CEDAR LAKE VILLAGE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CEDAR LAKE VILLAGE INC (EIN 48-1209650)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-06-27
IRS object ID
201331789349300148
Schema version
2012v2.1
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)
Timestamp2013-06-27T15:10:10-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1
CitySIOUX FALLSCity
StateSDState
ZIP Code571175125ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN481209650EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Cedar Lake Village IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCEDANameControl
Phone6053623100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14800 W 57th Street PO Box 5038AddressLine1
CitySioux FallsCity
StateSDState
ZIP Code571175038ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJoseph HerdinaName
TitleTreasurerTitle
Phone6053623100Phone
Date Signed2013-06-27DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaurie HansonName
PTINP00851848PTIN
Phone6053391999Phone
Date Prepared2013-06-27DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJoseph HerdinaNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14800 W 57th Street PO Box 5038AddressLine1
CitySioux FallsCity
StateSDState
ZIP Code571175038ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12557280GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.cedarlakevillagekc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionImproving the well-being and quality of life for older persons and others in need through the provision of housing, programs, and services.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers136TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year41732ContributionsGrantsPriorYear
Contributions Grants Current Year113337ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9962191ProgramServiceRevenuePriorYear
Program Service Revenue CY9917277ProgramServiceRevenueCY
Investment Income Prior Year-139455InvestmentIncomePriorYear
Investment Income Current Year153811InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year9864468TotalRevenuePriorYear
Total Revenue Current Year10184425TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2875233SalariesEtcPriorYear
Salaries Etc Current Year3083582SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year33774TotalFundrsngExpCurrentYear
Other Expense Prior Year6019022OtherExpensePriorYear
Other Expenses Current Year6376264OtherExpensesCurrentYear
Total Expenses Prior Year8894255TotalExpensesPriorYear
Total Expenses Current Year9459846TotalExpensesCurrentYear
Revenues Less Expenses Prior Year970213RevenuesLessExpensesPriorYear
Revenues Less Expenses CY724579RevenuesLessExpensesCY
Total Assets BOY33262695TotalAssetsBOY
Total Assets EOY33770450TotalAssetsEOY
Total Liabilities BOY24278636TotalLiabilitiesBOY
Total Liabilities EOY23832908TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8984059NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9937542NetAssetsOrFundBalancesEOY
Mission DescriptionImproving the well-being and quality of life for older persons and others in need through the provision of housing, programs, and services.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7757333Expense
Revenue9917277Revenue
DescriptionProviding housing, programs, and services in an effort to improve the quality of life for older persons and others in need. 11,446 assisted living resident days, 36,652 senior housing resident days, and 9,344 skilled nursing resident days in 2012.Description
Total Program Service Expense7757333TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109634NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address1OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledKSStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Joseph HerdinaBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6053623100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14800 W 57th Street PO Box 5038AddressLine1
CitySioux FallsCity
StateSDState
ZIP Code571175038ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Alan Hieb
President1.00XX000
James R Hubbard
Vice-President1.00XX000
Joseph Herdina
Treasurer1.00XX000
Cindy Moegenburg
Secretary1.00XX000
James K Bradley
Board of Trustees1.00X000
J Mack Bowen
Board of Trustees1.00X000
JoAnna Randall
Administrator31.00X9488304634
FieldValueIRS element (for citing)
Total Reportable Comp From Org94883TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation4634TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
The Evangelical Lutheran Good Samaritan
4800 W 57th Street PO Box 5038Sioux FallsSD57117Management Fees, Billing Services, and S3981590
Summit Care Inc
6830 W 121Overland ParkKS66209Therapy Services882091
Boulder Associates
1426 Pearl St Suite 300BoulderCO80302Architecture Services116492
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Fundraising Events594FundraisingEvents
All Other Contributions112743AllOtherContributions
Total Contributions113337TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Room Revenue & Ancilla62300098446329844632
Meals, Guest Rooms, and Other Rev6230007264572645
FieldValueIRS element (for citing)
Total Program Service Revenue9917277TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column50307TotalRevenueColumn
Exclusion$50,307ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2475334Securities
Other1025Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2363636Securities
Other9219Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities111698Securities
Other-8194Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column103504TotalRevenueColumn
Exclusion$103,504ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events594CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses0FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10184425TotalRevenueColumn
Related Or Exempt Function Income9917277RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$153,811ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total100151Total
Management And General100151ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2980375Total
Program Services2790953ProgramServices
Management And General161234ManagementAndGeneral
Fundraising28188Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3056Total
Program Services2375ProgramServices
Management And General660ManagementAndGeneral
Fundraising21Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total446571Total
Management And General446571ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3219Total
Management And General3219ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total447421Total
Management And General447421ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1156261Total
Program Services1072514ProgramServices
Management And General83095ManagementAndGeneral
Fundraising652Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total94781Total
Management And General94781ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total735961Total
Program Services640231ProgramServices
Management And General95724ManagementAndGeneral
Fundraising6Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total560Total
Management And General560ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total678369Total
Program Services624842ProgramServices
Management And General53527ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total16862Total
Program Services12935ProgramServices
Management And General3927ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total885444Total
Program Services885444ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1243201Total
Program Services1243201ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total54598Total
Management And General54598ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
Supplies474490473986504
Bad Debt5830858308
Employee, Public & Resi44964693230837724
Taxes and Licenses2719927199

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total8055Total
Program Services3920ProgramServices
Management And General40ManagementAndGeneral
Fundraising4095Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9459846Total
Program Services7757333ProgramServices
Management And General1668739ManagementAndGeneral
Fundraising33774Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY355456BOY
EOY365113EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY718180BOY
EOY823640EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY632626BOY
EOY537498EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY41553BOY
EOY48481EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4739BOY
EOY5207EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35806298LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8435087LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27954110BOY
EOY27371211EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3472142BOY
EOY4470266EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY83889BOY
EOY149034EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33262695BOY
EOY33770450EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY834254BOY
EOY889938EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9790000BOY
EOY9440000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3306071BOY
EOY3131071EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10348311BOY
EOY10371899EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY24278636BOY
EOY23832908EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8968188BOY
EOY9808742EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3869BOY
EOY27226EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY12002BOY
EOY101574EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8984059BOY
EOY9937542EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33262695BOY
EOY33770450EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses724579ReconcilationRevenueExpenses
Reconciliation Unrealized Invest205546ReconciliationUnrealizedInvest
Reconcilation Other Changes23358ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee0AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years34434CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17789CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22776CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year41732CurrentTaxYearMinus1Year
Current Tax Year113337CurrentTaxYear
Total230068Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7381684CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7771733CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7874637CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9962191CurrentTaxYearMinus1Year
Current Tax Year9917277CurrentTaxYear
Total42907522Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7416118CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7789522CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7897413CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10003923CurrentTaxYearMinus1Year
Current Tax Year10030614CurrentTaxYear
Total43137590Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50943137590PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years90977CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56321CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67172CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year82006CurrentTaxYearMinus1Year
Current Tax Year50307CurrentTaxYear
Total346783Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years90977CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56321CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67172CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year82006CurrentTaxYearMinus1Year
Current Tax Year50307CurrentTaxYear
Total346783Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7507095CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7845843CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7964585CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10085929CurrentTaxYearMinus1Year
Current Tax Year10080921CurrentTaxYear
Total43484373Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99200PublicSupportPercentage509
Prior Year Support Percentage0.98620PriorYearSupportPercentage
Investment Income Percentage0.00800InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00950PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance12002BeginningOfYearBalance
Contributions89572Contributions
End Of Year Balance101574EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance12002BeginningOfYearBalance
End Of Year Balance12002EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12002BeginningOfYearBalance
End Of Year Balance12002EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12002BeginningOfYearBalance
End Of Year Balance12002EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12002BeginningOfYearBalance
End Of Year Balance12002EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1701595OtherCostOrOtherBasis
Book Value1701595BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis28526086OtherCostOrOtherBasis
Depreciation6865059Depreciation
Book Value21661027BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2209880OtherCostOrOtherBasis
Depreciation899790Depreciation
Book Value1310090BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3368737OtherCostOrOtherBasis
Depreciation670238Depreciation
Book Value2698499BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings27371211TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Funded Depreciation3452448F
Other Investment18804C
Housing Entry Fees999014C
FieldValueIRS element (for citing)
Total Of Book Value Securities4470266TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Special Assessments Payable$281,916
Housing Entry Fees and Other Liabilities$2,786,049
Secured Mortgages and Notes Payable to Related Parties$7,174,334
Security Deposits$129,600
FieldValueIRS element (for citing)
Total Of Amounts10371899TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt10300399TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments205546NetUnrealizedGainsInvestments
Revenue Not Rptd F990205546RevenueNotRptdF990
Revenue Subtotal10094853RevenueSubtotal
Other Revenues Not Included89572OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt89572RevenueNotRptdOnFinStmt
Total Revenue Per Form99010184425TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9459846TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9459846ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909459846TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds: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.
Description of Uncertain Tax Positions Under FIN 48: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 89,572.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJoAnna RandallNamePerson
TitleAdministratorTitle
Base Compensation Filing Org63101BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org31782OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org5268NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org100151TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationSchedule 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.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Olathe KansasBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN483064756IssuerEIN
CUSIP Number679390FB5CUSIPNumber
Date Issued2004-12-16DateIssued
Issue Price11300000IssuePrice
Description Of PurposeProceeds for nonrefunding and credit enhancement.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired1860000AmountRetired
Total Proceeds11300000TotalProceeds
Issuance Costs From Proceeds162019IssuanceCostsFromProceeds
Credit Enhancement23500CreditEnhancement
Capital Expenditures11114481CapitalExpenditures
Year Of Subst Completion2006YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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.
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 11A 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 12cThe 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 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 VIIJames 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.Contact Addresses for Officers, Directors, Etc
Form 990, Part IX, line 11gContract Services : Program service expenses 1,072,514. Management and general expenses 83,095. Fundraising expenses 652. Total expenses 1,156,261.Other Fees
Form 990, Part XI, line 9:Net asset contributions (released from restr in excess of gifts rcvd) 23,358.Changes in Net Assets or Fund Balances:
Form 990, Schedule D, Part VI, Line 1e, columns B and C:Other property shown in the other column consists of land improvements of $2,676,292 with related accumulated depreciation of $670,238 and construction and development of $692,445 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.Other

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