CEDAR LAKE VILLAGE INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CEDAR LAKE VILLAGE INC (EIN 48-1209650)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-08
IRS object ID
202143129349301034
Schema version
2020v4.1
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)
Return2021-11-08T08:37:57-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

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 Begin2020-01-01TaxPeriodBeginDt

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
Signature2021-11-08SignatureDt
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 Customer0TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
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$12,912,798GrossReceiptsAmt
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 Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$41,737PYContributionsGrantsAmt
CY Contributions Grants$584,497CYContributionsGrantsAmt
PY Program Service Revenue$11,906,674PYProgramServiceRevenueAmt
CY Program Service Revenue$11,684,248CYProgramServiceRevenueAmt
PY Investment Income$78,684PYInvestmentIncomeAmt
CY Investment Income$299,345CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$12,027,095PYTotalRevenueAmt
CY Total Revenue$12,568,090CYTotalRevenueAmt
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$14,240CYTotalFundraisingExpenseAmt
PY Other Expenses$12,756,075PYOtherExpensesAmt
CY Other Expenses$12,519,790CYOtherExpensesAmt
PY Total Expenses$12,756,075PYTotalExpensesAmt
CY Total Expenses$12,519,790CYTotalExpensesAmt
PY Revenues Less Expenses-$728,980PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$48,300CYRevenuesLessExpensesAmt
Total Assets BOY$41,165,178TotalAssetsBOYAmt
Total Assets EOY$39,774,121TotalAssetsEOYAmt
Total Liabilities BOY$32,142,448TotalLiabilitiesBOYAmt
Total Liabilities EOY$31,107,968TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$9,022,730NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,666,153NetAssetsOrFundBalancesEOYAmt
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$10,086,714ExpenseAmt
Grant$0GrantAmt
Revenue$11,684,248RevenueAmt
DescPROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 20,657 ASSISTED LIVING RESIDENT DAYS, 37,617 SENIOR HOUSING RESIDENT DAYS AND 7,479 SKILLED NURSING RESIDENT DAYS IN 2020.Desc
Total Program Service Expenses$10,086,714TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
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 (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
NATHAN SCHEMA
PRESIDENT; CHAIR1.000.00Yes (X)$0$0$0
JAMES HUBBARD
VICE-PRESIDENT; VICE CHAIR1.000.00Yes (X)$0$0$0Yes (X)
ERIC VANDEN HULL
TREASURER; TRUSTEE1.000.00Yes (X)$0$0$0Yes (X)
RANDY FITZGERALD
SECRETARY; TRUSTEE End 11/201.000.00Yes (X)$0$0$0Yes (X)
AIMEE MIDDLETON
SECRETARY; TRUSTEE Beg 12/201.000.00Yes (X)$0$0$0Yes (X)
J MACK BOWEN
TRUSTEE1.000.00$0$0$0Yes (X)
VINCE DONOFRIO
TRUSTEE1.000.00$0$0$0Yes (X)
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$6,086,567
SUMMIT CARE INC
6830 W 121ST CTOVERLAND PARKKS66209CONTRACT THERAPY SERVICES$478,437
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$468,423GovernmentGrantsAmt
All Other Contributions$116,074AllOtherContributionsAmt
Total Contributions$584,497TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
ROOM REV, ANCILL SVCS623000$11,616,382$11,616,382
MEALS, GUEST RM, OTHER623000$67,866$67,866
FieldValueIRS element (for citing)
Total Program Service Revenue$11,684,248TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$238,709TotalRevenueColumnAmt
Exclusion$238,709ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$256,954SecuritiesAmt
Other$148,390OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$256,448SecuritiesAmt
Other$88,260OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$506SecuritiesAmt
Other$60,130OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$60,636TotalRevenueColumnAmt
Exclusion$60,636ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,568,090TotalRevenueColumnAmt
Related Or Exempt Func Income$11,684,248RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$299,345ExclusionAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$547,846TotalAmt
Management And General$547,846ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$80,950TotalAmt
Management And General$80,950ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$14,753TotalAmt
Management And General$14,753ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$718,400TotalAmt
Program Services$627,419ProgramServicesAmt
Management And General$90,981ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$81,346TotalAmt
Program Services$66,752ProgramServicesAmt
Management And General$14,544ManagementAndGeneralAmt
Fundraising$50FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$108,920TotalAmt
Program Services$41,530ProgramServicesAmt
Management And General$67,390ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$789,094TotalAmt
Program Services$789,094ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$18,934TotalAmt
Program Services$16,699ProgramServicesAmt
Management And General$2,235ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$27,465TotalAmt
Program Services$9,155ProgramServicesAmt
Management And General$18,310ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$882,281TotalAmt
Program Services$882,281ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,767,251TotalAmt
Program Services$1,767,251ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$147,981TotalAmt
Program Services$147,981ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
CONTRACT SERVICES$5,660,281$4,344,010$1,302,081$14,190
MEDICAL SUPPLIES$1,160,765$1,112,936$47,829
UNCOLLECTIBLE EXPENSE$152,432$152,432
MAINT/REPAIR EQUIP$143,011$142,645$366

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$218,080TotalAmt
Program Services$138,961ProgramServicesAmt
Management And General$79,119ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,519,790TotalAmt
Program Services$10,086,714ProgramServicesAmt
Management And General$2,418,836ManagementAndGeneralAmt
Fundraising$14,240FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,243,580BOYAmt
EOY$745,396EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$839,305BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$449,263BOYAmt
EOY$481,538EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$33,116BOYAmt
EOY$35,571EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$7,408BOYAmt
EOY$2,936EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$50,260,292LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$20,323,665LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$31,633,896BOYAmt
EOY$29,936,627EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$6,788,072BOYAmt
EOY$8,394,269EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$170,538BOYAmt
EOY$177,784EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$41,165,178BOYAmt
EOY$39,774,121EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$610,735BOYAmt
EOY$476,483EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$907BOYAmt
EOY$152,015EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,957,766BOYAmt
EOY$15,236,535EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,573,040BOYAmt
EOY$15,242,935EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$32,142,448BOYAmt
EOY$31,107,968EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,808,164BOYAmt
EOY$8,435,795EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$214,566BOYAmt
EOY$230,358EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,022,730BOYAmt
EOY$8,666,153EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$41,165,178BOYAmt
EOY$39,774,121EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$48,300ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$549,677NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$954,554OtherChangesInNetAssetsAmt
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$26,557CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,110CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,251CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$41,737CurrentTaxYearMinus1YearAmt
Current Tax Year$584,497CurrentTaxYearAmt
Total$682,152TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,199,969CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,178,236CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,389,121CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,906,674CurrentTaxYearMinus1YearAmt
Current Tax Year$11,684,248CurrentTaxYearAmt
Total$57,358,248TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,226,526CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,200,346CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,396,372CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,948,411CurrentTaxYearMinus1YearAmt
Current Tax Year$12,268,745CurrentTaxYearAmt
Total$58,040,400TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,000CurrentTaxYearMinus4YearsAmt
Total$1,000TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,000CurrentTaxYearMinus4YearsAmt
Total$1,000TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$58,039,400PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$70,108CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$105,639CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$154,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$68,915CurrentTaxYearMinus1YearAmt
Current Tax Year$238,709CurrentTaxYearAmt
Total$638,001TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$70,108CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$105,639CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$154,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$68,915CurrentTaxYearMinus1YearAmt
Current Tax Year$238,709CurrentTaxYearAmt
Total$638,001TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,296,634CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,305,985CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,551,002CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,017,326CurrentTaxYearMinus1YearAmt
Current Tax Year$12,507,454CurrentTaxYearAmt
Total$58,678,401TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98910PublicSupportCY509Pct
Public Support PY5090.99060PublicSupportPY509Pct
Investment Income CY0.01090InvestmentIncomeCYPct
Investment Income PY0.00760InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$148,937BeginningYearBalanceAmt
Investment Earnings Or Losses$16,939InvestmentEarningsOrLossesAmt
End Year Balance$165,876EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$140,611BeginningYearBalanceAmt
Investment Earnings Or Losses$8,326InvestmentEarningsOrLossesAmt
End Year Balance$148,937EndYearBalanceAmt
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$41,685,214OtherCostOrOtherBasisAmt
Depreciation$16,312,994DepreciationAmt
Book Value$25,372,220BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,314,604OtherCostOrOtherBasisAmt
Depreciation$2,253,803DepreciationAmt
Book Value$1,060,801BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,303,346OtherCostOrOtherBasisAmt
Depreciation$1,756,868DepreciationAmt
Book Value$1,546,478BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$29,936,627TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescHousing Entry FeesDesc
Book Value$8,394,269BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$8,394,269TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
Special Assessments Payable$86,232
Secured Mortgages and Notes Payable to Members$5,964,570
Security Deposits$169,900
Housing Entry Fees and Other Liabilities$7,227,767
Interest Rate Swap$1,794,466
FieldValueIRS element (for citing)
Total Liability$15,242,935TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$12,862,514TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$549,677NetUnrealizedGainsInvstAmt
Other Revenue-$152,609OtherRevenueAmt
Revenue Not Reported$397,068RevenueNotReportedAmt
Revenue Subtotal$12,465,446RevenueSubtotalAmt
Investment Expenses Not Incld$18,001InvestmentExpensesNotIncldAmt
Other Revenues Not Included$84,643OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$102,644RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$12,568,090TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,289,048TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included-$60,131OtherExpensesIncludedAmt
Expenses Not Reported-$60,131ExpensesNotReportedAmt
Expenses Subtotal$12,349,179ExpensesSubtotalAmt
Investment Expenses Not Incld2$18,001InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$152,610OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$170,611ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,519,790TotalExpensesPerForm990Amt

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 -152,432. Other Expenses -177.
Part XI, Line 4b - Other Adjustments:Gain/Loss Sale of Assets 60,131. Restricted Contributions 17,266. Change in Beneficial Interest 7,246.
Part XII, Line 2d - Other Adjustments:Gain/Loss Sale of Assets -60,131.
Part XII, Line 4b - Other Adjustments:Bad Debt Expense 152,432. Other Expense 178.

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
Purpose2015: CONSTRUCT ADDITIONAL FACILITIESPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$3,843,000RetiredAmt
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 Reference(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 $146,014 PLUS EMPLOYER PAID BENEFITS OF $9,236 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2020.
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 -954,554.

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