2017-07-19T06:56:03-05:00 2016-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 JOSEPH HERDINA TREASURER 6053623100 2017-07-12 1 LAURIE HANSON P00851848 6053391999 2017-07-12 199.116.169.103 2017-07-12 16:36:34 CD P 171BAB973F07BBF56AF44147332F3B8F939E6447 EF8011075554CB02D1779489BD3504755D118D03 2016 2021-01-29 14:40:06Z JOSEPH HERDINA 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 28100308 0 X WWW.CEDARLAKEVILLAGEKC.ORG X 1998 KS IMPROVING THE WELL-BEING AND QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED THROUGH THE PROVISION OF HOUSING, PROGRAMS, AND SERVICES. 6 6 0 423 0 0 161782 26557 10998654 11208202 104509 227256 0 0 11264945 11462015 0 0 0 0 3910126 4836194 0 0 28873 6564748 7180882 10474874 12017076 790071 -555061 48068249 45066360 35803175 33064663 12265074 12001697 X IMPROVING THE WELL-BEING AND QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED THROUGH THE PROVISION OF HOUSING, PROGRAMS, AND SERVICES. 1 0 9467061 11199969 PROVIDING 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. 9467061 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 1 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 JOSEPH HERDINA 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 1.00 X 0 0 0 J MACK BOWEN BOARD OF TRUSTEES 1.00 X 0 0 0 JOANNA RANDALL EXECUTIVE DIRECTOR 31.00 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 5291292 A L HUBER CONSTRUCTION INC 10770 EL MONTE OVERLAND PARK KS 66211 GENERAL CONTRACTOR 1321376 SUMMIT CARE INC 6830 W 121 OVERLAND PARK KS 66209 CONTRACT THERAPY SERVICES 756257 EMBASSY LANDSCAPE GROUP INC 6105 NW RIVER PARK DR RIVERSIDE MO 64150 LANDSCAPING, MAINTENANCE & SHRUB REPLACE 117201 4 26557 26557 ROOM REVENUE & ANCILLARY SERVICES 623000 11103381 11103381 MEALS, GUEST ROOMS, AND OTHER REV 623000 96588 96588 CHANGE IN TELGS FDTN INTEREST 623000 8233 8233 11208202 70108 70108 16621518 173923 16567643 70650 53875 103273 157148 157148 11462015 11199969 0 235489 3917958 3259348 635444 23166 918236 289814 626633 1789 559177 559177 4410 4410 1067048 983909 83139 104947 104947 914159 813007 101105 47 3772 3772 814514 801117 13397 41164 34778 5983 403 1025991 1025991 1702295 1702295 69300 69300 SUPPLIES 549639 549005 634 BAD DEBT 218500 218500 EMPLOYEE, PUBLIC & RESI 73434 2186 71246 2 TAXES AND LICENSES 23589 23589 8943 5611 500 2832 12017076 9467061 2521142 28873 232116 669583 1236857 481857 333 0 739144 420046 40320 45971 70183 37924 49262523 13922698 36010307 35339825 9343971 7922217 395018 148937 48068249 45066360 3118025 1558921 18837000 17965456 13848150 13540286 35803175 33064663 X 11666558 11817334 457929 35710 140587 148653 12265074 12001697 48068249 45066360 -555061 291684 0 X 0 1 X 1 0 X 113337 57960 258684 161782 26557 618320 9917277 9909828 10527710 10997283 11199969 52552067 10030614 9967788 10786394 11159065 11226526 53170387 66630 101200 1000 168830 0 66630 101200 1000 168830 53001557 50307 68041 50126 38862 70108 277444 50307 68041 50126 38862 70108 277444 10080921 10035829 10836520 11197927 11296634 53447831 0.99170 0.99120 0.00520 0.00550 X 140611 8326 148937 140599 12 140611 133936 1987 4676 140599 101574 17900 14462 133936 12002 89572 101574 1.00000 1 0 1922557 1922557 41024263 11195579 29828684 2949526 1559609 1389917 3366177 1167510 2198667 35339825 FUNDED DEPRECIATION 2199521 F OTHER INVESTMENT 38619 F HOUSING ENTRY FEES 5684077 F 7922217 SPECIAL ASSESSMENTS PAYABLE 194021 HOUSING ENTRY FEES AND OTHER LIABILITIES 6969934 SECURED MORTGAGES AND NOTES PAYABLE TO RELATED PARTIES 5761786 SECURITY DEPOSITS 185999 ACCM UNREALIZED SWAP ADJ. 428546 13540286 X 12167852 291684 449270 740954 11426898 35117 35117 11462015 12017076 0 12017076 0 12017076 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. A CITY OF OLATHE KANSAS 486034756 2015-05-15 19200000 SEE NARRATIVE 0 0 0 A 1234544 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 III, LINE 2 CEDAR LAKE VILLAGE STARTED OFFERING MEMORY CARE ASSISTED LIVING SERVICES IN 2016. 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 $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 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. 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.