2018-11-19T14:00:54-06:00 2017-12-31 540504608 BROWN EDWARDS & COMPANY LLP 319 MCCLANAHAN STREET SW ROANOKE VA 24014 990 2017-01-01 900345214 AMITY FELLOWSERVE INC AMIT 5402650322 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 THOMAS E CLARKE PRESIDENT 5402650322 2018-11-16 1 M C WINGFIELD P00005971 5403450936 2018-11-16 206.248.228.130 2018-11-16 15:57:07 ES P CE530EA759AC3AF6BB0EECEF8950573E07121913 D0156BD46B4B1FE921C9503B1D7FFBF99E37DBAB 2017 2019-02-21 02:37:17Z KISSITO HEALTHCARE INC THOMAS E CLARKE 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 52623131 1 1 9429 X WWW.KISSITO.ORG X 1988 IL KISSITO HEALTHCARE IS A NON-PROFIT ORGANIZATION THAT SEEKS TO SERVE THE WORLD'S MOST VERNERABLE POPULATIONS. KISSITO MANAGES AND COORDINATES THE OVERALL HEALTHCARE FOR THE FRAIL AND ELDERLY POPULATION IN SKILLED NURSING FACILITIES. X 5 2 1187 0 -286640 -351569 1402620 538953 51186195 48878327 -589085 2194712 -153042 -299661 51846688 51312331 0 0 0 0 24911502 31478311 0 0 0 26463312 40923219 51374814 72401530 471874 -21089199 26326242 55173888 28198887 330051876 -1872645 -274877988 X KISSITO HEALTHCARE EXISTS FOR THE BETTERMENT AND CARE OF HUMAN LIFE. WE SEEK TO PROVIDE VULNERABLE POPULATIONS WITH LOW-COST, HIGH IMPACT HEALTHCARE SOLUTIONS THAT IMPROVE OUTCOMES AND SAVE LIVES. 0 0 42056750 48755707 PROVIDING LONG-TERM CARE FOR THE ELDERLY AND HANDICAPPED IN THE FORM OF MEDICAL SERVICES. 740421 -969234 PROVIDING NATURAL RESOURCES STEWARDSHIP THROUGH CONSERVATION, EDUCATION, AND OUTDOOR RECREATION. 25497964 3265704 REDUCING THE RATE OF GROWTH OF ATMOSPHERIC CARBON DIOXIDE THROUGH GLOBAL REFORESTATION AND BY INCENTIVIZING COAL CONSUMERS TO ACCELERATE THE REDUCTION OF CO2 POLLUTION. 68295135 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 133 0 1 1187 1 0 0 0 0 0 0 0 0 X 5 2 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X JOE ALESANTRINO 5402650322 5228 VALLEYPOINT PARKWAY BLDG B STE ROANOKE VA 24019 THOMAS M CLARKE PRESIDENT 2.00 3.00 X X 0 0 0 ANA VELASQUEZ CLARKE SECRETARY 2.00 3.00 X X 0 0 0 REVEREND DAVID ERICKSON DIRECTOR 1.00 4.00 X 0 5500 0 WAYNE FUQUAY CHAIRMAN OF THE BOARD 4.00 1.00 X 0 13662 0 ANTENEH ZEWDIE DIRECTOR 4.00 0.00 X 0 0 0 JOSEPH ALESANTRINO CHIEF FINANCIAL OFFICER 10.00 30.00 X 0 170000 0 ROBERT MCCLINTIC CHIEF EXECUTIVE OFFICER 10.00 30.00 X 0 325000 0 KATHY SANDERS CHIEF NURSING OFFICER 30.00 10.00 X 0 172380 0 EMILIO ZAGA EMPLOYEE 40.00 0.00 X 145832 0 0 RICHIE ALBA EMPLOYEE 40.00 0.00 X 142762 0 0 RAYMOND ELAMPARO EMPLOYEE 40.00 0.00 X 106802 0 0 SCOTT NORBY EMPLOYEE 40.00 0.00 X 128812 0 0 BETH ZIERLER EMPLOYEE 40.00 0.00 X 105088 0 0 629296 686542 0 6 0 1 0 SGS NORTH AMERICA PO BOX 850 SOPHIA WV 25921 MINING SERVICES 1533688 ROGERS PETROLEUM SERVICES INC PO BOX 162 PIKEVILLE KY 41502 PETROLEUM SERVICES 1392570 CH2M HILL ENGINEERS INC DEOT 4152 PO BOX 2088 MILWAUKEE WI 53201 MINING ENGR SERVICES 1335697 ENVIROMINE INC 4332 1ST AVE NITRO WV 25143 MINING SERVICES 1093534 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACEUTICALS & SERVICES 1068672 38 535615 3338 538953 NURSING CARE 623000 45371818 45371818 MINING REVENUE 212000 3258416 3258416 NATURAL BRIDGE RESTUARANTS 722100 248093 248093 48878327 7841 7841 3391177 1204306 2186871 2186871 2186871 106494 -106494 -104598 -1896 OTHER REVENUE 531390 91577 91577 NATURAL BRIDGE CONFERENCE CENTER 721110 -284744 -284744 -193167 51312331 51052177 -286640 7841 26961574 26961574 312591 312591 1908572 1908572 2295574 2295574 2279402 2279402 391713 391713 283518 283518 6076552 5867272 209280 215888 215888 5369414 5369414 455242 455242 22200 22200 8939552 8939552 495858 495858 38116 38116 726594 726594 793417 793417 642334 642334 MISCELLANEOUS 3318749 3318749 SURETY BOND EXPENSE 2567683 2567683 DIETARY & NUTRITION EXP 2322396 2322396 MATERIALS & SUPPLIES 1937697 1937697 4046894 4046894 72401530 68295135 4106395 0 581920 15802516 4668484 12567803 6205 8711 20666181 5581476 18360219 15084705 2709414 11710153 26326242 55173888 10728231 14152041 33310 13450142 16744552 3987204 299155283 28198887 330051876 X -1872645 -274877988 -1872645 -274877988 26326242 55173888 X -21089199 -2294008 -249622136 X X 0 0 0 X 383863 548949 1339885 1402620 3338 3678655 38149177 459868654 47629027 51186195 48878327 645711380 38533040 460417603 48968912 52588815 48881665 649390035 0 0 0 649390035 76491 378560 482486 7622 7841 953000 74463 74463 76491 453023 482486 7622 7841 1027463 22922 18470 66921 80055 -193167 -4799 38632453 460889096 49518319 52676492 48696339 650412699 0.99840 0.99790 0.00160 0.00180 X 5015660 5015660 9887306 1802277 8085029 2610524 1132423 1478101 2720013 2348665 371348 432678 298111 134567 15084705 DEPOSITS & OTHER ASSETS 5584272 OTHER CURRENT ASSETS 164860 DUE FROM RELATED ENTITIES 5961021 11710153 RESIDENT TRUST LIABILITY 213563 DUE TO KISSITO HEALTHCARE, INC. PARENT 1657095 DEFERRED RENT & LEASE INCENTIVES 1473943 DUE TO CAVERNS AT NATURAL BRIDGE, INC. 622587 DUE TO CONSERVATION LEGACY FUND LAND TRUST, INC. 323741 OTHER LIABILITIES 279828127 OTHER LIABILITY RECLAMATION AGREEMENT 7500000 OTHER RELATED PARTY PAYABLES 7670 DUE TO ERP AFFILIATES 7528557 299155283 0 0 0 0 0 0 0 0 0 JOSEPH ALESANTRINO CHIEF FINANCIAL OFFICER 0 170000 0 0 0 0 0 0 0 0 0 170000 0 0 ROBERT MCCLINTIC CHIEF EXECUTIVE OFFICER 0 325000 0 0 0 0 0 0 0 0 0 325000 0 0 KATHY SANDERS CHIEF NURSING OFFICER 0 172380 0 0 0 0 0 0 0 0 0 172380 0 0 PART I, LINE 3 THE COMPENSATION FOR THE PRESIDENT AND CEO IS ESTABLISHED BY THE PARENT ORGANIZATION. THE PARENT ORGANIZATION DETERMINES THE PRESIDENT AND CEO'S COMPENSATION BY REFERENCE TO COMPARABILITY DATA THAT IS SUBJECT TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE PARENT'S BOARD AND TOP MANAGEMENT OF THE PARENT COMPANY. 100% EQUITY INTEREST IN KISSITO PACE OF ROANOKE, INC. 2017-04-07 2600000 SECURITIES PURCHASE AGGREEMENT TOTAL COMMUNITY OPTIONS INC DBA INNOVAGE 8950 EAST LOWRY BLVD DENVER CO 80230 0 0 1 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: THOMAS M. CLARKE PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: MR CLARKE IS PURCHASING A .66% EQUITY INTEREST IN TOTAL COMMUNITY OPTIONS, INC. DBA INNOVAGE. SUPPLEMENTAL INFORMATION: NURSING & REHABILITATION SERVICES - 6 SKILLED NURSING FACILITIES: KISSITO OPERATES SIX SKILLED NURSING AND REHABILITATION FACILITIES THAT DELIVER EXCEPTIONAL SPECIAL NEEDS SERVICES LIKE VENTILATOR DEPENDENT CARE, COMPLEX WOUND CARE, ALZHEIMER/DEMENTIA CARE, POST-ACUTE REHABILITATION, ASSISTED LIVING, AND CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS. KISSITO CARES FOR ARE SHORT-TERM REHABILITATION PATIENTS WITH A PLAN TO RETURN TO HOME. PATIENTS ARE GETTING OLDER; THEY'RE WAITING LONGER TO SEEK HELP; AND DISEASES CONTINUE TO EVOLVE. AS A FORWARD-LOOKING NURSING HOME OPERATOR, WE STRIVE TO MEET THE NEEDS OF TODAY WHILE EVOLVING WITH THE CHANGES SHAPING TOMORROW. HIGH ACUITY SKILLED NURSING - RESPIRATORY CARE CENTER OF EXCELLENCE: AS MORE AND MORE SENIORS AGE IN PLACE, THE ROLE OF THE NURSING HOME IS CHANGING. KISSITO BELIEVES THAT THE ROLE OF A NURSING HOME WILL BE TO CARE FOR THOSE SENIORS WHO NEED EXTENSIVE HIGH-ACUITY SERVICES BOTH SHORT-TERM AND LONG-TERM. IN VIRGINIA, KISSITO HAS DEVELOPED TWO HIGH-ACUITY RESPIRATORY CENTERS OF EXCELLENCE. THE CENTERS ARE DESIGNED TO CARE FOR VENTILATOR AND TRACHEOTOMY DEPENDENT PATIENTS. AT THESE FACILITIES WE BOTH WEAN PATIENTS OFF OF THE VENTILATOR SO THEY MAY RETURN TO THEIR COMMUNITY AND WE CARE FOR THOSE ON A VENTILATOR LONG TERM AND PROVIDE A HIGH QUALITY OF LIFE WHILE DOING SO. FORM 990, PART III, LINE 1 VIRGINIA CONSERVATION LEGACY FUND, INC. ("VCLF"): VIRGINIA CONSERVATION LEGACY FUND, INC. ("VCLF") WAS CREATED TO PROMOTE NATURAL RESOURCES STEWARDSHIP THROUGH CONSERVATION, EDUCATION, AND OUTDOOR RECREATION. VCLF PURCHASED THE NATURAL BRIDGE PARK WITH INTENT TO DONATE IT TO THE COMMONWEALTH OF VIRGINIA FOR THE CREATION OF NATURAL BRIDGE STATE PARK. THE PARK, ONCE OWNED BY THOMAS JEFFERSON, OFFERS INTERPRETIVE EDUCATION EXHIBITS, HIKING TRAILS, PICNIC AREAS, AND MANY SPECIAL FAMILY-FRIENDLY EVENTS. ERP ENVIRONMENTAL FUND: THE PRIMARY OBJECTIVE OF THE ENVIRONMENTAL FUND IS TO REDUCE THE RATE OF GROWTH OF ATMOSPHERIC CARBON DIOXIDE (CO2) THROUGH GLOBAL REFORESTATION AND BY INCENTIVIZING COAL CONSUMERS TO ACCELERATE THE REDUCTION OF CO2 POLLUTION. FORM 990, PART VI, SECTION A, LINE 2 THOMAS CLARKE, PRESIDENT AND DIRECTOR, IS RELATED BY MARRIGAGE TO ANA CLARKE, DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A WRITTEN CONFLICT OF INTEREST DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY REFERENCE TO COMPARABILITY DATA AND IS SUBJECT TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD, AND TOP MANAGEMENT OF THE COMPANY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ADDITION OF AMERICAN CONSERVATION EDUCATION CENTER INTO SUB GROUP -4,017,397. ADDITION OF ERP ENVIRONMENTAL FUND INTO SUB GROUP -245,604,739. FORM 990, PART XII, LINE 2C NO CHANGES IN METHOD SINCE PRIOR YEAR. 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