2023-02-13T13:30:25-06:00 2022-03-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2021-04-01 237365138 JOHN KNOX VILLAGE JOHN 8163472859 400 NW MURRAY ROAD LEES SUMMIT MO 64081 RICHARD KIM KLOCKENGA VP OF FINANCE & TREASURER 8163472859 2023-02-10 1 RICHARD KIM KLOCKENGA 999009999 JEFF PARKER P00970069 6182331200 2023-02-10 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z DANIEL REXROTH 400 NW MURRAY ROAD LEES SUMMIT MO 64081 106044492 0 X WWW.JKV.ORG X 1974 MO ENRICH THE LIVES OF OLDER ADULTS THROUGH COMMUNITY LIVING. "ENRICHING LIVES, BUILDING COMMUNITY" 9 9 1108 200 190046 0 5644332 7715338 63629186 62592003 1395430 4260069 1026329 1434992 71695277 76002402 1450000 0 0 0 41787237 40696437 0 0 0 40294776 40024785 83532013 80721222 -11836736 -4718820 188344073 191307617 251233557 263022526 -62889484 -71714909 X TO ENRICH THE LIVES OF OLDER ADULTS THROUGH COMMUNITY LIVING, "ENRICHING LIVES, BUILDING COMMUNITY." 0 0 33821383 0 27990899 HEALTH SERVICES - SEE SCHEDULE O 30481583 0 25226848 RESIDENT SERVICES - SEE SCHEDULE O 11326907 0 9374256 ASSISTED LIVING FACILITY AND ALZHEIMER'S ASSISTED LIVING FACILITY - SEE SCHEDULE O 75629873 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 0 0 0 0 0 1 1 0 0 0 1 152 0 1108 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 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 1.00 0.00 X 0 0 0 JIM HAM DIRECTOR 1.00 1.00 X 0 0 0 CHUCK ROBB VICE CHAIR 1.00 1.00 X X 0 0 0 DIANE DEMAREST DIRECTOR 1.00 1.00 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 CHRISTINE BUSHYHEAD DIRECTOR (TERM ENDED 5/21) 1.00 2.00 X 0 0 0 GEORGE PAGELS DIRECTOR (TERM ENDED 5/21) 1.00 0.00 X 0 0 0 DANIEL REXROTH PRESIDENT AND CEO 40.00 4.00 X 896807 0 34776 LAURIE JOHNSON VP OF HUMAN RESOURCES 40.00 0.00 X 213657 0 30246 RICHARD K KLOCKENGA VP OF FINANCE & CORPORATE TREASURER 40.00 4.00 X 473610 0 44291 RODNEY MCBRIDE VP OF HEALTH & COMMUNITY SERVICES 40.00 0.00 X 288476 0 23701 MARIA TIMBERLAKE VP OF SENIOR LIVING 40.00 1.00 X 377754 0 40161 DONNA BARRON ASSISTANT SECRETARY 40.00 1.00 X 70749 0 12699 ANTHONY COLUMBATTO VCC ADMINISTRATOR 40.00 0.00 X 186949 0 16191 STEVE SEGGERMAN ASST. TREASURER AND DIR. OF FINANCE 40.00 1.00 X 131071 0 21134 RICHARD SCOTT DIRECTOR OF OPERATIONS & DEVELOPMENT 40.00 0.00 X 137204 0 3424 TAMI HOVERSTEN ASSISTANT ADMINISTRATOR 40.00 0.00 X 157197 0 11786 MARYBETH ROBERTS DIRECTOR OF SALES & MARKETING 40.00 0.00 X 140566 0 7828 KETTI DAWSON ADMINISTRATOR HOSPICE 40.00 0.00 X 126004 0 726 SALLY ARREY RN SKIN SPEC NURSE MGR 40.00 0.00 X 116336 0 11509 3316380 0 258472 30 0 1 0 HAREN CONTRACTING LLC 8035 NIEMAN ROAD LENEXA KS 66214 CONSTRUCTION 6830698 UNITED METHODIST HOMES & SERVICES 1415 W FOSTER AVE CHICAGO IL 60640 MEDICAL STAFFING 2068127 HARKRADER CONSTRUCTION 401B NW MURRAY ROAD LEES SUMMIT MO 64081 CONSTRUCTION 1735206 ATTANE 8880 WARD PARKWAY SUITE 400 KANSAS CITY MO 64114 MARKETING 1059739 CASCADE HEALTH SERVICES 1045 SWIFT AVE NORTH KANSAS CITY MO 64116 MEDICAL STAFFING 734637 40 106672 7608666 7715338 NET PATIENT REVENUE 623000 62592003 62592003 62592003 751972 751972 103412 103412 227361 0 227361 227361 156946 70415 33446775 30042090 3404685 3404685 3404685 BEAUTY SHOPS 623000 348196 348196 UTILITY REVENUE 623000 274370 274370 CAFETERIA & MEALS 721310 248982 33100 215882 336083 336083 1207631 76002402 62592003 190046 5505015 2207067 1976649 230418 30524860 28055327 2469533 695274 436839 258435 4880533 4601668 278865 2388703 2231284 157419 51298 27457 23841 93882 20163 73719 2732 2732 99652 99652 6145313 5708322 436991 981469 880380 101089 5319431 5188748 130683 1321105 1273747 47358 3925711 3871086 54625 427507 421672 5835 45861 38380 7481 5530956 5368426 162530 12260170 11817568 442602 1272702 1215939 56763 MEDICAID TAX 761404 761404 MEDICAL SUPPLIES 682665 682665 BAD DEBT EXPENSE 425375 425375 RECRUITMENT 349895 324015 25880 327657 302759 24898 80721222 75629873 5091349 0 3303562 5065554 1615488 1652230 6732679 3135802 395857 447142 560135 926175 269874358 148898003 117065888 120976355 50639154 54986951 4040424 1535006 520382 647337 3470504 1935065 188344073 191307617 11456311 12543872 81075517 83093539 108476623 124711355 7043528 4847186 7075000 0 36106578 37826574 251233557 263022526 X -62889484 -71714909 -62889484 -71714909 188344073 191307617 -4718820 -4106605 0 X X 0 1 X 1 0 X 327832 494245 332396 5644332 7715338 14514143 66836572 67728518 69412221 63629186 62592003 330198500 963441 963441 67164404 68222763 69744617 69273518 71270782 345676084 109027 181301 220175 252048 197774 960325 0 109027 181301 220175 252048 197774 960325 344715759 1499620 1692913 1306832 1264040 925799 6689204 1499620 1692913 1306832 1264040 925799 6689204 10030 18318 9566 37914 1812660 1851163 1821585 870130 211093 6566631 70486714 71785157 72882600 71407688 72407674 358969833 0.96030 0.95690 0.01860 0.01890 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA - 2017 AMOUNT: $ 668,500. 2018 AMOUNT: $ 749,877. 2019 AMOUNT: $ 624,624. 2020 AMOUNT: $ 78,119. BEAUTY SHOPS - 2017 AMOUNT: $ 460,084. 2018 AMOUNT: $ 417,321. 2019 AMOUNT: $ 447,543. 2020 AMOUNT: $ 242,118. MISCELLANEOUS - 2017 AMOUNT: $ 242,762. 2018 AMOUNT: $ 206,750. 2019 AMOUNT: $ 249,219. 2020 AMOUNT: $ 229,169. 2021 AMOUNT: $ 211,093. TRANSPORTATION REVENUE - 2017 AMOUNT: $ 55,715. 2018 AMOUNT: $ 50,076. 2019 AMOUNT: $ 45,537. 2020 AMOUNT: $ 40. ROOM RENTAL - 2017 AMOUNT: $ 70,594. 2018 AMOUNT: $ 86,193. 2019 AMOUNT: $ 110,301. 2020 AMOUNT: $ 9,720. UTILITY REVENUE - 2017 AMOUNT: $ 315,005. 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 2732 2732 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 200742185 117088842 83653343 15860038 8307284 7552754 33851066 23501877 10349189 14233178 14233178 120976355 ASSET RETIREMENT OBLIGATION 4759843 DEPOSITS 33066731 37826574 X 71796145 -4106605 -4106605 75902750 99652 99652 76002402 80621570 0 80621570 99652 99652 80721222 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 349154 0 0 0 0 0 0 349154 0 349154 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 472542 0 341299 0 82966 0 26750 0 8026 0 931583 0 0 0 RICHARD K KLOCKENGA VP OF FINANCE & CORPORATE TREASURER 280909 0 182018 0 10683 0 26750 0 17541 0 517901 0 0 0 MARIA TIMBERLAKE VP OF SENIOR LIVING 228390 0 145523 0 3841 0 27422 0 12739 0 417915 0 0 0 RODNEY MCBRIDE VP OF HEALTH & COMMUNITY SERVICES 140324 0 147317 0 835 0 17303 0 6398 0 312177 0 0 0 LAURIE JOHNSON VP OF HUMAN RESOURCES 183524 0 29056 0 1077 0 22220 0 8026 0 243903 0 0 0 ANTHONY COLUMBATTO VCC ADMINISTRATOR 173780 0 13028 0 141 0 3452 0 12739 0 203140 0 0 0 TAMI HOVERSTEN ASSISTANT ADMINISTRATOR 143268 0 13667 0 262 0 3958 0 7828 0 168983 0 0 0 STEVE SEGGERMAN ASST. TREASURER AND DIR. OF FINANCE 125825 0 5000 0 246 0 3593 0 17541 0 152205 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 2021: 457(B) SUPPLEMENTAL SAVINGS PLAN: DANIEL REXROTH - $19,500 RICHARD KLOCKENGA - $19,500 RODNEY MCBRIDE - $13,698 MARIA TIMBERLAKE - $19,500 LAURIE JOHNSON - $17,591 SUPPLEMENTAL EXECUTIVE COMPENSATION PROGRAM: DANIEL REXROTH - $72,324 RICHARD KLOCKENGA - $8,520 MARIA TIMBERLAKE - $2,881 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 EARNED THE INCENTIVE OVER A 5-YEAR PERIOD AND BECAME VESTED IN THE 457(F) PLAN IN 2021. AS A RESULT, THE PAYOUTS FROM THIS PLAN ARE INCLUDED IN REPORTABLE COMPENSATION AND REPORTED BELOW. THERE WERE NO CONTRIBUTIONS TO THE 457(F) PLAN IN 2021. DANIEL REXROTH - $217,794 RICHARD KLOCKENGA - $135,735 RODNEY MCBRIDE - $110,030 MARIA TIMBERLAKE - $108,553 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 20716151 2097889 388239 14721468 3593443 2015 1 0 1 1 B 615000 42745005 2973735 789919 39225058 2018 0 0 1 1 C 7790000 54473157 5373364 1119918 7196255 41151446 2020 1 0 1 1 D 30714647 900179 609175 5019857 1741484 22442728 0 1 0 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. FORM 990, PAGE 2, PART III, LINES 4A, 4B, AND 4C: AS A LEADING PROVIDER OF CARE AND SERVICES FOR OLDER ADULTS, THE VILLAGE IS COMMITTED TO ACHIEVING ITS MISSION OF "ENRICHING LIVES, BUILDING COMMUNITY" IN LEE'S SUMMIT AND BEYOND AND CHALLENGES ITSELF TO MAKE THE MOST OF ITS COMMUNITY INOLVEMENT EFFORTS. * 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 * LOCATED IN LEE'S SUMMIT, MISSOURI, WITH HOME HEALTH OFFICES IN PRAIRIE VILLAGE, KANSAS * ANNUALLY SERVES ABOUT 1,200 RESIDENTS ON ITS CAMPUS AND ABOUT 5,000 COMMUNITY MEMBERS WHO LIVE IN WESTERN MISSOURI AND EASTERN KANSAS * WITH ABOUT 800 ASSOCIATES ON STAFF, ONE OF THE LARGEST EMPLOYERS IN LEE'S SUMMIT * PROVIDING A FULL CONTINUUM OF CARE AND SERVICES, THE VILLAGE SERVES ABOUT 820 INDEPENDENT LIVING HOUSEHOLDS; ABOUT 165 RESIDENTS OF VILLAGE ASSISTED LIVING AND THE THREE VILLAGE ASSISTED LIVING MEMORY CARE UNITS; AND ABOUT 125 RESIDENTS OF THE VILLAGE CARE CENTER. THE VILLAGE'S LARGE SIZE AND ITS DIVERSE SERVICES AND AMENITIES ENABLES IT TO ALLOCATE MULTIPLE RESOURCES TOWARD ITS COMMUNITY INVOLVEMENT COMMITMENTS. IT SHARES FACILITIES; FACILITATES THE GIVING OF TIME AND TALENTS VIA A VARIETY OF VOLUNTEER OPPORTUNITIES; OFFERS LEADERSHIP AND/OR MODEST FINANCIAL SUPPORT TO OTHER NOT-FOR-PROFIT ORGANIZATIONS; SHARES ENTERTAINMENT; AND PROMOTES EDUCATION AND INTERGENERATIONAL ACTIVITIES. VILLAGE RESIDENTS AND ASSOCIATES VOLUNTEER THEIR TIME AND TALENTS ON THE CAMPUS AS WELL AS IN THE SURROUNDING COMMUNITY. IN 2021, THE VILLAGE ACCUMULATED 14,784 VOLUNTEER HOURS. WHAT'S MORE, VILLAGE HOSPICE LOGGED IN AN ADDITIONAL 114 PATIENT CARE HOURS AND 479 HOURS OF COMMUNITY IMPACT TIME. ITS NINE-MEMBER BOARD OF DIRECTORS, WHICH CONSISTS OF THREE RESIDENTS AND SIX WHO LIVE OUTSIDE THE VILLAGE, ALSO VOLUNTEER THEIR TIME. THE VILLAGE ALSO OFFERS MODEST FINANCIAL SUPPORT TO ORGANIZATIONS THAT POSITIVELY IMPACT THE COMMUNITY AND/OR ENCOURAGE OLDER ADULTS. EXAMPLES OF CORPORATE GIVING IN 2021 INCLUDE FINANCIAL SUPPORT OF THE LEE'S SUMMIT PARKS AND RECREATION BASEBALL LEAGUE; THE LEE'S SUMMIT CHAMBER OF COMMERCE GOLF TOURNAMENT; LEE'S SUMMIT CHAMBER OF COMMERCE OKTOBERFEST; AND LEE'S SUMMIT SYMPHONY. THE VILLAGE ALSO SUPPORTS A VARIETY OF LOCAL ORGANIZATIONS SUCH AS LEE'S SUMMIT CARES AND LEE'S SUMMIT SOCIAL SERVICES. THE VILLAGE HOSTS MULTIPLE SPECIAL EVENTS THAT ALL MEMBERS OF THE COMMUNITY CAN ATTEND, INCLUDING AS RESIDENT THEATER, CHORAL AND INSTRUMENTAL GROUPS PERFORMANCES; CONCERTS BY THE AMERICAN LEGION BAND: UNITED STATES AIR FORCE JAZZ BAND: SHADES OF BLUE; THE HEARTLAND RECORDER ORCHESTRA CONCERT; AND OTHER TYPES OF CULTURAL EVENTS. WHAT'S MORE, THE VILLAGE HAS DONATED MEETING SPACES TO A DIVERSE ARRAY OF ORGANIZATIONS, SUCH AS THE LEE'S SUMMIT CHAMBER OF COMMERCE AND TOASTMASTERS INTERNATIONAL (DONATIONS VALUE ABOUT $16,000). THE VILLAGE ALSO DONATES ITS LARGE-SCALE SPECIAL EVENT VENUE, THE PAVILION AT JOHN KNOX VILLAGE, MULTIPLE TIMES A YEAR (DONATIONS VALUE ABOUT $50,000). EXAMPLES INCLUDE THE CITY OF LEE'S SUMMIT ANNUAL MEETING; LEE'S SUMMIT R-7 SCHOOL DISTRICT EVENTS; LEE'S SUMMIT MAYOR'S OUTREACH BREAKFAST FOR COMMUNITY OF CHARACTER; LEE'S SUMMIT MARTIN LUTHER KING TRIBUTE; AND OTHER EVENTS. FINALLY, THE VILLAGE DONATES EQUIPMENT, SUPPLIES OR GENTLY USED ITEMS TO OTHER NOT-FOR-PROFIT ORGANIZATIONS, SUCH AS THE SURPLUS EXCHANGE, HABITAT FOR HUMANITY AND THE LEE'S SUMMIT HOPE HOUSE. LOCAL SCHOOLS, CHILDREN'S CAMPS, CHILDCARE FACILITIES, NURSING HOMES AND CHURCHES ALSO HAVE RECEIVED SURPLUS SUPPLIES. FORM 990, PART VI, SECTION A, LINE 4 CHANGES TO BY-LAWS INCLUDE THE FOLLOWING: *MODERNIZING PLACE OF MEETING, ATTENDANCE AND APPROVAL METHODS TO EXPLICITLY INCLUDE ELECTRONIC AND VIRTUAL MEETINGS AND APPROVAL. *CLARIFYING CAP ON 2 SUCCESSIVE THREE YEAR TERMS AND WITH 1 YEAR OFF OF BOARD AND THEN CAN BE RE-ELECTED AND THE CAP ON 2 SUCCESSIVE 3 YEAR TERMS BEGINS AGAIN. *CLARIFYING IF APPOINTED TO FILL A VACANCY, IF THAT PERSON SERVES 1 YEARS OR MORE THAT COUNTS AS ONE TWO YEAR TERM TOWARD THE CAP. IF A PERSON APPOINTED TO FILL A VACANCY SERVES LESS THAN 1 YEARS, THAT DOES NOT COUNT TOWARD THE 2 SUCCESSIVE THREE YEAR TERM CAP. *INCREASED THRESHOLD FOR WHICH PREMIERLIFE APPROVAL IS REQUIRED FOR NON-BUDGETED EXPENDITURES FROM $100,000 TO $250,000 *REMOVING APPROVAL BY PREMIERLIFE OF FINANCIAL OR INVESTMENT POLICIES. *INCREASING THRESHOLD FOR WHICH PREMIERLIFE APPROVAL OF LONG TERM LEASES IS REQUIRED FROM 1 YEAR TO 5 YEARS *REMOVING OVERLAPPING DIRECTOR REQUIREMENTS WITH PREMIERLIFE AND OTHER SUBSIDIARY BOARDS 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 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0