2023-08-21T15:25:52-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 420 SOUTH ORANGE AVENUE SUITE 900 ORLANDO FL 32801 990 2022-01-01 591800721 JOHN KNOX VILLAGE OF FLORIDA INC JOHN 9547834000 651 SW 6TH STREET POMPANO BEACH FL 33060 DOUGLAS FOLSOM CHIEF FINANCIAL OFFICER 9547834000 2023-08-01 1 DOUGLAS FOLSOM 999009999 0 AMY CHAPMAN P00843460 4078021200 2023-07-26 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z DOUGLAS FOLSOM 651 SW 6TH STREET POMPANO BEACH FL 33060 247244874 0 X WWW.JOHNKNOXVILLAGE.COM X 1978 FL PROVIDE AN ENVIRONMENT OF WHOLE PERSON WELLNESS IN WHICH THE PEOPLE WE SERVE THRIVE. 10 10 869 14 0 0 1238529 1007155 58086933 63855117 1677698 2235239 305529 1178019 61308689 68275530 0 2585752 0 0 29236902 29086710 0 0 0 37738522 39194240 66975424 70866702 -5666735 -2591172 388984733 394794211 341580123 359180895 47404610 35613316 X JOHN KNOX VILLAGE OF FLORIDA, INC. IS DEDICATED TO PROVIDING AN ENVIRONMENT OF WHOLE PERSON WELLNESS IN WHICH THE PEOPLE WE SERVE THRIVE. JOHN KNOX VILLAGE OF FLORIDA IS COMMITTED TO SUPPORTING OUR EMPLOYEES, PARTNERS AND THE GREATER COMMMUNITY. 0 0 25703561 2585752 19696087 THE SKILLED NURSING PROGRAM IS AVAILABLE TO RESIDENTS AS A WELL AS MEMBERS OF THE LOCAL COMMUNITY. THE 194 BED LICENSED FACILITY IS ALSO MEDICARE AND MEDICAID CERTIFIED. RESIDENTS MAY USE THE NURSING FACILITY FOR SHORT-TERM REHABILITATION AFTER ILLNESS OR SURGERY OR FOR LONG-TERM CONTINUOUS CARE. 16028253 39201651 THE INDEPENDENT LIVING FACILITY CONSISTS OF 644 UNITS FOR SENIORS AND PROVIDES MEALS, SECURITY, FITNESS, WELLNESS, ACTIVITIES, TRANSPORTATION, HOUSEKEEPING, ON-SITE NURSING CARE AND VARIOUS OTHER SERVICES. 10628103 6059580 THE ASSISTED LIVING PROGRAM PROVIDES CARE TO THOSE RESIDENTS WHO MAY NEED MORE ASSISTANCE WITH THE ACTIVITIES OF DAILY LIVING. THIS THREE-STORY, DEDICATED BUILDING INCLUDES 64 UNITS. RESIDENTS RECEIVE THREE MEALS A DAY, HELP WITH ROUTINE ACTIVITIES SUCH AS BATHING, HOUSEKEEPING, LAUNDRY, PERSONAL SERVICES, APPOINTMENT SETTING, MEDICATION MANAGEMENT, AND ENJOY DAILY SOCIAL ACTIVITIES. THE SHARING AND CARING PROGRAM BEGAN IN 2008 AS A WAY IN WHICH JKV COULD FULFILL PART OF IT'S MISSION STATEMENT THAT COMMITS TO SUPPORT THE GREATER COMMUNITY. OVER THE PAST SEVERAL YEARS, JKV HAS BEEN IN THE PRIVILEGED POSITION TO DONATE OVER $1.7 MILLION TO CHARITIES IN THE LOCAL AND INTERNATIONAL COMMUNITIES IN AN EFFORT TO PROVIDE HELP TO OUR NEIGHBORS WHERE IT CAN MAKE THE MOST DIFFERENCE. THE JKV'S AFFILIATION WITH MEALS ON WHEELS HAS GIVEN JKV THE OPPORTUNITY TO ASSIST THOSE WHO ARE FOOD INSECURE. THE CLIENTS ARE OFTEN OLDER AND JKV'S MONETARY SUPPORT ALLOWED THEM TO REMOVE 13 PEOPLE FROM THE WAITING LIST. JKV HAS FOSTERED A RELATIONSHIP WITH INNOVATION CHARTER SCHOOL. THE CHILDREN PARTICIPATE IN OUR HOLIDAY PARADE AND OUR RESIDENTS AND STAFF VOLUNTEER TIME READING TO CHILDREN DURING THE YEAR. OUR BUDGETED FUNDS HELP AGENCIES THAT ARE DOING WORK WITH INDIVIDUALS WHO HAVE DAILY NEEDS. 52359917 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 101 0 1 869 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X DOUGLAS FOLSOM 9547834000 651 SW 6TH STREET POMPANO BEACH FL 33060 X MONICA MCAFEE CHIEF MARKETING & INNOVATION OFFICER 40.00 X 326528 0 9482 KIMBERLY ALI DIRECTOR OF SALES 40.00 X 318369 0 19208 WILLIAM PICKHARDT FORMER COO (EXITED 7.29.22) 40.00 X 268528 0 5574 CHARLES WILLIAMS CHIEF INFORMATION OFFICER 40.00 X 231389 0 17612 THOMAS PRICE DIRECTOR OF PLANT OPERATIONS 40.00 X 229132 0 11942 GERALD STRYKER FORMER PRESIDENT/CEO (EXITED 8.26.22) 40.00 X 223678 0 8478 DOUGLAS FOLSOM CHIEF FINANCIAL OFFICER 40.00 X 221209 0 6987 GAIL SUTTON-PAULING DIRECTOR OF PROJECT MANAGEMENT 40.00 X 200640 0 4411 MARK DOBOSZ EXECUTIVE DIRECTOR FOR FOUNDATION 1.00 40.00 X 199428 0 22252 MARK RAYNER ADMINISTRATOR 40.00 X 163247 0 3621 SALVATORE BARBERA PRESIDENT/CEO (EFFECTIVE 9.12.22) 40.00 X X 130944 0 1797 BRUCE CHITTENDEN FORMER CFO (EXITED 7.15.22) 40.00 X 109116 0 495 PAUL SIMPSON FORMER CHAIRMAN (STEPPED DOWN 8.26.22) 2.50 X X 0 0 0 JACK CRISSY CHAIRMAN (EFFECTIVE 9.12.22) 2.50 X 0 0 0 DR HM TODD MD VICE CHAIRMAN 2.50 X X 0 0 0 DIRK DEJONG SECRETARY/TREASURER (EFF. 11.14.22) 2.50 X X 0 0 0 REBECCA NETH-TOWNSEND DIRECTOR 2.50 X 0 0 0 DR MICHELLE CLARK DIRECTOR 2.50 X 0 0 0 TERRY COLLI DIRECTOR 2.50 2.50 X 0 0 0 DIANE BARTON DIRECTOR 2.50 X 0 0 0 TOM MCKAY DIRECTOR (EXITED 12.31.22) 2.50 2.50 X 0 0 0 TOM MCDOWELL DIRECTOR 2.50 2.50 X 0 0 0 WILLIAM O'LEARY DIRECTOR (EXITED 6.17.22) 2.50 X 0 0 0 KELLEY BABCOCK DIRECTOR (EXITED 6.17.22) 2.50 X 0 0 0 JONATHAN OSBORNE DIRECTOR (STEPPED DOWN 12.31.22) 2.50 X 0 0 0 PATRICK SHAVLOSKE DIRECTOR (STEPPED DOWN 6.26.22) 2.50 X 0 0 0 2622208 0 111859 32 0 1 0 MOSS & ASSOCIATES LLC 2101 N ANDREWS AVE FORT LAUDERDALE FL 33311 CONSTRUCTION SERVICES 41305357 G PROULX BUILDING PRODUCTS 3125 S ANDREWS AVE FORT LAUDERDALE FL 33316 CONSTRUCTION SERVICES 2397466 QUALITY CARE REHAB INC 8477 S SUNCOAST BLVD HOMOSASSA FL 34446 THERAPY & REHAB SERVICES 2049025 CONCIERGE CARE STAFFING 4723 W ATLANTIC AVE SUITE A4 DELRAY BEACH FL 33445 STAFFING SERVICES 595883 MARCO A SERVICES 7311 SADDLE ROAD LAKE WORTH FL 33463 RENOVATION/CONSTRUCTION SERVICES 563622 13 434381 572774 1007155 INDEPENDENT LIVING 623000 25274755 25274755 HEALTHCARE SERVICES 623000 18593886 18593886 AMORTIZATION OF FEES 623000 13926896 13926896 DINING SERVICES 623000 3859819 3859819 ASSISTED LIVING 623000 2199761 2199761 63855117 2521362 2521362 227529 151711 75818 75818 75818 178531510 178817633 -286123 -286123 -286123 OTHER RESIDENT SERVICES 900099 1102201 1102201 1102201 68275530 64957318 0 2311057 2585752 2585752 1563817 1317672 246145 21867189 18773082 3094107 245140 222451 22689 3416466 1883659 1532807 1994098 1629764 364334 789271 79289 709982 354413 354413 6775017 2406571 4368446 361563 -13110 374673 2906911 1772690 1134221 5550446 4302460 1247986 93933 53394 40539 2599629 2073012 526617 9919479 7993259 1926220 2533912 305750 2228162 DIETARY 4039190 3976023 63167 THERAPY 2678092 2678092 RESIDENT ACTIVITIES 302683 285534 17149 PRODUCTION COSTS 153858 42792 111066 135843 -8219 144062 70866702 52359917 18506785 0 125391 285312 15587463 3962269 1992320 2381140 77426 184137 2665280 2684377 365171811 134833884 152236893 230337927 215508375 154185361 704107 686209 87478 87479 388984733 394794211 9493333 20027766 81198523 85927006 245158925 242907427 5729342 10318696 341580123 359180895 X 45971102 35240960 1433508 372356 47404610 35613316 388984733 394794211 X -2591172 -9182224 -17898 X 0 1 X 1 0 X 901872 719807 2049896 1238529 1007155 5917259 52591016 56544803 56301391 58086933 63855117 287379260 53492888 57264610 58351287 59325462 64862272 293296519 0 0 0 293296519 2195295 2197148 1727321 1447420 2748891 10316075 2195295 2197148 1727321 1447420 2748891 10316075 2339136 336461 209355 47227 1102201 4034380 58027319 59798219 60287963 60820109 68713364 307646974 0.95340 0.95210 0.03350 0.03250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9564010 110562 -1334532 1873236 6466804 8876777 1381764 758494 1453025 9564010 8005457 264126 821159 213965 8876777 10984897 9649 -2667496 321593 8005457 11316242 15825 -379491 -32321 10984897 0.86000 0.14000 0 1 1 4232030 4232030 232515425 101804866 130710559 40996678 24535248 16461430 87427678 8493770 78933908 230337927 DEPOSITS 6770937 ANNUITY PAYMENT LIABILITY 1000839 DEPOSITS - PREVIEW TO LIFECARE 6655 INTERCOMPANY LIABILITIES 846512 LEASE LIABILITY 1693753 10318696 PART V, LINE 4: THE JOHN KNOX VILLAGE OF FLORIDA FOUNDATION, INC., A NONPROFIT RELATED ORGANIZATION, HOLD ENDOWMENT FUNDS AND CONTRIBUTIONS FOR THE SOLE SUPPORT OF THE JOHN KNOX VILLAGE OF FLORIDA, INC. 0 JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC 651 SW 6TH STREET POMPANO BEACH FL 33060 760784971 501(C)(3) 2585752 0 GENERAL OPERATING SUPPORT 1 X X X X 0 0 0 0 0 0 0 0 0 MONICA MCAFEE CHIEF MARKETING & INNOVATION OFFICER 157223 0 140790 0 28515 0 1769 0 7713 0 336010 0 0 0 KIMBERLY ALI DIRECTOR OF SALES 116175 0 187722 0 14472 0 5408 0 13800 0 337577 0 0 0 WILLIAM PICKHARDT FORMER COO (EXITED 7.29.22) 122802 0 25914 0 119812 0 5574 0 0 0 274102 0 0 0 CHARLES WILLIAMS CHIEF INFORMATION OFFICER 187234 0 17145 0 27010 0 5020 0 12592 0 249001 0 0 0 THOMAS PRICE DIRECTOR OF PLANT OPERATIONS 157903 0 35761 0 35468 0 0 0 11942 0 241074 0 0 0 GERALD STRYKER FORMER PRESIDENT/CEO (EXITED 8.26.22) 173654 0 20000 0 30024 0 5104 0 3374 0 232156 0 0 0 DOUGLAS FOLSOM CHIEF FINANCIAL OFFICER 155483 0 35675 0 30051 0 4599 0 2388 0 228196 0 0 0 GAIL SUTTON-PAULING DIRECTOR OF PROJECT MANAGEMENT 134472 0 34867 0 31301 0 4138 0 273 0 205051 0 0 0 MARK DOBOSZ EXECUTIVE DIRECTOR FOR FOUNDATION 163699 0 20636 0 15093 0 4384 0 17868 0 221680 0 0 0 MARK RAYNER ADMINISTRATOR 124400 0 1168 0 37679 0 3621 0 0 0 166868 0 0 0 A CITY OF POMPANO BEACH 596000411 732203AU8 2015-02-12 31980885 CONSTRUCT SKILLED NURSING FACILITY 0 0 0 B CITY OF POMPANO BEACH 596000411 732203BE3 2020-10-29 79360241 REFUND 2010 (12/30/10), FINANCE CONSTRUCTION 0 0 0 C CITY OF POMPANO BEACH 596000411 732203BJ2 2021-12-21 142259342 FINANCE CONSTRUCTION OF NEW IL TOWER 0 0 0 A 4255000 31980885 1864038 551847 29393529 171471 2018 0 0 1 1 B 2060000 79360241 4291187 2612928 1096229 66493180 4866717 1 0 0 1 C 142259342 4296800 1846038 65520644 70595860 0 0 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 0 1 0 0 1 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 0 A 1 B 1 C 1 SCHEDULE K, PART II, LINE 3 FOR THE CITY OF POMPANO BEACH 2/12/15, THE TOTAL PROCEEDS OF ISSUE HAS A VARIANCE FROM THE ISSUE PRICE THAT IS DUE TO INVESTMENT EARNINGS. FOR THE CITY OF POMPANO BEACH 10/19/20, THE TOTAL PROCEEDS OF ISSUE HAS A VARIANCE FROM THE ISSUE PRICE THAT IS DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 11 FOR THE CITY OF POMPANO BEACH 2/12/15, OTHER SPENT PROCEEDS ARE RESERVE EARNINGS SPENT FOR DEBT SERVICE. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A NOMINATING COMMITTEE WHOSE PURPOSE IS TO VET MEMBER CANDIDATES FOR SUITABILITY AND UPON PASSING THE VETTING PROCESS, THE NOMINATING COMMITTEE WILL SUBMIT THE NAMES FOR THE FULL BOARD OF DIRECTORS TO APPROVE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS WHOSE ROLE IS TO ELECT MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. A COPY OF THE APPROVED 990 IS DISTRIBUTED TO EACH MEMBER OF THE BOARD FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS POTENTIAL OR ACTUAL CONFLICT OF INTEREST AND ACTION IS TAKEN ACCORDINGLY. DIRECTORS, OFFICERS AND OTHER PERTINENT EMPLOYEES ARE INSTRUCTED REGARDING CONFLICT OF INTEREST, RECUSAL FROM DECISION MAKING. THEY HAVE AN AFFIRMATIVE DUTY TO REPORT THOSE CONFLICTS TO THE COMPLIANCE OFFICER DIRECTLY OR THROUGH THE COMPLIANCE HOTLINE ANNUALLY AND AS THEY BECOME AWARE. AN ONGOING LIST OF REPORTED ACTUAL OR POTENTIAL RELATED PARTIES IS KEPT BY THE COMPLIANCE OFFICER AND MADE AVAILABLE TO THOSE DETERMINED TO BE IN MAJOR DECISION MAKING ROLES. MAJOR CONTRACTS ARE REVIEWED BY THE PRESIDENT/CEO, CHIEF FINANCIAL OFFICER AND COMPLIANCE OFFICER FOR POTENTIAL OR ACTUAL CONFLICT. THIS ALLOWS DECISION MAKING IN THE BEST INTEREST OF THE ORGANIZATION, ASSESSMENT OF THE AVAILABILITY AND COST OF COMPARABLE GOODS AND SERVICES AND WHETHER IT MEETS THE CODE OF CONDUCT. IF AFTER ANY MATERIAL FACT GATHERING, THERE IS STILL A QUESTION WHETHER THE TRANSACTION IS APPROPRIATE, THE CORPORATE ATTORNEY IS CONSULTED. A FINAL DECISION IS THEN MADE BY THE PRESIDENT/CEO OR BOARD DEPENDING UPON THE NATURE OF THE TRANSACTION. ALL REPORTED CONFLICTS OF INTEREST ARE REPORTED ON THE ANNUAL FORM 990, AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 THE CHAIRMAN OF THE BOARD OF DIRECTORS REVIEWS THE CEO'S PERFORMANCE ON AN ANNUAL BASIS. THE ORGANIZATION USES AN OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES COMPARABLE WAGE AND BENEFIT DATA. BASED UPON THE PERFORMANCE REVIEW AS WELL AS DATA OBTAINED FROM THE INDEPENDENT CONSULTANT, THE CHAIRMAN OF THE BOARD MAKES A RECOMMENDATION TO THE EXECUTIVE COMMITTEE TO APPROVE THE CEO'S COMPENSATION. MINUTES ARE TAKEN AT THE EXECUTIVE COMMITTEE MEEINGS DOCUMENTATING THAT THE REVIEW HAS TAKEN PLACE AND THE ACTION TAKEN. THE CEO PREPARES THE PERFORMATION EVALUATIONS OF HIS DIRECT REPORTS ON AN ANNUAL BASIS. THE ORGANIZATION USES AN OUTSIDE COMPENSATION CUNSULTANT WHO PROVIDES COMPARABLE WAGE AND BENEFIT DATA. BASED UPON THE PERFORMANCE REVIEWS AS WELL AS DATA OBTAINED FROM THE INDEPENDENT CONSULTANT, THE CEO MAKES ADJUSTMENTS TO THE COMPENSATION OF KEY EMPLOYEES. THE CEO REVIEWS THE COMPENSATION OF KEY EMPLOYEES WITH THE EXECUTIVE COMMITTEE ON AN ANNUAL BASIS. MINUTES ARE TAKEN AT THE EXECUTIVE COMMITTEE MEEINGS DOCUMENTATING THAT THE REVIEW HAS TAKEN PLACE AND THE ACTION TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, (A) SALVATORE BARBERA WAS APPOINTED INTERIM PRESIDENT AND CEO ON AUGUST 29, 2022 AND SUBSEQUENTLY APPOINTED PRESIDENT AND CEO ON SEPTEMBER 12, 2022. JACK CRISSY WAS APPOINTED INTERIM JKV BOARD CHAIRMAN ON AUGUST 29, 2022 AND SUBSEQUENTLY APPOINTED JKV BOARD CHAIRMAN ON SEPTEMBER 12, 2022. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INVESTMENT IN SUBSIDIARY -17,898. JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC 651 SW 6TH STREET POMPANO BEACH FL 33060 760784971 CHARITABLE GIVING & SUPPORT JKV OF FLORIDA FL 501(C)(3) LINE 7 JOHN KNOX VILLAGE OF FLORIDA INC 1 JOHN KNOX HOME HEALTH AGENCY INC 651 SW 6TH STREET POMPANO BEACH FL 33060 592823932 HOME HEALTH CARE FL JOHN KNOX VILLAGE OF FLORIDA INC C 5720265 2029485 1.00000 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC A 249996 FMV JOHN KNOX HOME HEALTH AGENCY INC A 133234 FMV JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC C 434381 FMV JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC D 1288905 FMV JOHN KNOX HOME HEALTH AGENCY INC D 442393 FMV JOHN KNOX HOME HEALTH AGENCY INC L 1100000 FMV JOHN KNOX VILLAGE OF FLORIDA FOUNDATION INC R 2585752 FMV