCHEDULE O 30206594 0 26372912 RESIDENT SERVICES - SEE SCHEDULE O 13368534 0 11671861 ASSISTED LIVING FACILITY AND ALZHEIMER'S ASSISTED LIVING FACILITY - SEE SCHEDULE O 74529027 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 147 0 1131 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEVE SEGGERMAN 8163472859 400 NW MURRAY ROAD LEES SUMMIT MO 64081 HELEN DARBY SECRETARY 1.00 1.00 X X 0 0 0 GARY HAWKINS DIRECTOR (TERM ENDED MAY 2022) 1.00 0.00 X 0 0 0 JIM HAM DIRECTOR 1.00 2.00 X 0 0 0 CHUCK ROBB VICE CHAIR 1.00 1.00 X X 0 0 0 DIANE DEMAREST DIRECTOR 1.00 0.00 X 0 0 0 MELVIN GROSS CHAIR 1.00 0.00 X X 0 0 0 LINDA HARRELSON DIRECTOR 1.00 0.00 X 0 0 0 GABRIEL CLEMENTS DIRECTOR 1.00 0.00 X 0 0 0 CARL CHINNERY DIRECTOR 1.00 0.00 X 0 0 0 JOE STASI DIRECTOR 1.00 0.00 X 0 0 0 DANIEL REXROTH PRESIDENT AND CEO 40.00 5.00 X 740999 0 36992 LAURIE JOHNSON VP OF HUMAN RESOURCES 40.00 0.00 X 223441 0 31782 RICHARD K KLOCKENGA VP OF FINANCE & CORPORATE TREASURER 40.00 5.00 X 363249 0 46831 MARIA TIMBERLAKE VP OF SENIOR LIVING 40.00 2.00 X 289074 0 35397 DONNA BARRON ASSISTANT SECRETARY 40.00 1.00 X 77846 0 9886 ANTHONY COLUMBATTO VP OF HEALTHCARE SERVICES 40.00 0.00 X 238262 0 38409 STEVE SEGGERMAN ASST. TREASURER & DIR OF FINANCE 40.00 1.00 X 131522 0 23986 RICHARD SCOTT DIR. OF OPERATIONS & DEVELPOMENT 40.00 0.00 X 141558 0 3533 TAMI HOVERSTEN ASSISTANT ADMINISTRATOR 40.00 0.00 X 165965 0 12871 MARYBETH ROBERTS DIR. OF SALES & MARKETING 40.00 0.00 X 143866 0 8695 KETTI DAWSON ADMINISTRATOR HOSPICE 40.00 0.00 X 124796 0 726 JERI PARKER SALES COUNSELOR 40.00 0.00 X 125616 0 1053 2766194 0 250161 31 0 1 0 HAREN CONTRACTING LLC 8035 NIEMAN ROAD LENEXA KS 66214 CONSTRUCTION 9262975 HARKRADER CONSTRUCTION 401B NW MURRAY ROAD LEES SUMMIT MO 64081 CONSTRUCTION 3064774 UNITED METHODIST HOMES & SERVICES 1415 W FOSTER AVE CHICAGO IL 60640 MEDICAL STAFFING 1792475 ATTANE 8880 WARD PARKWAY SUITE 400 KANSAS CITY MO 64114 MARKETING 1012969 CASCADE HEALTH SERVICES 1045 SWIFT AVE NORTH KANSAS CITY MO 64116 MEDICAL STAFFING 884908 35 151489 81797 55785 233286 NET PATIENT REVENUE 623000 65070145 65070145 65070145 1024271 1024271 219492 219492 239673 0 239673 239673 169907 69766 25490208 25160967 329241 329241 329241 BEAUTY SHOPS 623000 320003 320003 CAFETERIA & MEALS 721310 302860 36298 266562 UTILITY REVENUE 623000 241995 241995 438707 438707 1303565 68419673 65070145 206205 2910037 2140245 1916803 223442 31679846 29010412 2669434 798032 513618 284414 2669729 2665143 4586 2494880 2316955 177925 231457 199889 31568 122911 23662 99249 2897 2897 99000 99000 6053838 5798852 254986 935463 839893 95570 5339529 5234962 104567 1246671 1187603 59068 4294941 4237381 57560 498670 493128 5542 52388 45988 6400 5842259 5667835 174424 10957515 10563441 394074 1723124 1646273 76851 MEDICAL SUPPLIES 716674 716674 MEDICAID TAX 685073 685073 BAD DEBT EXPENSE 385397 385397 RECRUITMENT 234537 211095 23442 178693 168950 9743 79383769 74529027 4854742 0 5065554 5995841 1652230 898790 3135802 5140579 447142 609636 926175 721493 285570986 157460852 120976355 128110134 54986951 47040362 1535006 1531194 647337 735334 1935065 1915020 191307617 192698383 12543872 10218168 83093539 99456821 124711355 122076875 4847186 5306758 37826574 41171900 263022526 278230522 X -71714909 -85532139 -71714909 -85532139 191307617 192698383 -10964096 -2853134 0 X X 0 1 X 1 0 X 494245 332396 5644332 7715338 233286 14419597 67728518 69412221 63629186 62592003 65070145 328432073 963441 1127851 2091292 68222763 69744617 69273518 71270782 66431282 344942962 181301 220175 252048 197774 209836 1061134 0 181301 220175 252048 197774 209836 1061134 343881828 1692913 1306832 1264040 925799 1483436 6673020 1692913 1306832 1264040 925799 1483436 6673020 18318 9566 27884 1851163 1821585 870130 211093 175714 4929685 71785157 72882600 71407688 72407674 68090432 356573551 0.96440 0.96030 0.01870 0.01860 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA - 2018 AMOUNT: $ 749,877. 2019 AMOUNT: $ 624,624. 2020 AMOUNT: $ 78,119. BEAUTY SHOPS - 2018 AMOUNT: $ 417,321. 2019 AMOUNT: $ 447,543. 2020 AMOUNT: $ 242,118. MISCELLANEOUS - 2018 AMOUNT: $ 206,750. 2019 AMOUNT: $ 249,219. 2020 AMOUNT: $ 229,169. 2021 AMOUNT: $ 211,093. 2022 AMOUNT: $ 175,714. TRANSPORTATION REVENUE - 2018 AMOUNT: $ 50,076. 2019 AMOUNT: $ 45,537. 2020 AMOUNT: $ 40. ROOM RENTAL - 2018 AMOUNT: $ 86,193. 2019 AMOUNT: $ 110,301. 2020 AMOUNT: $ 9,720. UTILITY REVENUE - 2018 AMOUNT: $ 340,946. 2019 AMOUNT: $ 344,361. 2020 AMOUNT: $ 310,964. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2897 2897 0 PART II-B, LINE 1: THE PORTION OF DUES PAID TO VARIOUS TRADE ASSOCIATIONS WHICH ARE DESIGNATED BY THOSE ORGANIZATIONS FOR LOBBYING EXPENSES. 5187891 5187891 224583784 124056602 100527182 16775169 8859274 7915895 34684097 24544976 10139121 4340045 4340045 128110134 ASSET RETIREMENT OBLIGATION 4970275 DEPOSITS 36201625 41171900 X 65467539 -2853134 -2853134 68320673 99000 99000 68419673 79284769 0 79284769 99000 99000 79383769 PART X, LINE 2: THE VILLAGE'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE VILLAGE IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS AND IT IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAX EXCEPT FOR THOSE THAT ARE ALREADY REPORTED ANNUALLY. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 225536 0 0 0 0 0 0 225536 0 225536 0 0 0 0 0 0 PART III ACCOUNTING METHOD: SCHEDULE F, PART I, LINE 3: THE INVESTMENTS ARE CARRIED AT FAIR MARKET VALUE IN THE FINANCIAL STATEMENTS OF JOHN KNOX VILLAGE. X X X X X 0 1 0 0 0 0 0 0 0 DANIEL REXROTH PRESIDENT AND CEO 485897 0 169441 0 85661 0 28099 0 8893 0 777991 0 0 0 RICHARD K KLOCKENGA VP OF FINANCE & CORPORATE TREASURER 290655 0 61988 0 10606 0 28099 0 18732 0 410080 0 0 0 MARIA TIMBERLAKE VP OF SENIOR LIVING 238384 0 46609 0 4081 0 25802 0 9595 0 324471 0 0 0 ANTHONY COLUMBATTO VP OF HEALTHCARE SERVICES 191825 0 46051 0 386 0 23859 0 14550 0 276671 0 0 0 LAURIE JOHNSON VP OF HUMAN RESOURCES 188825 0 33499 0 1117 0 22889 0 8893 0 255223 0 0 0 TAMI HOVERSTEN ASSISTANT ADMINISTRATOR 156269 0 9137 0 559 0 4176 0 8695 0 178836 0 0 0 STEVE SEGGERMAN ASST. TREASURER & DIR OF FINANCE 130985 0 275 0 262 0 3607 0 20379 0 155508 0 0 0 MARYBETH ROBERTS DIR. OF SALES & MARKETING 124702 0 18935 0 229 0 0 0 8695 0 152561 0 0 0 PART I, LINE 4B JOHN KNOX VILLAGE MADE THE FOLLOWING CONTRIBUTIONS TO NON-QUALIFIED RETIREMENT PLANS FOR THE FOLLOWING EMPLOYEES IN CALENDAR YEAR 2022: 457(B) SUPPLEMENTAL SAVINGS PLAN: DANIEL REXROTH - $20,500 RICHARD KLOCKENGA - $20,500 MARIA TIMBERLAKE - $20,500 LAURIE JOHNSON - $18,118 ANTHONY COLUMBATTO - $18,888 SUPPLEMENTAL EXECUTIVE COMPENSATION PROGRAM: DANIEL REXROTH - $77,169 RICHARD KLOCKENGA - $8,361 MARIA TIMBERLAKE - $2,553 JOHN KNOX VILLAGE SPONSORS A SECTION 457(F) DEFERRED COMPENSATION PLAN HEREINAFTER CALLED THE 457(F) PLAN. THE 457(F) PLAN WAS ESTABLISHED AND IS OVERSEEN BY THE JOHN KNOX VILLAGE EXECUTIVE COMMITTEE. THE 457(F) PLAN IS TIED TO ACHIEVING SPECIFIC CAMPUS DEVELOPMENT ACTIVITY PERFORMANCE INDICATORS AS ESTABLISHED, REVIEWED, AND APPROVED BY THE JOHN KNOX VILLAGE EXECUTIVE COMMITTEE. INDIVIDUALS WILL EARN THE INCENTIVE OVER A 3-YEAR PERIOD AND BECOME VESTED IN THE 457(F) PLAN IN 2024. NO AMOUNTS FROM THIS 457(F) PLAN ARE INCLUDED IN COLUMN C AS DEFERRED COMPENSATION, AS INDIVIDUALS ARE NOT VESTED AND DO NOT HAVE A RIGHT TO THESE MONIES UNTIL SPECIFIC PERFORMANCE INDICATORS HAVE BEEN MET. CURRENT YEAR ACCRUAL IS AS FOLLOWS: DANIEL REXROTH - $83,864 RICHARD KLOCKENGA - $53,737 ANTHONY COLUMBATTO - $35,169 LAURIE JOHNSON - $32,752 SCHEDULE J, PART II JOHN KNOX VILLAGE IS A LARGE COMPLEX ORGANIZATION THAT IS COMPRISED OF 5 SEPARATE LEGAL ENTITIES, EACH OF WHICH FILES ITS OWN TAX RETURN. DUE TO THE REQUIREMENTS FOR COMPLETING THESE 990'S, SOME OF THE INFORMATION CONTAINED WITHIN THE FORM, SUCH AS REVENUE AND EXPENSES, IS RELATED ONLY TO THAT PARTICULAR ENTITY. HOWEVER, SOME OF THE INFORMATION, SUCH AS EXECUTIVE COMPENSATION, RELATES TO THE ENTIRE ORGANIZATION. A INDUSTRIAL DEV AUTHORITY - CITY OF LEE'S SUMMIT 431255189 524292AN9 2014-07-31 20576185 SEE SUPPLEMENTAL INFORMATION 0 0 0 B INDUSTRIAL DEV AUTHORITY - CITY OF LEE'S SUMMIT 431255189 524292AS8 2016-11-09 42643706 CAPITAL IMPROVEMENTS 0 0 0 C INDUSTRIAL DEV AUTHORITY - CITY OF LEE'S SUMMIT 431255189 524292BG3 2018-03-15 54327696 SEE SUPPLEMENTAL INFORMATION 0 0 0 D THE INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF LEE'S SUMMIT MISSOURI 431255189 524292BH1 2021-04-29 30713423 CAPITAL IMPROVEMENTS AND REFUND PRIOR TAXABLE BONDS 0 0 0 A 20762341 2134365 388239 14721468 3593443 2015 1 0 1 1 B 1250000 42785597 3028012 789919 39225058 2018 0 0 1 1 C 9515000 54559510 5495491 1119918 7196255 41151446 2020 1 0 1 1 D 30761004 917280 609175 14732061 1741484 12713423 0 1 1 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: INDUSTRIAL DEV AUTHORITY - CITY OF LEE'S SUMMIT DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2019 ISSUER NAME: INDUSTRIAL DEV AUTHORITY - CITY OF LEE'S SUMMIT DATE THE REBATE COMPUTATION WAS PERFORMED: 08/15/2022 SCHEDULE K, PART I, LINE A, COLUMN F: THE SERIES 2014A BONDS WERE ISSUED FOR THE FOLLOWING PURPOSES: (1) REFUND A BANK LOAN DATED 9/1/2013 (2) FINANCE COSTS OF EXPANSIONS, RENOVATIONS, AND IMPROVEMENTS TO THE CORPORATION'S SENIOR LIVING FACILITIES SCHEDULE K, PART I, LINE C, COLUMN F: THE SERIES 2018A BONDS WERE ISSUED FOR THE FOLLOWING PURPOSES: (1) REFUND THE EXISTING SERIES 2007A REVENUE BONDS ISSUED ON MAY 24, 2007 (2) REPAY A PORTION OF AN EXISTING CONSTRUCTION LOAN (3) FINANCE COSTS OF EXPANSIONS, RENOVATIONS, AND IMPROVEMENTS TO THE CORPORATION'S SENIOR LIVING FACILITIES SCHEDULE K, PART I, LINE 3 - 2014, 2016, 2018 BONDS AND 2021 BONDS THE TOTAL PROCEEDS OF ISSUE DIFFER FROM THE ISSUE PRICE DUE TO INVESTMENT EARNINGS ON CERTAIN PROCEEDS. SCHEDULE K, PART III LINE 2 THE ORGANIZATION'S MISSION IS TO ENRICH OLDER ADULT LIVES THROUGH COMMUNITY LIVING. AS PART OF THIS MISSION, THE ORGANIZATION LEASES RESIDENTIAL LIVING FACILITIES TO THESE OLDER ADULTS. X FITNESS EQUIPMENT 1 31548 FMV X GOLF CART 1 10425 FMV X DINING EQUIPMENT 1 7000 FMV X HANDBELL CASES 1 3812 FMV X FURNITURE 1 3000 FMV 0 0 0 FORM 990, PAGE 2, PART III, LINES 4A, 4B, AND 4C: * FOUNDED IN 1970, ONE OF THE FIRST LIFE PLAN COMMUNITIES IN THE NATION * NOT-FOR-PROFIT ORGANIZATION 501(C)(3), RUN BY A NINE-MEMBER VOLUNTEER BOARD OF DIRECTORS * MISSION: TO ENRICH THE LIVES OF OLDER ADULTS THROUGH COMMUNITY LIVING ENRICHING LIVES, BUILDING COMMUNITY * LOCATED IN LEE'S SUMMIT, MISSOURI, WITH HOME HEALTH OFFICES IN PRAIRIE VILLAGE, KANSAS * SERVES ABOUT 1,200 RESIDENTS ON ITS CAMPUS AND ABOUT 5,000 COMMUNITY MEMBERS WHO LIVE IN WESTERN MISSOURI AND EASTERN KANSAS EACH YEAR. * WITH ABOUT 850 ASSOCIATES ON STAFF, ONE OF THE LARGEST EMPLOYERS IN LEE'S SUMMIT INDEPENDENT LIVING: RESIDENTS ENJOY MAINTENANCE-FREE LIVING WHILE RESIDING IN FREESTANDING HOMES, VILLAS OR APARTMENT HOMES. ON-CAMPUS AMENITIES INCLUDE ART STUDIO; LIBRARY; BEAUTY SALONS; MEETING AND BANQUET ROOMS; BOWLING ALLEY; CHAPEL AND PRAYER ROOM; 9-HOLE EXECUTIVE GOLF COURSE; TWO FITNESS CENTERS; A CONVENIENCE STORE; EIGHT RESTAURANTS, INCLUDING A COFFEE SHOP; 1,500-SEAT SPECIAL EVENT SPACE; GUEST ROOMS; TWO INDOOR SWIMMING POOLS AND AN OUTDOOR POOL; WHIRLPOOL; MOVIE THEATER; MEDIA CENTERS; AND MORE. JOHN KNOX VILLAGE EMERGENCY MEDICAL SERVICES: JKV EMS PROVIDES SERVICES TO LEE'S SUMMIT, HARRISONVILLE, AND KANSAS CITY FOR INTERFACILITY TRANSPORTS FOR EMERGENCY AND NON-EMERGENCY TRANSPORTS. FURTHERMORE, JKV EMS HAS MUTUAL AID AGREEMENTS WITH THE CITIES OF LEE'S SUMMIT, MISSOURI, AND RAYTOWN, MISSOURI. THROUGH THE AGREEMENT, JKV EMS CAN RESPOND IF A NEED ARISES DURING AN EMERGENCY. JKV EMS ADDED A BEHAVIORAL HEALTH VAN IN 2023 TO PROVIDE TRANSPORTATION FOR THOSE THAT ARE NOT REQUIRED TO BE TRANSPORTED BY AMBULANCE. VILLAGE HELPERS IN-HOME CARE: PROVIDING PERSONAL CARE SERVICES FOR JOHN KNOX VILLAGE RESIDENTS, STAFF MEMBERS ARE SPECIALLY TRAINED AND INSURED IN HOME CARE. THEY PROVIDE PERSON-CENTERED SERVICES, INCLUDING LIGHT HOUSEKEEPING, SHOWER ASSISTANCE, COMPANION VISITS, MEDICATION REMINDERS, TRANSPORTATION BY APPOINTMENT, PET CARE AND MORE. VILLAGE HOME HEALTH: WITH OFFICES IN BOTH LEE'S SUMMIT, MISSOURI, AND PRAIRIE VILLAGE, KANSAS, THE MEDICARE-CERTIFIED HOME HEALTH AGENCY PROVIDES INTERMITTENT SKILLED CARE AS ORDERED BY A PHYSICIAN, INCLUDING SKILLED NURSING; PHYSICAL, OCCUPATIONAL, SPEECH AND RESPIRATORY THERAPIES; AND MEDICAL SOCIAL WORK. LICENSED HEALTH CARE PROFESSIONALS PROVIDE SERVICES TO JOHN KNOX VILLAGE RESIDENTS AS WELL AS PATIENTS WHO LIVE IN 12 COUNTIES IN AND AROUND GREATER KANSAS CITY. VILLAGE ASSISTED LIVING: LICENSED BY THE STATE OF MISSOURI, THIS COMMUNITY OFFERS OFFER 24-HOUR NURSING ASSISTANCE (LPN, CNA, CMT); MEDICATION MANAGEMENT, REGULAR HOUSEKEEPING, THREE MEALS A DAY IN ITS ON-SITE RESTAURANT, PLANNED ACTIVITIES, EXERCISE CLASSES, AN ON-SITE THERAPY CLINIC, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, AND MORE. VILLAGE ASSISTED LIVING MEMORY CARE 1, 2 AND 3: EACH MEMORY CARE NEIGHBORHOOD IS LICENSED BY THE STATE OF MISSOURI AND PROVIDES A FULL RANGE OF SERVICES AND A SUPPORTIVE AND SECURE ENVIRONMENT FOR RESIDENTS WITH MEMORY-RELATED CONDITIONS. THE FACILITIES PROVIDE 24-HOUR HIGHLY-SUPERVISED AND INTERACTIVE CARE; PRIVATE AND SEMI-PRIVATE ROOMS; SECURED INDOOR AND OUTDOOR ENVIRONMENTS; MONITORING SYSTEMS IN RESIDENT ROOMS; AND MORE. VILLAGE CARE CENTER: THE FREESTANDING SKILLED NURSING FACILITY IS LICENSED FOR 430 BEDS. CARE NEIGHBORHOODS PROVIDE 24-HOUR NURSING SERVICES FOR LONG-TERM CARE, MEMORY CARE, AND REHABILITATIVE CARE IN THE MEDICARE-CERTIFIED VILLAGE REHAB UNIT. VILLAGE HOSPICE: VILLAGE HOSPICE PROVIDES COMFORT-ORIENTED SERVICES TO ASSIST INDIVIDUALS WITH LIFE-LIMITING ILLNESSES, WHO ARE IN THE FINAL STAGES OF THEIR LIVES. THE AGENCY IS LICENSED AND CERTIFIED BY THE STATE OF MISSOURI AND SERVES JOHN KNOX VILLAGE RESIDENTS AS WELL AS PATIENTS IN EIGHT MISSOURI COUNTIES. VILLAGE PALLIATIVE CARE: VILLAGE PALLIATIVE CARE IS DESIGNED TO ASSIST PATIENTS AT ANY STAGE OF A SERIOUS ILLNESS, INJURY OR HEALTH CONDITION, WHETHER IT IS CHRONIC, CURABLE OR LIFE-LIMITING. THE SERVICE FOCUSES ON IMPROVING QUALITY OF LIFE BY HELPING WITH UNCONTROLLED SYMPTOMS SUCH AS PAIN, STRESS, INCONTINENCE OR CONSTIPATION, DIFFICULTY BREATHING OR SLEEPING, FATIGUE, NAUSEA, ANXIETY, DEPRESSION OR LOSS OF APPETITE. FORM 990, PART VI, SECTION A, LINE 6 PREMIERLIFE, A MISSOURI NONPROFIT CORPORATION, IS THE SOLE MEMBER OF JOHN KNOX VILLAGE. PREMIERLIFE IS DESIGNATED AS THE SOLE MEMBER SO LONG AS PREMIERLIFE SHALL CONTINUE TO QUALIFY AS A TAX EXEMPT, NONPROFIT ENTITY RECOGNIZED UNDER SECTION 501 (C)(3) OF THE IRC. PREMIERLIFE HAS THE RIGHT TO ELECT THE MEMBERS OF JOHN KNOX VILLAGE'S GOVERNING BODY. PREMIERLIFE HAS THE RESERVED POWER TO APPROVE SIGNIFICANT DECISIONS OF JOHN KNOX VILLAGE'S GOVERNING BODY. PREMIERLIFE IS NOT ENTITLED TO RECEIVE A SHARE OF JOHN KNOX VILLAGE'S PROFITS, EXCESS DUES OR A SHARE OF JOHN KNOX VILLAGE'S NET ASSETS UPON DISSOLUTION. FORM 990, PART VI, SECTION A, LINE 7A PREMIERLIFE, BEING THE SOLE MEMBER OF JOHN KNOX VILLAGE, HAS THE RIGHT TO ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE BYLAWS OF JOHN KNOX VILLAGE IDENTIFY CERTAIN RIGHTS AND POWERS WHICH ARE RESERVED TO PREMIERLIFE, THE SOLE MEMBER IN EACH INSTANCE, THE RIGHTS AND POWERS RESERVED TO THE SOLE MEMBER MAY BE SUMMARIZED AS FOLLOWS: 1. ELECTION OF DIRECTORS THE SOLE MEMBER ELECTS ALL DIRECTORS OF JOHN KNOX VILLAGE BASED UPON NOMINATIONS SUBMITTED BY JOHN KNOX VILLAGE'S BOARD OF DIRECTORS TERMS OF OFFICE ARE STAGGERED ON JOHN KNOX VILLAGE'S BOARD SUCH THAT APPROXIMATELY 1/3 OF THE DIRECTORS' TERMS EXPIRE EACH YEAR. 2. ARTICLES OF INCORPORATION AND BYLAWS JOHN KNOX VILLAGE'S ARTICLES OF INCORPORATION AND BYLAWS MAY NOT BE AMENDED, RESTATED, ALTERED OR REPEALED BY THE CORPORATION UNLESS AND UNTIL SUCH ACTION IS RATIFIED AND APPROVED BY THE SOLE MEMBER. 3. ANNUAL BUDGETS/FINANCIAL POLICIES/INVESTMENT JOHN KNOX VILLAGE'S ANNUAL OPERATING AND CAPITAL BUDGETS PREPARED AND RECOMMENDED BY THE CORPORATE BOARD ARE SUBJECT TO REVIEW AND APPROVAL OF THE SOLE MEMBER CORPORATE FINANCIAL POLICIES AND INVESTMENT STRATEGIES RECOMMENDED BY JOHN KNOX VILLAGE'S BOARD ALSO ARE SUBJECT TO PRIOR REVIEW AND APPROVAL OF THE SOLE MEMBER. 4. SALE OF ASSETS/MERGER, CONSOLIDATION/DISSOLUTION ANY SALE, LEASE OR OTHER DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF JOHN KNOX VILLAGE, AND ANY MERGER, CONSOLIDATION, REORGANIZATION OR OTHER NOT-IN-THE- ORDINARY-COURSE TRANSACTION IS SUBJECT TO THE PRIOR REVIEW, RATIFICATION AND APPROVAL OF THE SOLE MEMBER JOHN KNOX VILLAGE SHALL NOT BE DISSOLVED OR LIQUIDATED NOR ANY PLAN OF DISSOLUTION ADOPTED BY THE CORPORATION'S BOARD OF DIRECTORS WITHOUT THE RATIFICATION AND APPROVAL OF THE SOLE MEMBER, 5. LONG-TERM DEBT/LEASES ALL LONG-TERM DEBT OBLIGATIONS AND LONG-TERM LEASE OBLIGATIONS IN EXCESS OF ONE YEAR ARE SUBJECT TO PRIOR REVIEW/APPROVAL OF THE SOLE MEMBER 6. CHIEF EXECUTIVE OFFICER: ALL ACTIONS OF THE BOARD OF DIRECTORS OF JOHN KNOX VILLAGE TO EMPLOY OR TERMINATE THE EMPLOYMENT OF THE CEO OF THE CORPORATION ARE SUBJECT TO REVIEW AND APPROVAL BY THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE AUDIT COMMITTEE OF THE PREMIERLIFE BOARD FOR THEIR REVIEW. ANY QUESTIONS OR CONCERNS THE AUDIT COMMITTEE HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE JOHN KNOX VILLAGE EXECUTIVE COMMITTEE, WHO OVERSEES EXECUTIVE COMPENSATION, FOR THEIR REVIEW. ANY QUESTIONS OR CONCERNS THE EXECUTIVE COMMITTEE HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD FOR THEIR REVIEW. ANY QUESTIONS OR CONCERNS THE VOTING MEMBERS OF THE BOARD HAVE ARE ADDRESSED AND ANY CORRECTION OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. ONCE ALL THESE REVIEWS ARE COMPLETE, THE FINAL 990 IS THEN FILED WITH THE IRS, AND SUBSEQUENTLY POSTED ON THE WEBSITE WWW.GUIDESTAR.ORG BY THE COMPANY GUIDESTAR. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF HIRE (OR ELECTION IN THE CASE OF CORPORATE DIRECTORS AND TRUSTEES) AND ANNUALLY THEREAFTER, THE CEO OR HIS/HER DESIGNEE SHALL PROVIDE TO THE BOARD AND TO ALL EXECUTIVE OFFICERS, ADMINISTRATIVE STAFF, ASSOCIATES AND VOLUNTEERS A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE, WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. SUCH ANNUAL MONITORING AND REVIEW PROCEDURES SHALL BE PART OF THE CORPORATE COMPLIANCE PLAN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE AUDIT COMMITTEE CONCERNING ANY INTEREST SO DISCLOSED. EACH MEMBER OF THE BOARD OF DIRECTORS AND ALL MANAGEMENT ASSOCIATES SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OR DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL OR BUSINESS, WHICH MAY EXIST OR APPEAR AS TO PREMIERLIFE OR ANY SYSTEM ENTITY OR ANY MATTER OR BUSINESS WHICH MAY COME BEFORE THE BOARD (INCLUDING ITS COMMITTEES). THREE OF NINE BOARD OF DIRECTORS ARE RESIDENTS AND APPROVE THE VILLAGE'S ANNUAL BUDGET, WHICH INCLUDES APPROVAL OF THE INCREASES IN RESIDENTS' MONTHLY SERVICE FEES SINCE THOSE RESIDENT DIRECTORS ONLY REPRESENT ONE THIRD OF THE VOTING BOARD OF DIRECTORS, THIS PARTICIPATORY ACTION BY THE RESIDENT DIRECTORS IS BELIEVED TO BE IN COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ALSO, MISSOURI LAW REQUIRES CERTAIN SYSTEM ENTITIES TO HAVE AT LEAST ONE MEMBER OF ITS BOARD OF DIRECTORS WHO IS A RESIDENT. THE DISCLOSING INDIVIDUAL SHALL NEITHER VOTE NOR ENDEAVOR TO INFLUENCE CORPORATE ACTION IN ANY SUCH MATTER UPON REQUEST OF THE SUBJECT BOARD, THE AFFECTED INDIVIDUAL SHALL LEAVE THE BOARDROOM WHILE THE MATTER IS DISCUSSED AND A VOTE, IF ANY, SHALL BE RECORDED IN THE MINUTES OF THE BOARD OR ITS COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 JOHN KNOX VILLAGE USES THE FOLLOWING: 1. PEER GROUP: THE PEER GROUP WILL INCLUDE CONTINUING-CARE COMMUNITIES, NURSING HOMES AND CLOSELY RELATED ORGANIZATIONS, NATIONALLY. 2. BASE SALARIES WILL BE POSITIONED SO THAT MIDPOINTS TARGET THE 60TH PERCENTILE EXECUTIVE SALARIES WILL BE ADMINISTERED WITHIN RANGES BUILT AROUND THE 60TH PERCENTILE AND BASED ON PERFORMANCE, EXPERIENCE AND OTHER RELEVANT FACTORS. 3. INCENTIVES WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 60TH PERCENTILE OF THE PEER GROUP FOR ON-PLAN PERFORMANCE ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH TO 75TH PERCENTILE. 4. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS, APPROXIMATING THE 60TH TO 75TH PERCENTILE OF THE PEER GROUP. 5. TOTAL COMPENSATION WILL BE POSITIONED AT APPROXIMATELY THE 60TH PERCENTILE FOR ON-PLAN PERFORMANCE WITH TARGET INCENTIVE AWARDS AND APPROXIMATELY THE 65TH TO 75TH PERCENTILE FOR OUTSTANDING PERFORMANCE WITH MAXIMUM INCENTIVE AWARDS. JOHN KNOX VILLAGE EXECUTIVE COMMITTEE WILL DETERMINE THE TOTAL COMPENSATION PACKAGE FOR THE CEO. THE CEO SHALL MAKE RECOMMENDATIONS FOR THE SALARIES AND INCENTIVE PAYMENTS FOR OTHER EXECUTIVES. THESE AMOUNTS WILL BE PROVIDED ANNUALLY TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL. THE EXECUTIVE COMMITTEE WILL REPORT THE AGGREGATE INCREASES AND PERCENTAGE COMPARISON TO THE PHILOSOPHY TO THE BOARD OF DIRECTORS FOR APPROVAL. A SALARY REVIEW WAS LAST CONDUCTED BY AN INDEPENDENT ACCOUNTING FIRM IN FY2020. A WRITTEN OPINION FROM THE CONSULTANT WAS RECEIVED STATING THAT THE EXECUTIVE COMPENSATION PACKAGES ARE REASONABLE AND DO NOT CONSTITUTE EXCESS BENEFIT TRANSACTIONS. THE LETTER ALSO OUTLINES THE STEPS THE COMMITTEE TOOK TOWARD ESTABLISHING A REBUTTABLE PRESUMPTION THAT TOTAL PAY LEVELS ARE REASONABLE. THE CONSULTANT REVIEWED THE MINUTES TO ENSURE THE STEPS TAKEN SATISFIED THE IRS REQUIREMENTS. THE LETTER IS ON FILE AT THE FACILITY. JOHN KNOX VILLAGE'S PHILOSOPHY REGARDING EXECUTIVE COMPENSATION IS TO PAY AT APPROXIMATELY THE 60TH PERCENTILE OF THE MARKET, AND IT IS OUR PRACTICE TO ENSURE THE SALARIES ARE CONSISTENT WITH THE VILLAGE'S GOAL. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS (BYLAWS) ARE AVAILABLE FOR PUBLIC INSPECTION IN THE ADMINSTRATIVE CENTER BUILDING, THE CONFLICT OF INTEREST POLICY IS AVAILABLE FOR PUBLIC INSPECTION IN THE ADMINISTRATIVE CENTER BUILDING, A COPY OF THE MOST RECENTLY FILED IRS FORM 990 AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT THE ADMINISTRATIVE CENTER BUILDING, SECOND FLOOR. AUDITED FINANCIALS ARE ALSO AVAILABLE AT THE MARKETING OFFICE. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESSES DURING THE YEAR. PREMIERLIFE 400 NW MURRAY ROAD LEES SUMMIT MO 64081 203587205 SUPPORTING ORGANIZATION MO 501(C)(3) LINE 12B, II N/A 0 THE JOHN KNOX VILLAGE FOUNDATION 400 NW MURRAY ROAD LEES SUMMIT MO 64081 431304714 SUPPORTING ORGANIZATION MO 501(C)(3) LINE 7 PREMIERLIFE 0 PREMIERLIFE REAL ESTATE HOLDING 400 NW MURRAY ROAD LEES SUMMIT MO 64081 203587252 REAL ESTATE MO 501(C)(2) PREMIERLIFE 0 JOHN KNOX VILLAGE AUXILIARY 400 NW MURRAY ROAD LEES SUMMIT MO 64081 431528124 SUPPORTING ORGANIZATION MO 501(C)(3) LINE 10 PREMIERLIFE 0 THE JKV REDEVELOPMENT CORPORATION 400 NW MURRAY ROAD LEES SUMMIT MO 64081 200528072 REAL ESTATE MO JOHN KNOX VILLAGE C 1000 1.00000 1 WOODSIDE RIDGE COMMERCIAL PARK OWNERS ASSOCIATION 400 NW MURRAY ROAD LEES SUMMIT MO 64081 932774257 HOMEOWNER'S ASSOCIATION MO N/A C 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0