2017-02-07T07:46:04-06:00 2015-12-31 540504608 BROWN EDWARDS & COMPANY LLP 319 MCCLANAHAN STREET SW ROANOKE VA 24014 990 2015-01-01 900345214 AMITY FELLOWSERVE INC AMIT 5402650322 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 THOMAS E CLARKE CEO 5402650322 2017-02-02 1 M C WINGFIELD P00005971 5403450936 2017-02-02 2015 2021-01-29 14:40:06Z KISSITO HEALTHCARE INC THOMAS E CLARKE 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 50224718 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. IN THE UNITED STATES, KISSITO MANAGES AND COORDINATES THE OVERALL HEALTHCARE FOR THE FRAIL AND ELDERLY POPULATION IN SEVERAL SETTINGS, INCLUDING SKILLED NURSING FACILITIES, SERVICE ENRICHED AFFORDABLE ELDER HOUSING, AND PACE.IN EAST AFRICA KISSITO PROVIDES EMERGENCY NUTRITION MANAGEMENT AND HEALTH SYSTEMS STRENTHENING FOCUSED ON IMPROVING MATERNAL AND CHILD HEALTH IN SOUTH SUDAN.KISSITO IS FOCUSED ON FINDING WAYS TO CREATE SUSTAINABLE SOLUTIONS TO THE PROBLEMS FACED BY THE VURNERABLE POPULATIONS WE SERVE BOTH IN THE THE U.S. AND EAST AFRICA. 4 2 1170 50 773368 -78940 1811055 1339885 46279724 48027466 -1771 -57515 279648 278815 48368656 49588651 0 0 0 0 23177830 25152281 0 0 875 24670403 27190422 47848233 52342703 520423 -2754052 26992140 27772390 26074005 30134820 918135 -2362430 X KISSITO HEALTHCARE EXISTS FOR THE BETTERMENT AND CARE OF HUMAN LIFE. WE SEEK TO PROVIDE THE WORLD'S MOST VULNERABLE POPULATIONS WITH LOW-COST, HIGH IMPACT HEALTHCARE SOLUTIONS THAT IMPROVE OUTCOMES AND SAVE LIVES. 0 0 45042970 44699085 PROVIDING LONG-TERM CARE FOR THE ELDERLY AND HANDICAPPED IN THE FORM OF HOUSING AND MEDICAL SERVICES. 1986278 2773267 PROVIDING NATURAL RESOURCES STEWARDSHIP THROUGH CONSERVATION, EDUCATION, AND OUTDOOR RECREATION. 47029248 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 89 0 1 1170 1 1 1 1 ET UG SU 0 0 0 0 0 0 X 4 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 10.00 30.00 X X 0 119882 0 ANA CLARKE SECRETARY 10.00 30.00 X X 0 184963 0 REVEREND DAVID ERICKSON DIRECTOR 1.00 4.00 X 0 0 0 WAYNE FUQUAY VICE PRESIDENT 1.00 4.00 X 0 682 0 JENNIFER BELL OFFICER 10.00 30.00 X 98011 0 0 JOSEPH ALESANTRINO ADMINISTRATIVE STAFF 10.00 30.00 X 0 35510 0 CHERIE HICKS ADMINISTRATIVE STAFF 10.00 30.00 X 0 138395 0 ANDY DAMERON ADMINISTRATIVE STAFF 10.00 30.00 X 0 167433 0 SEAN PRESSMAN ADMINISTRATIVE STAFF 30.00 10.00 X 0 142308 0 JOSH MCGILLIARD ADMINISTRATIVE STAFF 10.00 30.00 X 0 129933 0 ADEL SALAMA EMPLOYEE 40.00 0.00 X 189997 0 0 EMILIO ZAGA EMPLOYEE 40.00 0.00 X 138648 0 0 BETH ZIERLER EMPLOYEE 40.00 0.00 X 129560 0 0 VICKY SCHMERMAN EMPLOYEE 40.00 0.00 X 141303 0 0 MONIQUE LOOMIS EMPLOYEE 40.00 0.00 X 121384 0 0 818903 919106 0 11 0 1 0 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACEUTICALS & SERVICES 1606460 RESPIRATORY HEALTH SERVICES LLC PO BOX 821322 PHILADELPHIA PA 19182 RESPIRATORY SERVICES 620041 AZIRONA DEPARTMENT OF REVENUE PO BOX 29085 PHOENIX AZ 85038 PROVIDED BED ASSESSMENT 392564 PALM VIEW REHABILITATION & CARE CENTER 2222 S AVE A YUMA AZ 85364 THERAPY SERVICES 373954 PREMIUM ASSIGNMENT CORPORATION PO BOX 79153 BALTIMORE MD 21279 FINANCING OF INSURANCE PREMIUMS 348706 11 1339885 1339885 NURSING CARE 623000 45425430 45425430 NATURAL BRIDGE ADMISSIONS 712110 1874436 1874436 NATURAL BRIDGE GIFT SHOP 453220 277113 91447 185666 NATURAL BRIDGE RESTUARANT 722100 237714 237714 CONSULTING SERVICES 541620 212773 212773 48027466 3046 3046 479440 0 479440 479440 479440 307960 368521 -60561 -60561 -60561 267546 -267546 -163035 -104511 OTHER REVENUE 531390 66075 66075 VENDING MACHINE 623000 846 846 66921 49588651 47472352 773368 3046 98011 98011 23256970 23256970 151528 151528 7799 7799 1637973 1637973 3261173 3261173 129112 129112 374460 374460 92271 92271 306622 306622 4272238 4272238 321992 321992 6621067 6621067 264082 264082 20854 20854 829782 829782 864942 864942 411431 411431 DIETARY & NUTRITION EXP 2259408 2259408 PURCHASED SERVICES 1967917 1967917 BAD DEBTS 1522178 1522178 UBIT TAXES 20886 20886 3650007 3649132 875 52342703 47029248 5312580 875 577322 1157280 393074 374174 5820289 5063453 121131 39607 23489951 4500783 19268698 18989168 811626 2148708 26992140 27772390 9824641 12035558 13650751 15211745 2598613 2887517 26074005 30134820 X 918135 -2362430 918135 -2362430 26992140 27772390 X -2754052 -548907 22394 X X 0 0 0 X 607069 17145172 383863 548949 1339885 20024938 35934290 37512195 38149177 45986864 47629027 205211553 36541359 54657367 38533040 46535813 48968912 225236491 0 0 0 225236491 6360 178932 76491 378560 482486 1122829 74463 0 74463 6360 178932 76491 453023 482486 1197292 19139 19654 22922 18470 66921 147106 36566858 54855953 38632453 47007306 49518319 226580889 0.99410 0.99610 0.00530 0.00340 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: 50 ACRES AT NATURAL BRIDGE VA AMOUNT: 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7331169 7331169 9741748 908418 8833330 2811241 945086 1866155 2820436 2216466 603970 785357 430813 354544 18989168 DEFERRED FINANCING COSTS, NET 424929 DEPOSITS & OTHER ASSETS 264617 OTHER CURRENT ASSETS 77095 DUE FROM KISSITO HEALTHCARE, INC. PARENT 1382067 2148708 8767 RESIDENT TRUST LIABILITY 214304 DUE TO KISSITO HEALTHCARE, INC. PARENT 766161 DEFERRED RENT & LEASE INCENTIVES 1465472 DUE TO CAVERNS AT NATURAL BRIDGE, INC. 397694 DUE TO CONSERVATION LEGACY FUND LAND TRUST, INC. 35119 2887517 SUB-SAHARAN AFRICA - SOUTH SUDAN 3 17 PROGRAM SERVICES HEALTHCARE STABILIZATION, MALNUTRITION AND MATERNAL/INFANT HEALTH 3 17 0 0 3 17 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 ANA CLARKE SECRETARY 0 184963 0 0 0 0 0 0 0 0 0 184963 0 0 ANDY DAMERON ADMINISTRATIVE STAFF 0 167433 0 0 0 0 0 0 0 0 0 167433 0 0 ADEL SALAMA EMPLOYEE 189997 0 0 0 0 0 0 0 0 0 189997 0 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. PART I, LINE 4B THOMAS M. CLARKE, PRESIDENT PARTICPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. AT DECEMBER 31, 2015 THE BALANCE IN THE PLAN WAS $250,000. SUPPLEMENTAL INFORMATION: NURSING & REHABILITATION SERVICES - 6 AWARD WINNING FACILITIES: KISSITO OPERATES SIX AWARD WINNING 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. TWO-THIRDS OF THE PATIENTS 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 TRANSFORMED A TRADITIONAL NURSING HOME INTO A 60-BED HIGH-ACUITY RESPIRATORY CENTER OF EXCELLENCE. THE CENTER IS DESIGNED TO CARE FOR VENTILATOR AND TRACHEOTOMY DEPENDENT PATIENTS. AT THIS FACILITY WE BOTH WEAN PATIENTS OFF OF THE VENTILATOR SO THEY MAY RETURN TO THEIR COMMUNITY AND WE CARE OF THOSE ON A VENTILATOR LONG TERM AND PROVIDE A HIGH QUALITY OF LIFE WHILE DOING SO. NATIONALLY RECOGNIZED AND AWARD BY THE AMERICAN ASSOCIATION OF RESPIRATORY CARE, KISSITO'S RESPIRATORY CENTER OF EXCELLENCE IS IN HIGH DEMAND AND RECEIVES PATIENTS FROM AS FAR AWAY AS THE U.S. VIRGIN ISLANDS AND HAWAII. MODEL OF CARE CP2 (COLLABORATE PATIENT CARE PATHWAY): OVER 22 PERCENT OF MEDICARE PATIENTS RELEASED FROM THE HOSPITAL RETURN WITHIN 30 DAYS, AND THE LEADING CAUSE IS THEIR INABILITY TO MANAGE THEIR CONDITION. KISSITO RECOGNIZED THAT PATIENTS AND THEIR FAMILIES COULD BE EMPOWERED TO MAINTAIN THEIR HEALTH AND BREAK THE HOSPITALIZATION CYCLE. WORKING WITH DR. STEVEN R. HAHN OF THE ALBERT EINSTEIN COLLEGE OF MEDICINE, KISSITO DEVELOPED THE COLLABORATIVE PATIENT CARE PATHWAY OR CP2. THIS EVIDENCE-BASED MODEL OF CARE HAS ALREADY BEEN IMPLEMENTED IN MULTIPLE PROVIDER SETTINGS ACROSS THE COUNTRY AND EARLY RESULTS SHOW DRAMATICALLY REDUCED READMISSION RATES WITH PATIENTS ENJOYING LONGER, HEALTHIER, AND HAPPIER LIVES. KISSITO IS COMMITTED TO MAKING CP2 THE STANDARD MODEL OF CARE ACROSS MULTIPLE PROVIDER SETTINGS. HOME AND COMMUNITY BASED SERVICES - PACE AND MFP: IN AMERICA, WE INSTITUTIONALIZE OUR ELDERS IN NURSING HOMES AT A FAR GREATER RATE THAN ANYWHERE ELSE IN THE WORLD. ARIZONA AND OREGON OFFER UP STUNNING EXCEPTIONS: 1.6/1.7 PERCENT OF THE OVER 65 POPULATION IS INSTITUTIONALIZED COMPARED TO A NATIONAL AVERAGE THAT IS DOUBLE THAT. WHEN THE COUNTRY'S DEFICIT SPENDING HAS RUN ITS COURSE, AND AS HEALTHCARE SERVICES MORE HOLISTIC AND INTEGRATED, KISSITO BELIEVES OUR ELDERLY POPULATION WILL ONCE AGAIN BE CARED FOR AT HOME WITH BETTER OUTCOMES AND AT LOWER COSTS. FEDERALLY FUNDED PACE (PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY) AND MFP (MONEY FOLLOWS THE PERSON) ARE TWO PROGRAMS KISSITO HAS IMPLEMENTED TO KEEP OR BRING OUR ELDERS HOME TO LIVE AMONGST FAMILY AND FRIENDS. KISSITO BELIEVES HIGH-QUALITY, HOME-CENTERED CARE IS THE WAY OF THE FUTURE AND WE INTEND TO BE AT THE FOREFRONT OF IT. KISSITO AT HOME (MFP): RESEARCH SHOWS THERE ARE FAR TOO MANY ELDERS INSTITUTIONALIZED IN NURSING HOMES, MANY OF WHOM COULD LIVE INDEPENDENTLY IN THE COMMUNITY WITH THE RIGHT HOME AND COMMUNITY BASED SERVICES AVAILABLE TO THEM. KISSITO AT HOME IS A MONEY FOLLOWS THE PERSON PROGRAM DESIGNED TO ALLOW A PERSON LIVING IN A NURSING HOME TO TRANSITION BACK INTO THE COMMUNITY AND HAVE THEIR HOME AND COMMUNITY BASED SERVICES COORDINATED FOR THEM UNTIL THE TRANSITION IS COMPLETE. KISSITO PACE: STAYING INDEPENDENT AND REMAINING AT HOME IS IMPORTANT FOR OUR COMMUNITY'S SENIORS. HOWEVER, SAFETY AND PROPER CARE ARE SERIOUS CONCERNS. KISSITO PACE UNDERSTANDS THIS AND HELPS SENIORS TO STAY HEALTHY AND LIVING AT HOME. SENIORS IN THE KISSITO PACE PROGRAM BENEFIT FROM A WIDE RANGE OF HEALTHCARE SERVICES PROVIDED IN OUR PACE CENTER AND AT HOME, 24 HOURS A DAY, 7 DAYS A WEEK, AND 365 DAYS A YEAR. KISSITO PACE RELIEVES THE BURDEN ON FAMILY CAREGIVERS BY PROVIDING WHEELCHAIR ACCESSIBLE TRANSPORTATION, CARE COORDINATION, AND COMPLETE ACCESS TO HEALTHCARE SERVICES FOR THEIR PARTICIPANTS. ELDER HOUSING: AFFORDABLE HOUSING FOR THE FRAIL AND ELDERLY: KISSITO HAS TAKEN STEPS TO CREATE PARTNERSHIPS AND PROGRAMS THAT ADDRESS THE LACK OF AFFORDABLE ELDER HOUSING AND THE ACCESS OF HOME AND COMMUNITY BASED SERVICES IN OUR COMMUNITIES. FORM 990, PART III, LINE 1 SOUTH SUDAN: KISSITO'S PROJECT WAS FUNDED BY IMA TO PROVIDE LIFESAVING EMERGENCY NUTRITION SERVICES AND LOCAL HEALTHCARE CAPACITY STRENGTHENING FOR MALNOURISHED MOTHERS AND CHILDREN IN THE STATE OF JONGLEI OF SOUTH SUDAN. THE PROJECT INCLUDES: RAPID ASSESSMENTS ESTABLISHMENT OF STABILIZATION CENTERS FOR MOTHERS AND CHILDREN ESTABLISHMENT OF OUTPATIENT THERAPEUTIC PROGRAMS SUPPLEMENTARY FEEDING PROGRAMS COMMUNITY OUTREACH AND EDUCATION CAPACITY BUILDING OF LOCAL HEALTH WORKERS IMPROVED HEALTH MANAGEMENT INFORMATION SYSTEM COORDINATION OF LOCAL PARTNERS AND GOVERNMENT HEALTH SERVICES 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. FORM 990, PART VI, SECTION A, LINE 2 THOMAS CLARKE, PRESIDENT/CEO AND DIRECTOR, IS RELATED BY MARRIGAGE TO ANA CLARKE, DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11 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: FAIR VALUE ASSESSMENT OF PROPERTY CONTRIBUTION 22,394. FORM 990, PART XII, LINE 2C NO CHANGES IN METHOD SINCE PRIOR YEAR. AMITY FELLOWSERVE INC 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 363666533 MANAGEMENT SERVICES IL 501(C)(3) LINE 9 N/A 0 AMITY FELLOWSERVE OF HONDO INC 5228 VALLEYPOINTE PKWY BLDG B 1 ROANOKE VA 24019 311594605 NURSING CARE MD 501(C)(3) LINE 9 AMITY FELLOWSERVE INC 0 KISSITO COLLABORATIVE CARE SOLUTIONS LLC 5228 VALLEYPOINTE PKWY BLDG B STE 1 ROANOKE VA 24019 462226860 CONSULTATION VA N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1