2019-11-01T06:34:44-05:00 2018-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2018-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 NATHAN SCHEMA PRESIDENT 6053623100 2019-10-21 1 LAURIE HANSON P00851848 6053391999 2019-10-21 216.147.181.46 2019-10-21 08:36:32 CD P C5ADF3E96DC5FD5E5884512D59AB882B10EDFEC1 2498296C43E1E89153AA0CA2385E379BE62769D4 2018 2020-03-31 21:24:44Z NATHAN SCHEMA 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 16016558 0 X WWW.CEDARLAKEVILLAGEKC.ORG X 1998 KS HOUSING, PROGRAMS AND SERVICES FOR ELDERLY PERSONS AND OTHERS IN NEED. 6 6 0 379 0 0 22110 7251 11195175 11389121 119850 -54303 330177 69661 11667312 11411730 0 0 0 0 5503025 5416885 0 0 27952 6894791 7058873 12397816 12475758 -730504 -1064028 44375797 41103064 32746481 30521446 11629316 10581618 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 10105726 11389121 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 15,369 ASSISTED LIVING RESIDENT DAYS, 36,913 SENIOR HOUSING RESIDENT DAYS, AND 8,823 SKILLED NURSING RESIDENT DAYS IN 2018. 10105726 1 0 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 6 6 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 PO BOX 5038 SIOUX FALLS SD 571175038 X THOMAS A SYVERSON PRESIDENT 1.00 X X 0 0 0 JAMES R HUBBARD VICE-PRESIDENT 1.00 X X 0 0 0 JOSEPH HERDINA TREASURER 1.00 X X 0 0 0 RANDY FITZGERALD SECRETARY 1.00 X X 0 0 0 JAMES K BRADLEY BOARD OF TRUSTEES UNTIL 12/2018 1.00 X 0 0 0 J MACK BOWEN BOARD OF TRUSTEES 1.00 X 0 0 0 VINCE DONOFRIO BOARD OF TRUSTEES BEG 12/2018 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, AND S 6055036 SUMMIT CARE INC 6830 W 121 OVERLAND PARK KS 66209 CONTRACT THERAPY SERVICES 691759 A L HUBER CONSTRUCTION INC 10770 EL MONTE OVERLAND PARK KS 66211 GENERAL CONTRACTOR 288406 PREMIER CONTRACTING 3940 S FERREE STREET KANSAS CITY KS 66103 GENERAL CONTRACTOR 169803 4 7251 7251 ROOM REVENUE & ANCILLARY SERVICES 623000 11299716 11299716 MEALS, GUEST ROOMS, AND OTHER REV 623000 89405 89405 11389121 154630 154630 4395895 4276613 328215 119282 -328215 -208933 -208933 INSURANCE PROCEEDS 623000 69661 69661 69661 11411730 11389121 0 15358 4330519 3614718 691223 24578 1086366 350663 732926 2777 561086 561086 3237 3237 974269 874322 99947 94510 94187 323 837985 727334 110651 1191 1191 847264 847264 36916 30056 6768 92 1017457 1017457 1811629 1811629 112503 106503 6000 SUPPLIES 434049 423208 10768 73 EMPLOYEE, PUBLIC & RESI 248060 204274 43784 2 BAD DEBT 34019 34019 TAXES AND LICENSES 33985 33985 10713 4111 6172 430 12475758 10105726 2342080 27952 47472 81006 292806 19760 496404 553100 40608 53505 81940 9952 50117150 17013133 34575338 33104017 8675353 7073672 165876 208052 44375797 41103064 2371121 1520080 17322226 16652996 13053134 12348370 32746481 30521446 X 11434271 10386149 28659 17889 166386 177580 11629316 10581618 44375797 41103064 X -1064028 166300 -149970 X 0 1 X 1 0 X 258684 161782 26557 22110 7251 476384 10527710 10997283 11199969 11178236 11389121 55292319 10786394 11159065 11226526 11200346 11396372 55768703 66630 101200 1000 168830 0 66630 101200 1000 168830 55599873 50126 38862 70108 105639 154630 419365 50126 38862 70108 105639 154630 419365 10836520 11197927 11296634 11305985 11551002 56188068 0.98950 0.99080 0.00750 0.00610 X 165876 8480 174356 148937 16939 165876 140611 8326 148937 140599 12 140611 133936 1987 4676 140599 0.00000 1.00000 0.00000 1 0 1922557 1922557 41737514 13643581 28093933 3114026 1889909 1224117 3343053 1479643 1863410 33104017 FUNDED DEPRECIATION 568661 F OTHER INVESTMENT 215128 F HOUSING ENTRY FEES 6289883 F 7073672 SPECIAL ASSESSMENTS PAYABLE 150905 HOUSING ENTRY FEES AND OTHER LIABILITIES 7123911 SECURED MORTGAGES AND NOTES PAYABLE TO MEMBERS 4898547 SECURITY DEPOSITS 175007 12348370 X 11427636 166300 -143572 22728 11404908 6822 6822 11411730 12475758 0 12475758 0 12475758 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: CEDAR LAKE VILLAGE, INC. IS ORGANIZED AS A NONPROFIT ORGANIZATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE 501(C)(3). THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. 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 14,878. NET ASSET DISTRIBUTION TO MEMBERS -158,450. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS AND EARNINGS - TEMP RESTRISTED NET ASSETS 6,822. A CITY OF OLATHE KANSAS 486034756 2015-05-15 19200000 SEE NARRATIVE 0 0 0 A 2547004 19200000 270367 7509781 11419852 2015 1 0 1 1 A 0 0 0 0 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 TAXABLE 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 $133,525 PLUS EMPLOYER PAID BENEFITS OF $8,760 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2018. 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. JAMES K. BRADLEY - 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: NET ASSET DISTRIBUTION TO MEMBERS -158,450. CHANGE IN TELGSS FDTN INTEREST 8,480. FORM 990, SCHEDULE D, PART VI, LINE 1E, COLUMNS B AND C: OTHER PROPERTY SHOWN IN THE OTHER COLUMN CONSISTS OF LAND IMPROVEMENTS OF $3,232,860 WITH RELATED ACCUMULATED DEPRECIATION OF $1,479,643 AND CONSTRUCTION AND DEVELOPMENT OF $110,193 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.