CEDAR LAKE VILLAGE INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CEDAR LAKE VILLAGE INC (EIN 48-1209650)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-08
IRS object ID
202213129349304381
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-08T16:34:22-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN861065772PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line150 S 6TH STREETAddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN481209650EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CEDAR LAKE VILLAGE INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCEDABusinessNameControlTxt
Phone6053331000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 5039 RTE 5218AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175039ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonERIC VANDEN HULLPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6053331000PhoneNum
Signature2022-10-21SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstERICPersonFirstNm
Person LastVANDEN HULLPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHRIS MESKIMENPreparerPersonNm
PTINP01314196PTIN
Phone6123974000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerNATHAN SCHEMAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57TH STREETAddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57117ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,837,677GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SANFORDHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1998FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionHOUSING, PROGRAMS AND SERVICES FOR ELDERLY PERSONS AND OTHER IN NEEDActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers19TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$584,497PYContributionsGrantsAmt
CY Contributions Grants$191,518CYContributionsGrantsAmt
PY Program Service Revenue$11,684,248PYProgramServiceRevenueAmt
CY Program Service Revenue$12,484,080CYProgramServiceRevenueAmt
PY Investment Income$299,345PYInvestmentIncomeAmt
CY Investment Income$291,909CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$8,409CYOtherRevenueAmt
PY Total Revenue$12,568,090PYTotalRevenueAmt
CY Total Revenue$12,975,916CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$84CYTotalFundraisingExpenseAmt
PY Other Expenses$12,519,790PYOtherExpensesAmt
CY Other Expenses$13,053,892CYOtherExpensesAmt
PY Total Expenses$12,519,790PYTotalExpensesAmt
CY Total Expenses$13,053,892CYTotalExpensesAmt
PY Revenues Less Expenses$48,300PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$77,976CYRevenuesLessExpensesAmt
Total Assets BOY$39,774,121TotalAssetsBOYAmt
Total Assets EOY$38,142,658TotalAssetsEOYAmt
Total Liabilities BOY$31,107,968TotalLiabilitiesBOYAmt
Total Liabilities EOY$29,141,515TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,666,153NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,001,143NetAssetsOrFundBalancesEOYAmt
MissionIMPROVING THE WELL-BEING AND QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED THROUGH THE PROVISION OF HOUSING, PROGRAMS, AND SERVICES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$11,121,016ExpenseAmt
Grant$0GrantAmt
Revenue$12,484,080RevenueAmt
DescPROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 19,508 ASSISTED LIVING RESIDENT DAYS, 36,513 SENIOR HOUSING RESIDENT DAYS AND 8,658 SKILLED NURSING RESIDENT DAYS IN 2021.Desc
Total Program Service Expenses$11,121,016TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldKSStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ERIC VANDEN HULLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6053623100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57TH STREETAddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175038ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JAMES HUBBARD
TRUSTEE, VICE CHAIR, VP1.000.00Yes (X)Yes (X)$0$0$0
ERIC VANDEN HULL
TRUSTEE, TREASURER1.000.00Yes (X)Yes (X)$0$0$0
AIMEE MIDDLETON
TRUSTEE, SECRETARY1.000.00Yes (X)Yes (X)$0$0$0
J MACK BOWEN
TRUSTEE1.000.00Yes (X)$0$0$0
VINCE DONOFRIO
TRUSTEE1.000.00Yes (X)$0$0$0
NATHAN SCHEMA
TRUSTEE, CHAIR, PRESIDENT1.000.00Yes (X)$0$0$0
JOANNA RANDALL
EXECUTIVE DIRECTOR45.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
THE EVANGELICAL LUTHERAN GOOD SAMARITAN
4800 W 57TH STREETSIOUX FALLSSD57108MNGMT FEES & SHARED EMPLOYEES$6,638,385
SELECT REHABILITATION INC
PO BOX 809056CHICAGOIL606809056CONTRACT THERAPY SERVICES$506,864
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$167,253GovernmentGrantsAmt
All Other Contributions$24,265AllOtherContributionsAmt
Total Contributions$191,518TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
ROOM REV, ANCILL SVCS623000$12,421,332$12,421,332
MEALS, GUEST RM, OTHER623000$62,748$62,748
FieldValueIRS element (for citing)
Total Program Service Revenue$12,484,080TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$253,076TotalRevenueColumnAmt
Exclusion$253,076ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$812,334SecuritiesAmt
Other$88,260OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$772,576SecuritiesAmt
Other$89,185OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$39,758SecuritiesAmt
Other-$925OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,833TotalRevenueColumnAmt
Exclusion$38,833ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescEMPLOYEE MEALSDesc
Business722514BusinessCd
Total Revenue Column$8,409TotalRevenueColumnAmt
Exclusion$8,409ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$8,409OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,975,916TotalRevenueColumnAmt
Related Or Exempt Func Income$12,484,080RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$300,318ExclusionAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$582,410TotalAmt
Management And General$582,410ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$342TotalAmt
Management And General$342ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$13,958TotalAmt
Management And General$13,958ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$15,110TotalAmt
Management And General$15,110ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$804,704TotalAmt
Program Services$709,029ProgramServicesAmt
Management And General$95,675ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$64,044TotalAmt
Program Services$50,579ProgramServicesAmt
Management And General$13,465ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$117,545TotalAmt
Program Services$41,059ProgramServicesAmt
Management And General$76,486ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$893,071TotalAmt
Program Services$893,071ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$25,358TotalAmt
Program Services$24,027ProgramServicesAmt
Management And General$1,331ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$32,569TotalAmt
Program Services$18,491ProgramServicesAmt
Management And General$14,078ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$823,939TotalAmt
Program Services$823,939ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,638,681TotalAmt
Program Services$1,638,681ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$180,316TotalAmt
Program Services$180,316ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
CONTRACT SERVICES$5,969,905$5,147,899$821,922$84
MEDICAL SUPPLIES$1,240,103$1,199,485$40,618
PURCHASED SERVICES - SH$251,489$251,489
UNCOLLECTIBLE EXPENSE$183,690$183,690

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$216,658TotalAmt
Program Services$142,951ProgramServicesAmt
Management And General$73,707ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$13,053,892TotalAmt
Program Services$11,121,016ProgramServicesAmt
Management And General$1,932,792ManagementAndGeneralAmt
Fundraising$84FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$745,396BOYAmt
EOY$1,933,400EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$481,538BOYAmt
EOY$573,862EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$35,571BOYAmt
EOY$6,563EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,936BOYAmt
EOY$193,279EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$49,759,860LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,160,730LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$29,936,627BOYAmt
EOY$28,599,130EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$8,394,269BOYAmt
EOY$6,648,097EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$177,784BOYAmt
EOY$188,327EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$39,774,121BOYAmt
EOY$38,142,658EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$476,483BOYAmt
EOY$521,925EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$152,015BOYAmt
EOY$92,484EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,236,535BOYAmt
EOY$14,485,304EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,242,935BOYAmt
EOY$14,041,802EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$31,107,968BOYAmt
EOY$29,141,515EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,435,795BOYAmt
EOY$8,765,351EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$230,358BOYAmt
EOY$235,792EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,666,153BOYAmt
EOY$9,001,143EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$39,774,121BOYAmt
EOY$38,142,658EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$77,976ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$358,272NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$771,238OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,110CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,251CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$41,737CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$584,497CurrentTaxYearMinus1YearAmt
Current Tax Year$191,518CurrentTaxYearAmt
Total$847,113TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,178,236CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,389,121CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,906,674CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,684,248CurrentTaxYearMinus1YearAmt
Current Tax Year$12,492,489CurrentTaxYearAmt
Total$58,650,768TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,200,346CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,396,372CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,948,411CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,268,745CurrentTaxYearMinus1YearAmt
Current Tax Year$12,684,007CurrentTaxYearAmt
Total$59,497,881TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$59,497,881PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$105,639CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$154,630CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$68,915CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$238,709CurrentTaxYearMinus1YearAmt
Current Tax Year$253,076CurrentTaxYearAmt
Total$820,969TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$105,639CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$154,630CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$68,915CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$238,709CurrentTaxYearMinus1YearAmt
Current Tax Year$253,076CurrentTaxYearAmt
Total$820,969TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,305,985CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,551,002CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,017,326CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,507,454CurrentTaxYearMinus1YearAmt
Current Tax Year$12,937,083CurrentTaxYearAmt
Total$60,318,850TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98640PublicSupportCY509Pct
Public Support PY5090.98910PublicSupportPY509Pct
Investment Income CY0.01360InvestmentIncomeCYPct
Investment Income PY0.01090InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$177,093BeginningYearBalanceAmt
Investment Earnings Or Losses-$64,970InvestmentEarningsOrLossesAmt
End Year Balance$112,123EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$170,538BeginningYearBalanceAmt
Investment Earnings Or Losses$6,555InvestmentEarningsOrLossesAmt
End Year Balance$177,093EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$174,356BeginningYearBalanceAmt
Investment Earnings Or Losses-$3,818InvestmentEarningsOrLossesAmt
End Year Balance$170,538EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$165,876BeginningYearBalanceAmt
Investment Earnings Or Losses$8,480InvestmentEarningsOrLossesAmt
End Year Balance$174,356EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$148,937BeginningYearBalanceAmt
Investment Earnings Or Losses$16,939InvestmentEarningsOrLossesAmt
End Year Balance$165,876EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,957,128OtherCostOrOtherBasisAmt
Book Value$1,957,128BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$41,322,612OtherCostOrOtherBasisAmt
Depreciation$17,191,524DepreciationAmt
Book Value$24,131,088BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,326,966OtherCostOrOtherBasisAmt
Depreciation$2,218,803DepreciationAmt
Book Value$1,108,163BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,153,154OtherCostOrOtherBasisAmt
Depreciation$1,750,403DepreciationAmt
Book Value$1,402,751BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$28,599,130TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescHOUSING ENTRY FEESDesc
Book Value$6,648,097BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$6,648,097TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
SPECIAL ASSESSMENTS PAYABLE$64,674
SEC MORT & NOTE PAY TO MEMB$5,562,006
SECURITY DEPOSITS$245,269
HOUSING ENTRY FEES AND OTHER$7,146,623
INTEREST RATE SWAP$1,023,230
FieldValueIRS element (for citing)
Total Liability$14,041,802TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$12,405,224TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$358,272NetUnrealizedGainsInvstAmt
Other Revenue-$184,417OtherRevenueAmt
Revenue Not Reported-$542,689RevenueNotReportedAmt
Revenue Subtotal$12,947,913RevenueSubtotalAmt
Investment Expenses Not Incld$18,385InvestmentExpensesNotIncldAmt
Other Revenues Not Included$9,618OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$28,003RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$12,975,916TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,852,705TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$925OtherExpensesIncludedAmt
Expenses Not Reported$925ExpensesNotReportedAmt
Expenses Subtotal$12,851,780ExpensesSubtotalAmt
Investment Expenses Not Incld2$18,385InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$183,727OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$202,112ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$13,053,892TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:EARNINGS ON THE CEDAR LAKE VILLAGE ENDOWMENT FUNDS WILL BE USED AS DIRECTED BY DONOR RESTRICTIONS OR THE BOARD'S DESIGNATION, ABSENT DONOR RESTRICTIONS.
PART X, LINE 2:THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES WERE INCURRED. THE ORGANIZATION IS SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE -183,690. OTHER EXPENSES -727.
PART XI, LINE 4B - OTHER ADJUSTMENTS:GAIN/LOSS SALE OF ASSETS -925. CHANGE IN BENEFICIAL INTEREST 10,543.
PART XII, LINE 2D - OTHER ADJUSTMENTS:GAIN/LOSS SALE OF ASSETS 925.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE 183,690. OTHER EXPENSE 37.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF OLATHE KANSASBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN486034756BondIssuerEIN
CUSIP000000000CUSIPNum
Bond Issued2015-05-15BondIssuedDt
Issue Price$19,200,000IssuePriceAmt
PurposeSEE PART VPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$4,621,000RetiredAmt
Total Proceeds$19,200,000TotalProceedsAmt
Issuance Costs From Proceeds$270,367IssuanceCostsFromProceedsAmt
Capital Expenditures$7,509,781CapitalExpendituresAmt
Other Spent Proceeds$11,419,852OtherSpentProceedsAmt
Substantial Completion2015SubstantialCompletionYr
Refunding Tax Exempt BondsYes (1)RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To RebateYes (1)ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And RecYes (1)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1CENTER STATE BANKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Term Of Hedge20.600000000000TermOfHedgePct
Superintegrated Hedge0SuperintegratedHedgeInd
Hedge Terminated0HedgeTerminatedInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K, PART I, COLUMN (F) DESCRIPTION OF PURPOSE:FormAndLineReferenceDesc
Explanation2015: CONSTRUCT ADDITIONAL FACILITIES, PAY COSTS RELATED TO BOND ISSUANCE, REFUND OF CITY OF OLATHE, KS BOND ISSUE DATED 12/16/04, CUSIP 679390FB5, AND REFUND OF BANK OF AMERICA LINE OF CREDIT.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART V, LINES 1A AND 2AFORM 1099 AND W-2 PROCESSING IS COMPLETED BY THE MANAGEMENT COMPANY, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, A MEMBER OF THE ORGANIZATION. AS SUCH, PART V LINES 1A AND 2A REPORT NO 1099'S OR W-2'S FOR THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION HAS DELEGATED MANAGEMENT DUTIES TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, A MEMBER OF THE ORGANIZATION. JOANNA RANDALL, THE ADMINISTRATOR FOR THE ORGANIZATION, RECEIVED COMPENSATION OF $142,650 PLUS EMPLOYER PAID BENEFITS OF $13,371 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2021.
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERS ARE OLATHE MEDICAL CENTER, INC. AND THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.
FORM 990, PART VI, SECTION A, LINE 7ATHE TRUSTEES ARE APPOINTED BY THE MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BTHE DECISIONS OF THE GOVERNING BODY THAT ARE SUBJECT TO APPROVAL INCLUDE: ELECTION OF TRUSTEES AND OFFICERS; APPROVE ARTICLE AND BYLAW CHANGES; APPROVE OR REJECT NON-BUDGETED ACQUISITIONS, EXPENDITURES, OR DISPOSALS OF A VALUE IN EXCESS OF $100,000; DISTRIBUTIONS TO MEMBERS; APPROVE INCURRENCE OF DEBT BY CEDAR LAKE VILLAGE, INC ("CLV") IN EXCESS OF $100,000; AND APPROVE LIENS OF ANY CLV PROPERTY HAVING A VALUE IN EXCESS OF $100,000.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE ANY COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11BAN ELECTRONIC COPY OF FORM 990 IS SENT TO EACH MEMBER OF THE BOARD PRIOR TO ITS FILING. THE ORGANIZATION'S OFFICERS AND MANAGEMENT ARE AN INTEGRAL PART OF THE PREPARATION OF THE FORM 990 AND HAVE AN ON-GOING REVIEW OF THE FORM 990 AS IT IS PREPARED.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION ASKS THAT ALL OFFICERS AND DIRECTORS COMPLY WITH THE IRS CONFLICT OF INTEREST AND DISCLOSURE CERTIFICATION. THE ORGANIZATION REQUIRES ALL OFFICERS AND DIRECTORS TO PROVIDE A SIGNED COPY TO THE CORPORATION'S MAIN OFFICE ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15ATHE ADMINISTRATOR FOR THE ORGANIZATION IS COMPENSATED THROUGH A MANAGEMENT AGREEMENT WITH AN UNRELATED MANAGEMENT COMPANY, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. THE COMPENSATION IS REVIEWED AND DETERMINED BY THE UNRELATED MANAGEMENT COMPANY ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:SWAP VALUATION CHANGE 771,238.

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