2014-06-27T08:04:53-05:00 2013-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2013-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 JOSEPH HERDINA TREASURER 6053623100 2014-06-23 1 LAURIE HANSON P00851848 6053391999 2014-06-23 2013 2015-11-30 17:44:51Z JOSEPH HERDINA 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 15026592 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 0 152 0 0 113337 57960 9917277 9909828 153811 16792 0 0 10184425 9984580 0 0 0 0 3083582 3111371 0 0 36026 6376264 6305516 9459846 9416887 724579 567693 33770450 34919910 23832908 24140748 9937542 10779162 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 7608364 9909828 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 12,005 ASSISTED LIVING RESIDENT DAYS, 37,136 SENIOR HOUSING RESIDENT DAYS, AND 8,784 SKILLED NURSING RESIDENT DAYS IN 2013. 7608364 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 37 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 ALAN HIEB 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 CINDY MOEGENBURG 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 106271 0 4958 106271 0 4958 1 0 0 1 THE EVANGELICAL LUTHERAN GOOD SAMARITAN 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 57117 MANAGEMENT FEES, BILLING SERVICES, AND S 3859096 A L HUBER CONSTRUCTION INC 10770 EL MONTE OVERLAND PARK KS 66211 GENERAL CONTRACTOR 1061744 SUMMIT CARE INC 6830 W 121 OVERLAND PARK KS 66209 THERAPY SERVICES 828426 3 1173 56787 57960 ROOM REVENUE & ANCILLARY SERVICES 623000 9818113 9818113 MEALS, GUEST ROOMS, AND OTHER REV 623000 91715 91715 9909828 68041 68041 4990763 4868815 173197 121948 -173197 -51249 -51249 0 1173 0 0 9984580 9909828 0 16792 X 111905 111905 2975604 2747907 200529 27168 23862 1002 20551 2309 447883 447883 26172 26172 447883 447883 1062253 1002383 56801 3069 94270 94270 754987 653429 101544 14 750810 688674 62136 25227 20170 5057 786984 786984 1277633 1277633 55631 55631 SUPPLIES 425283 424710 573 EMPLOYEE, PUBLIC & RESI 104460 2527 101683 250 TAXES AND LICENSES 23435 23435 BAD DEBT 17000 17000 5605 2945 17 2643 9416887 7608364 1772497 36026 365113 713057 823640 469489 24101 537498 594882 48481 33463 5207 15336 37725396 9571883 27371211 28153513 4470266 4763222 149034 152847 33770450 34919910 889938 1339745 9440000 9070000 3131071 2956071 10371899 10774932 23832908 24140748 X 9808742 10570597 27226 74629 101574 133936 9937542 10779162 33770450 34919910 X 567693 226524 47403 X 0 1 X 1 0 X 17789 22776 41732 113337 57960 253594 7771733 7874637 9962191 9917277 9909828 45435666 7789522 7897413 10003923 10030614 9967788 45689260 0 0 0 45689260 56321 67172 82006 50307 68041 323847 56321 67172 82006 50307 68041 323847 7845843 7964585 10085929 10080921 10035829 46013107 0.99300 0.99200 0.00700 0.00800 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 101574 17900 14462 133936 12002 89572 101574 12002 12002 12002 12002 12002 12002 1.00000 1 0 1742186 1742186 28686112 7760000 20926112 2199266 1029285 1169981 5097832 782598 4315234 28153513 FUNDED DEPRECIATION 3146328 F OTHER INVESTMENT 19488 F HOUSING ENTRY FEES 1597406 F 4763222 SPECIAL ASSESSMENTS PAYABLE 280135 HOUSING ENTRY FEES AND OTHER LIABILITIES 3485409 SECURED MORTGAGES AND NOTES PAYABLE TO RELATED PARTIES 6856188 SECURITY DEPOSITS 153200 10774932 X 10178742 226524 226524 9952218 32362 32362 9984580 9416887 0 9416887 0 9416887 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. 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 4B - OTHER ADJUSTMENTS: PERMANENTLY RESTRICTED CONTRIBUTIONS 32,362. 0 0 0 0 0 0 0 0 0 JOANNA RANDALL ADMINISTRATOR 72686 0 0 0 33585 0 0 0 5634 0 111905 0 0 0 SCHEDULE J, PART II: JOANNA RANDALL IS AN EMPLOYEE OF AND IS COMPENSATED BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, AN UNRELATED MANAGEMENT COMPANY, WHICH OWNS 50% OF THE FILING ENTITY. JOANNA IS CONSIDERED AN OFFICER OF THE ORGANIZATION BY VIRTUE OF HER ROLE AS THE ADMINISTRATOR WHICH IS THE TOP MANAGEMENT OFFICIAL. 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 2230000 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 0 1 0 0 0 0 A 0 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. 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 A HARD COPY OR 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 ADOPTED A POLICY CHANGE IN 2011 AND NOW 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 833,847. MANAGEMENT AND GENERAL EXPENSES 56,801. FUNDRAISING EXPENSES 3,069. TOTAL EXPENSES 893,717. C/SERV-NURSE/DOCTOR/LAB: PROGRAM SERVICE EXPENSES 81,350. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,350. C/SERV-MAINT. SVCS: PROGRAM SERVICE EXPENSES 87,186. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,186. FORM 990, PART XI, LINE 9: NET ASSET CONTRIBUTIONS (RELEASED FROM RESTR IN EXCESS OF GIFTS RCVD) 47,403. FORM 990, SCHEDULE D, PART VI, LINE 1E, COLUMNS B AND C: OTHER PROPERTY SHOWN IN THE OTHER COLUMN CONSISTS OF LAND IMPROVEMENTS OF $2,687,475 WITH RELATED ACCUMULATED DEPRECIATION OF $782,598 AND CONSTRUCTION AND DEVELOPMENT OF $2,410,357 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.