CEDAR LAKE VILLAGE INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
CEDAR LAKE VILLAGE INC (EIN 48-1209650)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-07-19
IRS object ID
201722009349300602
Schema version
2016v3.0
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)
Return2017-07-19T06:56:03-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175125ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

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
Phone6053623100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57TH STREET PO BOX 5038AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175038ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOSEPH HERDINAPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6053623100PhoneNum
Signature2017-07-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLAURIE HANSONPreparerPersonNm
PTINP00851848PTIN
Phone6053391999PhoneNum
Preparation2017-07-12PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address199.116.169.103IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-07-12IPDt
IP Tm16:36:34IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id171BAB973F07BBF56AF44147332F3B8F939E6447AtSubmissionCreationDeviceId
At Submission Filing Device IdEF8011075554CB02D1779489BD3504755D118D03AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOSEPH HERDINAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57TH STREET PO BOX 5038AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175038ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$28,100,308GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CEDARLAKEVILLAGEKC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1998FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionIMPROVING THE WELL-BEING AND QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED THROUGH THE PROVISION OF HOUSING, PROGRAMS, AND SERVICES.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers423TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$161,782PYContributionsGrantsAmt
CY Contributions Grants$26,557CYContributionsGrantsAmt
PY Program Service Revenue$10,998,654PYProgramServiceRevenueAmt
CY Program Service Revenue$11,208,202CYProgramServiceRevenueAmt
PY Investment Income$104,509PYInvestmentIncomeAmt
CY Investment Income$227,256CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$11,264,945PYTotalRevenueAmt
CY Total Revenue$11,462,015CYTotalRevenueAmt
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$3,910,126PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,836,194CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$28,873CYTotalFundraisingExpenseAmt
PY Other Expenses$6,564,748PYOtherExpensesAmt
CY Other Expenses$7,180,882CYOtherExpensesAmt
PY Total Expenses$10,474,874PYTotalExpensesAmt
CY Total Expenses$12,017,076CYTotalExpensesAmt
PY Revenues Less Expenses$790,071PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$555,061CYRevenuesLessExpensesAmt
Total Assets BOY$48,068,249TotalAssetsBOYAmt
Total Assets EOY$45,066,360TotalAssetsEOYAmt
Total Liabilities BOY$35,803,175TotalLiabilitiesBOYAmt
Total Liabilities EOY$33,064,663TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$12,265,074NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$12,001,697NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
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 SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$9,467,061ExpenseAmt
Revenue$11,199,969RevenueAmt
DescPROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 14,268 ASSISTED LIVING RESIDENT DAYS, 42,675 SENIOR HOUSING RESIDENT DAYS, AND 8,115 SKILLED NURSING RESIDENT DAYS IN 2016.Desc
Total Program Service Expenses$9,467,061TotalProgramServiceExpensesAmt
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
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
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
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
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 AddressYes (1)OfficerMailingAddressInd
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 Line1JOSEPH HERDINABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6053623100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57TH STREET PO BOX 5038AddressLine1Txt
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 WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
THOMAS A SYVERSON
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
JAMES R HUBBARD
VICE-PRESIDENT1.00Yes (X)Yes (X)$0$0$0
JOSEPH HERDINA
TREASURER1.00Yes (X)Yes (X)$0$0$0
RANDY FITZGERALD
SECRETARY1.00Yes (X)Yes (X)$0$0$0
JAMES K BRADLEY
BOARD OF TRUSTEES1.00Yes (X)$0$0$0
J MACK BOWEN
BOARD OF TRUSTEES1.00Yes (X)$0$0$0
JOANNA RANDALL
EXECUTIVE DIRECTOR31.00Yes (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 (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
THE EVANGELICAL LUTHERAN GOOD SAMARITAN
4800 W 57TH STREETSIOUX FALLSSD57108MANAGEMENT FEES, BILLING SERVICES, AND S$5,291,292
A L HUBER CONSTRUCTION INC
10770 EL MONTEOVERLAND PARKKS66211GENERAL CONTRACTOR$1,321,376
SUMMIT CARE INC
6830 W 121OVERLAND PARKKS66209CONTRACT THERAPY SERVICES$756,257
EMBASSY LANDSCAPE GROUP INC
6105 NW RIVER PARK DRRIVERSIDEMO64150LANDSCAPING, MAINTENANCE & SHRUB REPLACE$117,201
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
All Other Contributions$26,557AllOtherContributionsAmt
Total Contributions$26,557TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
ROOM REVENUE & ANCILLARY SERVICES623000$11,103,381$11,103,381
MEALS, GUEST ROOMS, AND OTHER REV623000$96,588$96,588
CHANGE IN TELGS FDTN INTEREST623000$8,233$8,233
FieldValueIRS element (for citing)
Total Program Service Revenue$11,208,202TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,108TotalRevenueColumnAmt
Exclusion$70,108ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$16,621,518SecuritiesAmt
Other$173,923OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$16,567,643SecuritiesAmt
Other$70,650OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$53,875SecuritiesAmt
Other$103,273OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$157,148TotalRevenueColumnAmt
Exclusion$157,148ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,462,015TotalRevenueColumnAmt
Related Or Exempt Func Income$11,199,969RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$235,489ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,917,958TotalAmt
Program Services$3,259,348ProgramServicesAmt
Management And General$635,444ManagementAndGeneralAmt
Fundraising$23,166FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$918,236TotalAmt
Program Services$289,814ProgramServicesAmt
Management And General$626,633ManagementAndGeneralAmt
Fundraising$1,789FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$559,177TotalAmt
Management And General$559,177ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,410TotalAmt
Management And General$4,410ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,067,048TotalAmt
Program Services$983,909ProgramServicesAmt
Management And General$83,139ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$104,947TotalAmt
Management And General$104,947ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$914,159TotalAmt
Program Services$813,007ProgramServicesAmt
Management And General$101,105ManagementAndGeneralAmt
Fundraising$47FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,772TotalAmt
Management And General$3,772ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$814,514TotalAmt
Program Services$801,117ProgramServicesAmt
Management And General$13,397ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$41,164TotalAmt
Program Services$34,778ProgramServicesAmt
Management And General$5,983ManagementAndGeneralAmt
Fundraising$403FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,025,991TotalAmt
Program Services$1,025,991ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,702,295TotalAmt
Program Services$1,702,295ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$69,300TotalAmt
Management And General$69,300ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$549,639$549,005$634
BAD DEBT$218,500$218,500
EMPLOYEE, PUBLIC & RESI$73,434$2,186$2$71,246
TAXES AND LICENSES$23,589$23,589

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$8,943TotalAmt
Program Services$5,611ProgramServicesAmt
Management And General$500ManagementAndGeneralAmt
Fundraising$2,832FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,017,076TotalAmt
Program Services$9,467,061ProgramServicesAmt
Management And General$2,521,142ManagementAndGeneralAmt
Fundraising$28,873FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$232,116BOYAmt
EOY$669,583EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,236,857BOYAmt
EOY$481,857EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$333BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$739,144BOYAmt
EOY$420,046EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$40,320BOYAmt
EOY$45,971EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$70,183BOYAmt
EOY$37,924EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$49,262,523LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$13,922,698LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$36,010,307BOYAmt
EOY$35,339,825EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$9,343,971BOYAmt
EOY$7,922,217EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$395,018BOYAmt
EOY$148,937EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$48,068,249BOYAmt
EOY$45,066,360EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,118,025BOYAmt
EOY$1,558,921EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,837,000BOYAmt
EOY$17,965,456EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,848,150BOYAmt
EOY$13,540,286EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$35,803,175BOYAmt
EOY$33,064,663EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$11,666,558BOYAmt
EOY$11,817,334EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$457,929BOYAmt
EOY$35,710EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$140,587BOYAmt
EOY$148,653EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$12,265,074BOYAmt
EOY$12,001,697EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$48,068,249BOYAmt
EOY$45,066,360EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$555,061ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$291,684NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
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$113,337CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$57,960CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$258,684CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$161,782CurrentTaxYearMinus1YearAmt
Current Tax Year$26,557CurrentTaxYearAmt
Total$618,320TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9,917,277CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,909,828CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,527,710CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$10,997,283CurrentTaxYearMinus1YearAmt
Current Tax Year$11,199,969CurrentTaxYearAmt
Total$52,552,067TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$10,030,614CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,967,788CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,786,394CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,159,065CurrentTaxYearMinus1YearAmt
Current Tax Year$11,226,526CurrentTaxYearAmt
Total$53,170,387TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$66,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$101,200CurrentTaxYearMinus1YearAmt
Current Tax Year$1,000CurrentTaxYearAmt
Total$168,830TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$66,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$101,200CurrentTaxYearMinus1YearAmt
Current Tax Year$1,000CurrentTaxYearAmt
Total$168,830TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$53,001,557PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$50,307CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$68,041CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$50,126CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$38,862CurrentTaxYearMinus1YearAmt
Current Tax Year$70,108CurrentTaxYearAmt
Total$277,444TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$50,307CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$68,041CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$50,126CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$38,862CurrentTaxYearMinus1YearAmt
Current Tax Year$70,108CurrentTaxYearAmt
Total$277,444TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$10,080,921CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,035,829CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,836,520CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,197,927CurrentTaxYearMinus1YearAmt
Current Tax Year$11,296,634CurrentTaxYearAmt
Total$53,447,831TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99170PublicSupportCY509Pct
Public Support PY5090.99120PublicSupportPY509Pct
Investment Income CY0.00520InvestmentIncomeCYPct
Investment Income PY0.00550InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$140,611BeginningYearBalanceAmt
Investment Earnings Or Losses$8,326InvestmentEarningsOrLossesAmt
End Year Balance$148,937EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$140,599BeginningYearBalanceAmt
Investment Earnings Or Losses$12InvestmentEarningsOrLossesAmt
End Year Balance$140,611EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$133,936BeginningYearBalanceAmt
Contributions$1,987ContributionsAmt
Investment Earnings Or Losses$4,676InvestmentEarningsOrLossesAmt
End Year Balance$140,599EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$101,574BeginningYearBalanceAmt
Contributions$17,900ContributionsAmt
Investment Earnings Or Losses$14,462InvestmentEarningsOrLossesAmt
End Year Balance$133,936EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$12,002BeginningYearBalanceAmt
Contributions$89,572ContributionsAmt
End Year Balance$101,574EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,922,557OtherCostOrOtherBasisAmt
Book Value$1,922,557BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$41,024,263OtherCostOrOtherBasisAmt
Depreciation$11,195,579DepreciationAmt
Book Value$29,828,684BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,949,526OtherCostOrOtherBasisAmt
Depreciation$1,559,609DepreciationAmt
Book Value$1,389,917BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,366,177OtherCostOrOtherBasisAmt
Depreciation$1,167,510DepreciationAmt
Book Value$2,198,667BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$35,339,825TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
FUNDED DEPRECIATION$2,199,521F
OTHER INVESTMENT$38,619F
HOUSING ENTRY FEES$5,684,077F
FieldValueIRS element (for citing)
Total Book Value Securities$7,922,217TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
SPECIAL ASSESSMENTS PAYABLE$194,021
HOUSING ENTRY FEES AND OTHER LIABILITIES$6,969,934
SECURED MORTGAGES AND NOTES PAYABLE TO RELATED PARTIES$5,761,786
SECURITY DEPOSITS$185,999
ACCM UNREALIZED SWAP ADJ.$428,546
FieldValueIRS element (for citing)
Total Liability$13,540,286TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$12,167,852TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$291,684NetUnrealizedGainsInvstAmt
Other Revenue$449,270OtherRevenueAmt
Revenue Not Reported$740,954RevenueNotReportedAmt
Revenue Subtotal$11,426,898RevenueSubtotalAmt
Other Revenues Not Included$35,117OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$35,117RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$11,462,015TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,017,076TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$12,017,076ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,017,076TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 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: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. FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE WOULD BE RECOGNIZED 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 449,270.
PART XI, LINE 4B - OTHER ADJUSTMENTS:CONTRIBUTIONS AND EARNINGS - TEMP RESTRICTED NET ASSETS 26,884. CHANGE IN BENEFICIAL INTEREST IN TELGS FOUNDATION 8,233.

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
Bond Issued2015-05-15BondIssuedDt
Issue Price$19,200,000IssuePriceAmt
PurposeSEE NARRATIVEPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,234,544RetiredAmt
Total Proceeds$19,200,000TotalProceedsAmt
Issuance Costs From Proceeds$270,367IssuanceCostsFromProceedsAmt
Capital Expenditures$7,509,781CapitalExpendituresAmt
Other Spent Proceeds$11,419,852OtherSpentProceedsAmt
Substantial Completion2015SubstantialCompletionYr
Current RefundingYes (1)CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
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
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 YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
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
Business Name Line2OF FLORIDA NABusinessNameLine2Txt
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, LINE AFormAndLineReferenceDesc
ExplanationCONSTRUCT 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.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 2CEDAR LAKE VILLAGE STARTED OFFERING MEMORY CARE ASSISTED LIVING SERVICES IN 2016.
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 $122,248 PLUS EMPLOYER PAID BENEFITS OF $7,864 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2016.
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 VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETCJAMES R. HUBBARD - 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. JOANNA RANDALL - 15325 S LONE ELM ROAD, OLATHE, KS 66061.
FORM 990, SCHEDULE D, PART VI, LINE 1E, COLUMNS B AND C:OTHER PROPERTY SHOWN IN THE OTHER COLUMN CONSISTS OF LAND IMPROVEMENTS OF $3,067,273 WITH RELATED ACCUMULATED DEPRECIATION OF $1,167,510 AND CONSTRUCTION AND DEVELOPMENT OF $298,904 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.

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