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      <GeneralExplanation>
        <ReturnReference>Program Services Description: Research and Health Care Delivery/U.S.</ReturnReference>
        <Explanation>Skilled Nursing and Rehabilitation Facilities: Kissito Healthcare (U.S.) operates nine exceptional skilled nursing and rehabilitation facilities throughout the U.S. states of Virginia, Arizona and Texas. These include Kissito Healthcare Bland in Bastian, VA; Kissito Healthcare Botetourt in Fincastle, VA; Kissito Healthcare Hot Springs in Hot Springs, VA; Kissito Healthcare Maple Grove in Lebanon, VA; Kissito Post Acute Alleghany in Low Moor, VA; Kissito Healthcare Hondo in Hondo, TX; Kissito Healthcare Midland in Midland, TX; Kissito Post Acute Cane Island in Katy, TX; and Kissito Healthcare Palm View in Yuma, AZ. We care for nearly 600 patients at any given time. Collaborative Patient Care Pathway (CP2) Model: Kissito researchers and physicians working with Dr. Steven Hahn have pioneered the Collaborative Patient Care Pathway (CP2) concept, which is now being piloted throughout our centers. Compared to standard care, the CP2 Model aims to address the organization's mission to deliver quality patient-centered care and demonstrate greater continuity of care, a shorter duration of stay and improved patient outcomes. Care is coordinated and integrated across all elements and in a culturally and linguistically appropriate manner. The intended outcomes of the CP2 Model include reduction in preventable rehospitalization, reduction in mortality and readmission rates, continuity of care across all post acute settings, and patient-driven shorter rehabilitation and recuperation periods as opposed to Payment Setting. The model is theory-based, collaborative and multidisciplinary, primarily focusing on patient-centered care. Phase 1 has been completed in 3 facilities, Kissito Palm View, Kissito Cane Island and Kissito Alleghany. Masonic Pathways in Alma, Michigan, a 200+ bed skilled nursing facility, has recently adopted the CP2 Model. With Masonic Pathways, Kissito is partnering to develop analysis tools to evaluate the CP2 Model's influence on patient care.Program of All-Inclusive Care for the Elderly (PACE): Kissito Healthcare (U.S.) was awarded designation as the sole provider of the Program of All-Inclusive Care for the Elderly (PACE) in the Roanoke Valley by the Department of Medical Assistance Services, Virginia on March 24, 2011. Under PACE, Kissito Healthcare will provide all-inclusive care to the nursing home-eligible population in the Roanoke Valley and surrounding areas in a Wellness-based model. This Model illustrates a meaningful care delivery reform for vulnerable and chronically ill populations and offers access to the full continuum of preventive, primary, acute, rehabilitative, and long-term care services for the frail and elderly while integrating all Medicare and Medicaid services into one seamless service package for beneficiaries. Improved outcomes include fewer hospitalizations, fewer nursing home admissions, higher contact with primary care providers, longer survival rates, better health, better quality of life, greater satisfaction with overall care arrangements, and better functional status. PACE has proven to be a highly successful model demonstrating significant health outcomes and at a much reduced cost. Kissito Healthcare intends to open its first PACE center in Roanoke in the first half of 2013.</Explanation>
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      <GeneralExplanation>
        <ReturnReference>Program Services Description: Research and Health Care Delivery/Abroad</ReturnReference>
        <Explanation>Kissito Healthcare International serves the world's most vulnerable people with low-cost, high-impact healthcare solutions with a special focus on improving Maternal and Child Health in the communities we serve. KHI works in East Africa specifically and currently has several active programs:Ethiopia: 1.Malaria Prevention: "Begara" for a Malaria-Free Society (joint program with CCRDA-Ethiopia and CORE Group-Ethiopia funded by The Global Fund)2.Morris Cerullo Kamashi Teaching Hospital: Construction, Operation and Health Delivery Integration Program 3.Operational, Public-Private Partnership with Kamashi Health Center, Kamashi Zone4.Ottoro Health Center5.Sipara Maternal and Child Health Hospital6.Southern, Nations, Nationalities, and People's Region (SNNPR) Emergency NutritionUganda:1.Emergency Obstetrical and Newborn Care Training Initiatives in Mbale and Manafwa Districts2.Operational, Public-Private Partnership with Bugobero Health Center IV, Manafwa District3.Training, Equipping Community Health Workers (CHW) Program in Manafwa District4.University Research Partnership: Pediatric Diarrhea in Uganda and Developing SocietiesSomalia:1.Health System Strengthening and Emergency NutritionSouth Sudan:1.Emergency Nutrition</Explanation>
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      <GeneralExplanation>
        <ReturnReference>Initiative Descriptions/Uganda</ReturnReference>
        <Explanation>Uganda: Emergency Obstetrical and Newborn Care Training Initiatives in Mbale and Manafwa DistrictsAddressing Uganda's unacceptably high maternal mortality rate and infant mortality ratio, Kissito is training local clinicians and lay people alike to identify high-risk mothers and help save lives through an intensive, multi-year training program involving more than 30 Ugandan physicians, nurses and midwives.Uganda: Operational, Public-Private Partnership with Bugobero Health Center IV, Manafwa DistrictKissito's Transformative Partnership Plan includes Kissito cost-sharing with the Manafwa District Government Administration to sponsor staff, medications, equipment, and ongoing training. Physical improvements include extensive renovations and upgrades to meet and exceed health codes put in place by the Ministry of Health. Uganda: Training, Equipping Community Health Workers (CHW) Program in Manafwa DistrictManafwa District has retained 183 CHWs but funding and staff constraints leave them undertrained and underutilized. Kissito will partner with the Administration of Manafwa and its Health Ministry to provide resources for ongoing training, equipping and deployment of these 183 individuals.Uganda: University Research Partnership: Pediatric Diarrhea in Uganda and Developing SocietiesThe major goal of Kissito/University of Texas School of Public Health's ambitious undertaking is to establish the etiology of diarrhea among children in the developing world, using populations in Ethiopia, Uganda and Mexico as points of entry into understanding this complex global issue.</Explanation>
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        <ReturnReference>Initiative Descriptions/South Sudan</ReturnReference>
        <Explanation>South Sudan: Emergency NutritionTogether with our partner Plan International, Kissito will assist with Emergency Nutrition efforts across South Sudan as the world's newest country gains stability. Working with the Nutrition Cluster, KHI hopes to assist with the large number of acutely malnourished cases of young children and women in need.</Explanation>
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        <ReturnReference>Initiative Descriptions/Somalia</ReturnReference>
        <Explanation>Somalia: Health System Strenghtening and Emergency NutritionWorking together with the World Health Organization (WHO) and the Ministry of Health, Kissito has committed to helping the state of Puntland with Health System Strengthening and Emergency Nutrition efforts over the coming years. Kissito will work first to strengthen the Regional Hospital in the Capital of Garowe, as well as assist with EN work at feeding centers. Kissito wants to work to support the Somali Health Sector Committee, and KHI is now part of the Health and Nutrition Clusters.</Explanation>
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        <ReturnReference>Initiative Descriptions/Ethiopia</ReturnReference>
        <Explanation>Ethiopia: Malaria Prevention: "Begara" for a Malaria-Free Society (joint program with CCRDA-Ethiopia and CORE Group-Ethiopia funded by The Global Fund)While Kissito's hospital is under construction in Kamashi, the organization is committed to fighting the root causes of malaria's deadly persistence. Together with CORE Group-Ethiopia and CCRDA, Kissito has joined forces with the government in its commitment to reduce malaria morbidity and mortality by 75% by 2013, compared to 2001-2005 levels. The program is a 3-year, multi-phase project combining various public relations/educational campaigns to improve treatment-seeking and preventative behaviors among Kamashi's people.Ethiopia: Morris Cerullo Kamashi Teaching Hospital: Construction, Operation and Health Delivery Integration Program The goal of The Morris Cerullo Kamashi Teaching Hospital Construction, Operation and Health Delivery Integration Program is to provide quality health services to communities in Kamashi Zone, with a special focus on maternal and child health. Program strategies include: Construction of a 60-bed acute care hospital of International Standards in the Kamashi Zone; operation of the hospital to International Standards; healthcare delivery system integration; health workers' training, placement and retention; health extension workers' training, placement and retention; improved medical equipment and supplies delivery through utilization of or strengthening of existing networks and partnerships and/or the development of new ones as appropriate.Ethiopia: Operational, Public-Private Partnership with Kamashi Health Center, Kamashi ZoneModeled on Kissito's success with the Bugobero Health Center in Uganda, Kissito is collaborating with the Ethiopian government in a cost-sharing, task-sharing model to address critical shortages in trained staff, supplies, equipment and essential drugs. In addition, Kissito's partnership with the government and the community it serves will address needed renovations and improvements to meet and exceed health codes set by the country's Ministry of Health. Ethiopia: Ottoro Health Center After acquiring the 90% constructed health facility in August 2011, Kissito works to complete renovations, meet equipment, supply and staffing needs and introduce the Ottoro Health Center as a safe, clean and fully functional Health Center IV serving the community. Similar to Kissito's Transformative Partnership Plan at the Bugobero Health Center in Uganda, Kissito plans to pursue a cost-sharing, responsibility-sharing model with the Hadiya Zone, SNNP Region where Ottoro is located. Ethiopia: Sipara Maternal and Child Health Hospital Kissito draws from a wealth of expertise in transforming challenged facilities to implement a revitalized Operational Plan for Sipara. Highlights include administrative reorganization, improvements to supply chain management, namely drugs and medical supplies, increased funding for departments in need, and provision of new and/or refurbished equipment. Ethiopia: SNNPR Emergency NutritionIn the Duna Wareda, with funding and collaboration coming from UNOCHA and Plan International, Kissito has been able to treat 4,184 Severely and Moderately Malnourished Children (SAM and MAM) and Pregnant and Lactating Women (PLW) using a Community-based Management of Acute Malnutrition (CMAM) approach. The failure of crops in 2010 and 2011 has led to a large need of humanitarian support. In the Halaba Special Wareda, Kissito will be helping 8,000+ more malnourished women and children in a new intervention.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 19</Identifier>
        <ReturnReference>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</ReturnReference>
        <Explanation>The Organization's governing documents, conflict of interest policy and financial statements are made available to the public upon request.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 15b</Identifier>
        <ReturnReference>Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees</ReturnReference>
        <Explanation>Compensation is determined by reference to comparability data and is subject to review and approval by top management of the company.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 12c</Identifier>
        <ReturnReference>Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts</ReturnReference>
        <Explanation>Officers, directors and key employees are required to annually complete a written conflict of interest disclosure.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 11</Identifier>
        <ReturnReference>Form 990, Part VI, Line 11: Form 990 Review Process</ReturnReference>
        <Explanation>Form 990 will be reviewed by the Board of Directors before it is filed.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 2</Identifier>
        <ReturnReference>Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et</ReturnReference>
        <Explanation>Thomas M. Clarke, President/CEO and Director, is related by marriage to Ana Clarke, Director.</Explanation>
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      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Morris Cerullo Kamashi Teaching Hospital</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>b</TransactionType>
        <AmountInvolved>85740</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Amity Fellowserve of Hondo Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>142663</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Amity Fellowserve of Hondo Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>b</TransactionType>
        <AmountInvolved>881513</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Amity Fellowserve Realty of Hondo Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>214427</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Lebanon Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>259654</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Lebanon Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>136934</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Bastian Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>203520</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Bastian Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>b</TransactionType>
        <AmountInvolved>319491</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Hot Springs Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>187058</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Hot Springs Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>b</TransactionType>
        <AmountInvolved>175295</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Low Moor Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>327443</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Low Moor Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>87232</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Fincastle Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>342757</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Yuma Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>k</TransactionType>
        <AmountInvolved>463214</AmountInvolved>
        <MethodOfAmtDetermination>Revenue %</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AFS of Yuma Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>4680070</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Amity Fellowserve of Katy Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>271749</AmountInvolved>
        <MethodOfAmtDetermination>FMV</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>