2012-07-23T14:31:50-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-01-01 237302390 KANSAS CITY UNITED METHODIST RETIREMENT HOME INC D/B/A KINGSWOOD KANS 8169420994 10000 WORNALL ROAD KANSAS CITY MO 64114 JAMES MORDY 8169420994 2012-07-20 1 ALLAN LARSON P00028482 3149254300 2011 2016-02-24 21:20:13Z JAMES MORDY 10000 WORNALL ROAD KANSAS CITY MO 64114 15015340 0 X WWW.KINGSWOODATHOME.ORG X 1972 MO KINGSWOODS' MISSION IS TO PROVIDE RESIDENTAL AND HEALTH CARE FACILITIES, SERVICES AND OPPORTUNITIES FOR OLDER ADULTS. KINGSWOOD, A MINISTRY OF THE UNITED METHODIST CHURCH. 15 15 297 104 0 0 151090 372962 14225617 14098864 151791 74271 548013 469243 15076511 15015340 6198 0 0 0 6221605 6579138 0 0 0 9051496 9038463 15279299 15617601 -202788 -602261 36726889 34408337 49958968 48295412 -13232079 -13887075 X KINGSWOODS' MISSION IS TO WELCOME OLDER ADULTS WITH OPPORTUNITIES TO ENRICH THEIR LIVES WITH EXCELLENT RESIDENTIAL AND HEALTHCARE SERVICES OFFERED IN A SAFE, LOVING AND CARING COMMUNITY. A MINISTRY OF THE UNITED METHODIST CHURCH. 0 0 13733917 14098864 KINGSWOODS' MISSION IS TO WELCOME OLDER ADULTS WITH OPPORTUNITIES TO ENRICH THEIR LIVES WITH EXCELLENT RESIDENTIAL AND HEALTHCARE SERVICES OFFERED IN A SAFE, LOVING, AND CARING COMMUNITY. KINGSWOOD, A MINISTRY OF THE UNITED METHODIST CHURCH, MAINTAINS 201 APARTMENTS, 82 BEDS IN THE HEALTH CENTER, 17 ASSISTED LIVING APARTMENTS, AND 54 VILLA HOMES. THE HEALTH CENTER IS LICENSED BY THE STATE OF MISSOURI AS A SKILLED NURSING FACILITY. KINGSWOOD AVERAGES AROUND 300 RESIDENTS ON THE 32 ACRE CAMPUS. SERVICES PROVIDED BY KINGSWOOD INCLUDE MEALS, HOUSEKEEPING, LAUNDRY, UTILITIES, MAINTENANCE, LIGHTED PARKING, RELIGIOUS/SOCIAL PROGRAMMING, SECURITY, ADMINISTRATIVE SERVICES, LOUNGES, CRAFT AREAS, TRANSPORTATION, PERSONAL CARE ASSISTANCE, REHABILITATITVE THERAPY, A CHAPEL, A LIBRARY, A COMPUTER LAB, BEAUTY AND BARBER SALON, GIFT SHOP, OUTDOOR PATIOS AND WALKING AREAS. 13733917 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 46 0 1 297 1 0 0 0 0 0 0 0 0 0 0 X 15 15 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CONNIE CARGIN 8164423255 10000 WORNALL ROAD KANSAS CITY MO 64114 ROBERT ADAMS 1.00 X X 0 0 0 DAVID CARNES 1.00 X X 0 0 0 SALLY FIRESTONE 1.00 X 0 0 0 DR HEATHER ANDERSON 1.00 X 0 0 0 GEORGE HEYMACH 1.00 X 0 0 0 JOANNE KELLEY 1.00 X 0 0 0 EVELYN CRAIG 1.00 X 0 0 0 RICHARD LANE 1.00 X 0 0 0 JAMES MORDY 1.00 X X 0 0 0 FRED WIMAN 1.00 X X 0 0 0 JANICE WOLLARD 1.00 X 0 0 0 JOELLEN WURTH 1.00 X 0 0 0 MILTON ADAMS 1.00 X 0 0 0 WILLIAM FRANKLIN 1.00 X 0 0 0 RUTH KINTIGH 1.00 X 0 0 0 RUSSELL LYTLE 1.00 X 0 0 0 SCOTT CORBIN 1.00 X 0 0 0 DR JAMES DALEY 1.00 X 0 0 0 RUTHANNE PHILLIPS 1.00 X 0 0 0 JEFFREY HARKINS 40.00 X 0 28062 0 TERRI MOORE 40.00 X 0 116055 0 0 144117 0 0 0 0 0 REHABCARE GROUP 7733 FORSYTH BLVD STE 2300 ST LOUIS MO 63105 THERAPY PROVIDER 640778 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT 514742 BLUE CROSS BLUE SHIELD OF KC PO BOX 219451 KANSAS CITY MO 64121 HEALTH INSURANCE 506541 SYSCO FOODS 1915 KANSAS CITY RD OLATHE KS 66061 FOOD SERVICE 496870 KANSAS CITY POWER & LIGHT PO BOX 219330 KANSAS CITY MO 64121 ELECTRICITY 419034 14 372962 372962 RESIDENT REVENUE 623000 14098864 14098864 14098864 74271 74271 24476 24476 24476 24476 MISCELLANEOUS 623000 250691 250691 BEAUTY SHOP 623000 97057 97057 DINING SERVICES 623000 76631 76631 20388 20388 444767 15015340 14098864 0 543514 5554059 4777254 776805 738 635 103 618984 532411 86573 405357 348663 56694 404444 404444 91151 91151 44854 44854 309511 298477 11034 7155 7155 139037 139037 303547 293716 9831 18234 8172 10062 1266235 1225226 41009 2167133 2096947 70186 132490 128199 4291 ANCILLARY SERVICES 1264007 1264007 FOOD 795482 795482 UTILITIES 664049 642543 21506 MAINTENANCE 471684 456408 15276 959450 865777 93673 15617601 13733917 1883684 0 782171 482683 2184914 816967 48836 52460 62411 76040 50710144 27136326 25348797 23573818 8299760 9406369 36726889 34408337 3375434 3194613 4678727 4192892 18337003 17789349 3053029 2642581 20514775 20475977 49958968 48295412 X -15849842 -16372806 795907 663480 1821856 1822251 -13232079 -13887075 36726889 34408337 X -602261 -52735 X X 0 1 1 X 0 X 193297 348301 151090 372962 1065650 13393751 13024580 13562820 14225617 14098864 68305632 13393751 13217877 13911121 14376707 14471826 69371282 0 0 0 69371282 361940 290229 175983 168142 98747 1095041 361940 290229 175983 168142 98747 1095041 291197 447480 505982 531662 446102 2222423 14046888 13955586 14593086 15076511 15016675 72688746 0.95440 0.95170 0.01510 0.01870 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1930509 26488 -5536 108648 1842813 1773191 35570 172057 50309 1930509 1547455 20220 210576 5060 1773191 2016690 56415 -434368 91292 1547445 1.00000 0 1 1 1543850 1543850 46531323 24854058 21677265 2634971 2282268 352703 23573818 DEFERRED FINANCING COSTS 457957 INTEREST IN ASSETS OF FOUNDATION 834190 DONOR RESTRICTED FUND- PERM RESTRICTED 1724303 DONOR RESTRICTED FUND- TEMP RESTRICTED 118509 BOND FUNDS 6271410 9406369 RESIDENT DEPOSITS 163046 REFUNDABLE ENTRANCE FEES 20312931 20475977 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: KINGSWOOD MAINTAINS A WESLEY ENDOWMENT FUND. THE FUNDS ARE USED FOR FINANCIAL ASSISTANCE FOR THE RESIDENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2008 THROUGH 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 WESLEY ASSISTANCE GRANT THE ORGANIZATION REVIEWS ANNUALLY THE NEED BY RESIDENTS WHOSE RESOURCES ARE NOT SUFFICIENT TO PAY THEIR MONTHLY FEES. THE WESLEY ASSISTANCE FUND PROVIDES THE DIFFERENCE BETWEEN THE COST AND THE RESOURCES AVAILABLE. FORM 990, PART VI, SECTION A, LINE 2 MILTON ADAMS HAS A FAMILY RELATIONSHIP. ROBERT ADAMS HAS A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 LIFE CARE SERVICES WAS HIRED AS A MANAGEMENT COMPANY IN 2009. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED 990 WILL BE E-MAILED TO BOARD MEMBERS PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED ANNUALLY TO REVIEW THE CONFLICT OF INTEREST POLICY AND SIGN THAT THEY WILL COMPLY WITH THE POLICY. IF AND WHEN A CONFLICT ARISES, THE BOARD MEMBER IS ASKED TO DISCLOSE MATERIAL FACTS AND LEAVE THE MEETING. A DETERMINATION IS MADE BY THE REMAINING BOARD MEMBERS WHETHER OR NOT A CONFLICT OF INTEREST EXIST. IF A CONFLICT EXISTS, THE BOARD MEMBER IS REQUESTED TO LEAVE THE MEETING DURING THE DISCUSSION AND THE REST OF THE BOARD VOTES ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS AN EMPLOYEE OF LIFE CARE SERVICES, THE MANAGEMENT COMPANY. COMPARATIVE INFORMATION ON OTHER DIRECTOR'S COMPENSATION IS AVAILABLE THROUGH LIFE CARE SERVICES. A PERFORMANCE REVIEW IS COMPLETED BY THE EMPLOYEE AND THE CEO. COMPARATIVE INFORMATION ON SIMILAR POSITIONS ARE AVAILABLE THROUGH LIFE CARE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -52,735. FORM 990 PAGE 12, PART XI, LINE 2C THE POLICY FOR REVIEWING THE FINANCIAL STATEMENT REMAINS UNCHANGED FROM THE PRIOR YEAR FORM 990, SCHEDULE R, PART III, COLUMN A THE PARTNERSHIPS ARE RELATED AS THERE IS COMMON CONTROL WHERE AS BOARD MEMBERS OF THE FILING ORGANIZATION OWN A VOTING MAJORITY OF THESE PARTNERSHIPS. KINGSWOOD SENIOR LIVING COMMUNITY FOUNDATION 10000 WORNALL ROAD KANSAS CITY MO 64114 200639597 PROVIDES SUPPORT FOR KANSAS CITY UNITED METHODIST RETIREMENT HOME, INC. MO 501 (C)(3) LINE 11A, TYPE I 0 614 WEST 99TH LLC 10000 WORNALL ROAD KANSAS CITY MO 64114 203437324 REAL ESTATE MO N/A WEST 100TH TERRACE LLC 10000 WORNALL ROAD KANSAS CITY MO 64114 753134697 REAL ESTATE MO N/A 457 WEST 100TH TERRACE LLC 10000 WORNALL ROAD KANSAS CITY MO 64114 274598541 REAL ESTATE MO N/A LIFE CARE SERVICES 400 LOCUST SUITE 820 CAPITAL SQUARE DES MOINES IA 50309 MANAGEMENT OF COMMUNITY IA N/A N/A 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 KINGSWOOD SENIOR LIVING COMMUNITY FOUNDATION C 372962 LIFE CARE SERVICES N 514742 MANAGEMENT AGREEMENT