2015-08-21T14:24:36-05:00 2014-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2014-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 JOSEPH HERDINA TREASURER 6053623100 2015-08-21 1 LAURIE HANSON P00851848 6053391999 2015-08-21 2014 2016-02-25 16:41:14Z JOSEPH HERDINA 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 17381484 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 0 120 0 0 57960 258684 9909828 10537220 16792 91913 0 0 9984580 10887817 0 0 0 0 3111371 3545889 0 0 34528 6305516 6050510 9416887 9596399 567693 1291418 34919910 38112776 24140748 25910105 10779162 12202671 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 7540654 10527710 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 11,871 ASSISTED LIVING RESIDENT DAYS, 40,770 SENIOR HOUSING RESIDENT DAYS, AND 8,967 SKILLED NURSING RESIDENT DAYS IN 2014. 7540654 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 27 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 X JOSEPH HERDINA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 X TOM SYVERSON PRESIDENT 1.00 X X 0 0 0 ALAN HIEB TIL 1214 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 ADMINISTRATOR 31.00 X 0 0 0 0 0 0 0 0 0 0 THE EVANGELICAL LUTHERAN GOOD SAMARITAN 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 57117 MANAGEMENT FEES, BILLING SERVICES, AND S 4215868 SUMMIT CARE INC 6830 W 121 OVERLAND PARK KS 66209 THERAPY SERVICES 541987 BANK OF AMERICA 1 FLEET WAY SCRANTON PA 18507 LETTER OF CREDIT FEES 122196 3 545 258139 258684 ROOM REVENUE & ANCILLARY SERVICES 623000 10443074 10443074 MEALS, GUEST ROOMS, AND OTHER REV 623000 84636 84636 CHANGE IN TELGSS FDTN INTEREST 623000 9510 9510 10537220 50126 50126 6535454 6488924 4743 46530 -4743 41787 41787 0 545 0 0 10887817 10527710 0 101423 X 116818 116818 2804226 2436562 345778 21886 624845 163345 458853 2647 513612 513612 1109973 1001801 108172 119984 119984 829155 722086 107060 9 759359 709456 49903 43157 39335 3741 81 632364 632364 1351032 1351032 55701 55701 SUPPLIES 476749 476417 332 EMPLOYEE, PUBLIC & RESI 82290 3963 78327 BAD DEBT 35444 35444 TAXES AND LICENSES 19920 19920 21770 4293 7904 9573 9596399 7540654 2021217 34528 713057 228095 469489 784981 24101 97335 594882 718793 33463 32951 15336 5449 39724192 10873721 28153513 28850471 4763222 7255368 152847 139333 34919910 38112776 1339745 1603093 9070000 8680000 2956071 2781071 10774932 12845941 24140748 25910105 X 10570597 11739151 74629 322921 133936 140599 10779162 12202671 34919910 38112776 1291418 132091 0 X 0 1 X 1 0 X 22776 41732 113337 57960 258684 494489 7874637 9962191 9917277 9909828 10527710 48191643 7897413 10003923 10030614 9967788 10786394 48686132 9130 9130 0 9130 9130 48677002 67172 82006 50307 68041 50126 317652 67172 82006 50307 68041 50126 317652 7964585 10085929 10080921 10035829 10836520 49003784 0.99330 0.99300 0.00650 0.00700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133936 1987 4676 140599 101574 17900 14462 133936 12002 89572 101574 12002 12002 12002 12002 1.00000 1 0 1922557 1922557 31634750 8783500 22851250 2285114 1183987 1101127 3881771 906234 2975537 28850471 FUNDED DEPRECIATION 3010694 F OTHER INVESTMENT 52954 F HOUSING ENTRY FEES 4191720 F 7255368 SPECIAL ASSESSMENTS PAYABLE 237136 HOUSING ENTRY FEES AND OTHER LIABILITIES 5926819 SECURED MORTGAGES AND NOTES PAYABLE TO RELATED PARTIES 6515772 SECURITY DEPOSITS 166214 12845941 X 10764953 132091 7144 139235 10625718 262099 262099 10887817 9596399 0 9596399 0 9596399 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 7,144. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS AND EARNINGS - TEMP RESTRICTED NET ASSETS 252,589. CHANGE IN BENEFICIAL INTEREST IN TELGSS FOUNDATION 9,510. A CITY OF OLATHE KANSAS 483064756 679390FB5 2004-12-16 11300000 CONSTRUCT ADDITIONAL FACILITIES AND PAY COSTS RELATED TO BOND ISSUANCE. 0 0 0 A 2620000 11300000 162019 23500 11114481 2006 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF OLATHE, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 12/01/2008 SCHEDULE K, PART IV, LINE 2C AN INSTALLMENT COMPUTATION WAS PERFORMED AS OF 12/01/2008. NO REBATE LIABILITY WAS DUE, AND NO FUTURE COMPUTATIONS WERE REQUIRED AS ALL PROCEEDS WERE SPENT PRIOR TO THAT COMPUTATION DATE. 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 $111,622 PLUS EMPLOYER PAID BENEFITS OF $5,196 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2014. 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 11 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 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, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 831,487. MANAGEMENT AND GENERAL EXPENSES 108,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 939,659. PROFESSIONAL MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 92,876. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,876. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 77,438. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 77,438. FORM 990, SCHEDULE D, PART VI, LINE 1E, COLUMNS B AND C: OTHER PROPERTY SHOWN IN THE OTHER COLUMN CONSISTS OF LAND IMPROVEMENTS OF $2,896,350 WITH RELATED ACCUMULATED DEPRECIATION OF $906,234 AND CONSTRUCTION AND DEVELOPMENT OF $985,421 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.