2013-06-27T15:10:10-05:00 2012-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2012-01-01 481209650 Cedar Lake Village Inc CEDA 6053623100 4800 W 57th Street PO Box 5038 Sioux Falls SD 571175038 Joseph Herdina 6053623100 2013-06-27 1 Laurie Hanson P00851848 6053391999 2013-06-27 2012 2016-02-25 16:41:14Z Joseph Herdina 4800 W 57th Street PO Box 5038 Sioux Falls SD 571175038 12557280 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 0 136 0 0 41732 113337 9962191 9917277 -139455 153811 0 0 9864468 10184425 0 0 0 0 2875233 3083582 0 0 33774 6019022 6376264 8894255 9459846 970213 724579 33262695 33770450 24278636 23832908 8984059 9937542 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 7757333 9917277 Providing 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. 7757333 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 34 0 1 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 1.00 X X 0 0 0 James R Hubbard 1.00 X X 0 0 0 Joseph Herdina 1.00 X X 0 0 0 Cindy Moegenburg 1.00 X X 0 0 0 James K Bradley 1.00 X 0 0 0 J Mack Bowen 1.00 X 0 0 0 JoAnna Randall 31.00 X 94883 0 4634 94883 0 4634 0 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 3981590 Summit Care Inc 6830 W 121 Overland Park KS 66209 Therapy Services 882091 Boulder Associates 1426 Pearl St Suite 300 Boulder CO 80302 Architecture Services 116492 3 594 112743 113337 Room Revenue & Ancilla 623000 9844632 9844632 Meals, Guest Rooms, and Other Rev 623000 72645 72645 9917277 50307 50307 2475334 1025 2363636 9219 111698 -8194 103504 103504 0 594 0 0 10184425 9917277 0 153811 X 100151 100151 2980375 2790953 161234 28188 3056 2375 660 21 446571 446571 3219 3219 447421 447421 1156261 1072514 83095 652 94781 94781 735961 640231 95724 6 560 560 678369 624842 53527 16862 12935 3927 885444 885444 1243201 1243201 54598 54598 Supplies 474490 473986 504 Bad Debt 58308 58308 Employee, Public & Resi 44964 6932 37724 308 Taxes and Licenses 27199 27199 8055 3920 40 4095 9459846 7757333 1668739 33774 355456 365113 718180 823640 632626 537498 41553 48481 4739 5207 35806298 8435087 27954110 27371211 3472142 4470266 83889 149034 33262695 33770450 834254 889938 9790000 9440000 3306071 3131071 10348311 10371899 24278636 23832908 X 8968188 9808742 3869 27226 12002 101574 8984059 9937542 33262695 33770450 X 724579 205546 23358 X 0 1 X 0 0 X 34434 17789 22776 41732 113337 230068 7381684 7771733 7874637 9962191 9917277 42907522 7416118 7789522 7897413 10003923 10030614 43137590 0 0 0 43137590 90977 56321 67172 82006 50307 346783 90977 56321 67172 82006 50307 346783 7507095 7845843 7964585 10085929 10080921 43484373 0.99200 0.98620 0.00800 0.00950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12002 89572 101574 12002 12002 12002 12002 12002 12002 12002 12002 1.00000 1 0 1701595 1701595 28526086 6865059 21661027 2209880 899790 1310090 3368737 670238 2698499 27371211 Funded Depreciation 3452448 F Other Investment 18804 C Housing Entry Fees 999014 C 4470266 Special Assessments Payable 281916 Housing Entry Fees and Other Liabilities 2786049 Secured Mortgages and Notes Payable to Related Parties 7174334 Security Deposits 129600 10371899 X 10300399 205546 205546 10094853 89572 89572 10184425 9459846 0 9459846 0 9459846 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. 0 0 0 0 0 0 0 0 0 JoAnna Randall 63101 0 0 0 31782 0 0 0 5268 0 100151 0 0 0 Supplemental Information Part III 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 Proceeds for nonrefunding and credit enhancement. 0 0 0 A 1860000 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. Contact Addresses for Officers, Directors, Etc 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. Other Fees Form 990, Part IX, line 11g Contract Services : Program service expenses 1,072,514. Management and general expenses 83,095. Fundraising expenses 652. Total expenses 1,156,261. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Net asset contributions (released from restr in excess of gifts rcvd) 23,358. Other 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.