2020-10-27T12:44:36-05:00 2019-12-31 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2019-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053331000 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 ERIC VANDEN HULL TREASURER 6053331000 2020-10-23 1 LAURIE HANSON P00851848 6053391999 2020-10-23 184.83.199.194 2020-10-23 10:25:23 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 50CCFF325394DF76E401CCE6D67578A0FB45D135 2019 2021-01-29 14:40:06Z X NATHAN SCHEMA 4800 W 57TH STREET SIOUX FALLS SD 57117 24905261 0 X WWW.SANFORDHEALTH.ORG X 1998 KS HOUSING, PROGRAMS AND SERVICES FOR ELDERLY PERSONS AND OTHERS IN NEED. 5 5 0 363 0 0 7251 41737 11389121 11906674 -54303 78684 69661 0 11411730 12027095 0 0 0 0 5416885 0 0 0 29848 7058873 12756075 12475758 12756075 -1064028 -728980 41103064 41165178 30521446 32142448 10581618 9022730 IMPROVING THE WELL-BEING AND QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED THROUGH THE PROVISION OF HOUSING, PROGRAMS, AND SERVICES. 0 0 10333796 11906674 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 20,572 ASSISTED LIVING RESIDENT DAYS, 39,647 SENIOR HOUSING RESIDENT DAYS, AND 8,305 SKILLED NURSING RESIDENT DAYS IN 2019. 10333796 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 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 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 0 0 KS X ERIC VANDEN HULL 6053623100 4800 W 57TH STREET SIOUX FALLS SD 571175038 X THOMAS A SYVERSON PRES UNTIL 8/19; TRUSTEE UNTIL 8/19 1.00 X X 0 0 0 NATHAN SCHEMA PRESIDENT BEG. 9/19; CHAIR BEG. 9/19 1.00 X X 0 0 0 JAMES R HUBBARD VICE-PRESIDENT; VICE CHAIR 1.00 X X 0 0 0 JOSEPH HERDINA TREASURER UNTIL 8/19 1.00 X X 0 0 0 RANDY FITZGERALD SECRETARY; TRUSTEE 1.00 X X 0 0 0 ERIC VANDEN HULL TREAS. BEG 9/19; TRUSTEE BEG. 9/19 1.00 X X 0 0 0 J MACK BOWEN TRUSTEE 1.00 X 0 0 0 VINCE DONOFRIO TRUSTEE 1.00 X 0 0 0 JOANNA RANDALL EXECUTIVE DIRECTOR 45.00 X 0 0 0 0 0 0 0 0 0 0 THE EVANGELICAL LUTHERAN GOOD SAMARITAN 4800 W 57TH STREET SIOUX FALLS SD 57108 MANAGEMENT FEES & BILLING SERVICES, SHAR 6347489 SUMMIT CARE INC 6830 W 121ST CT OVERLAND PARK KS 66209 CONTRACT THERAPY SERVICES 616657 2 41737 41737 ROOM REVENUE & ANCILLARY SERVICES 623000 11813062 11813062 MEALS, GUEST ROOMS, AND OTHER REV 623000 93612 93612 11906674 68915 68915 12887935 12846015 32151 41920 -32151 9769 9769 12027095 11906674 0 78684 651202 651202 905355 867506 37849 69080 68718 362 1151144 1097245 53489 410 7536 7536 984770 945272 39498 18578 11175 7403 920000 920000 1791527 1791527 131352 131352 CONTRACT SERVICES - PER 5754584 4450266 1274880 29438 BAD DEBT 221003 221003 EMPLOYEE, PUBLIC & RESI 63377 21556 41821 TAXES AND LICENSES 52206 52206 34361 29179 5182 12756075 10333796 2392431 29848 81006 1243580 19760 839305 553100 449263 53505 33116 9952 7408 50394656 18760760 33104017 31633896 7073672 6788072 208052 170538 41103064 41165178 1520080 610735 907 16652996 15957766 12348370 15573040 30521446 32142448 X 10386149 8808164 195469 214566 10581618 9022730 41103064 41165178 X -728980 -826090 -3818 X 0 1 X 1 0 X 161782 26557 22110 7251 41737 259437 10997283 11199969 11178236 11389121 11906674 56671283 11159065 11226526 11200346 11396372 11948411 56930720 101200 1000 102200 0 101200 1000 102200 56828520 38862 70108 105639 154630 68915 438154 38862 70108 105639 154630 68915 438154 11197927 11296634 11305985 11551002 12017326 57368874 0.99060 0.98950 0.00760 0.00750 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 174356 -3818 170538 165876 8480 174356 148937 16939 165876 140611 8326 148937 140599 12 140611 0.00000 1.00000 0.00000 1 0 1922557 1922557 41923344 15069335 26854009 3174760 2066223 1108537 3373995 1625202 1748793 31633896 HOUSING ENTRY FEES 6788072 F 6788072 SPECIAL ASSESSMENTS PAYABLE 129347 SECURED MORTGAGES AND NOTES PAYABLE TO MEMBERS 7861079 SECURITY DEPOSITS 177400 HOUSING ENTRY FEES AND OTHER LIABIL 6565302 INTEREST RATE SWAP 839912 15573040 X 11178090 -826090 15136 -810954 11989044 38051 38051 12027095 12756075 0 12756075 0 12756075 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: NET ASSET RELEASED FROM RESTRICTION 15,136. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS AND EARNINGS - TEMP RESTRISTED NET ASSETS 38,051. A CITY OF OLATHE KANSAS 486034756 2015-05-15 19200000 SEE NARRATIVE 0 0 0 A 3095000 19200000 270367 7509781 11419852 2015 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 CENTER STATE BANK OF FLORIDA NA 20.600000000000 0 0 0 0 1 A 1 SCHEDULE K, PART I, COLUMN F, LINE A 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. FORM 990, PART VI, SECTION A, LINE 3 THE 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 $134,018 PLUS EMPLOYER PAID BENEFITS OF $8,909 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2019. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS ARE OLATHE MEDICAL CENTER, INC. AND THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. FORM 990, PART VI, SECTION A, LINE 7A THE TRUSTEES ARE APPOINTED BY THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE 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 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B AN 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 12C THE 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 15A THE 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 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC JAMES R. HUBBARD - 15325 S LONE ELM ROAD, OLATHE, KS 66061. RANDY FITZGERALD - 15325 S LONE ELM ROAD, OLATHE, KS 66061. J. MACK BOWEN - 15325 S LONE ELM ROAD, OLATHE, KS 66061. VINCE DONOFRIO - 15325 S LONE ELM ROAD, OLATHE, KS 66061. JOANNA RANDALL - 15325 S LONE ELM ROAD, OLATHE, KS 66061. FORM 990, PART XI, LINE 9: CHANGE IN TELGSS FDTN INTEREST -3,818. FORM 990, SCHEDULE D, PART VI, LINE 1E, COLUMNS B AND C: OTHER PROPERTY SHOWN IN THE OTHER COLUMN CONSISTS OF LAND IMPROVEMENTS OF $3,225,795 WITH RELATED ACCUMULATED DEPRECIATION OF $1,625,202 AND CONSTRUCTION AND DEVELOPMENT OF $148,200 WITH NO RELATED ACCUMULATED DEPRECIATION. DEPRECIATION WILL BE RECOGNIZED FOR THE CONSTRUCTION AND DEVELOPMENT ASSETS ONCE CONSTRUCTION HAS BEEN COMPLETED AND THE ASSETS HAVE BEEN PLACED INTO SERVICE. FORM 990, PART V, LINES 1A AND 2A: FORM 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.