CEDAR LAKE VILLAGE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CEDAR LAKE VILLAGE INC (EIN 48-1209650)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-02
IRS object ID
201211849349300441
Schema version
2011v1.2
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)
Timestamp2012-07-02T14:35:21-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 STREET PO BOX 5125AddressLine1
CitySIOUX FALLSCity
StateSDState
ZIP Code571175125ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

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 Signed2012-07-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaurie HansonName
PTINP00851848PTIN
Phone6053391999Phone
Date Prepared2012-07-02DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts14558681GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.cedarlakevillage.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 Volunteers140TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year22776ContributionsGrantsPriorYear
Contributions Grants Current Year41732ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7874637ProgramServiceRevenuePriorYear
Program Service Revenue CY9962191ProgramServiceRevenueCY
Investment Income Prior Year210111InvestmentIncomePriorYear
Investment Income Current Year-139455InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year8107524TotalRevenuePriorYear
Total Revenue Current Year9864468TotalRevenueCurrentYear
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 Year2333334SalariesEtcPriorYear
Salaries Etc Current Year2875233SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year34849TotalFundrsngExpCurrentYear
Other Expense Prior Year5054335OtherExpensePriorYear
Other Expenses Current Year6019022OtherExpensesCurrentYear
Total Expenses Prior Year7387669TotalExpensesPriorYear
Total Expenses Current Year8894255TotalExpensesCurrentYear
Revenues Less Expenses Prior Year719855RevenuesLessExpensesPriorYear
Revenues Less Expenses CY970213RevenuesLessExpensesCY
Total Assets BOY33162998TotalAssetsBOY
Total Assets EOY33262695TotalAssetsEOY
Total Liabilities BOY24909132TotalLiabilitiesBOY
Total Liabilities EOY24278636TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8253866NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8984059NetAssetsOrFundBalancesEOY
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
Expense7280912Expense
Revenue9962191Revenue
DescriptionProviding housing, programs, and services in an effort to improve the quality of life for older persons and others in need. 11,235 assisted living resident days, 36,873 senior housing resident days, and 8,739 skilled nursing resident days in 2011.Description
Total Program Service Expense7280912TotalProgramServiceExpense
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109632NumberFormsTransmittedWith1096
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
Administrator31.00X91804011176
FieldValueIRS element (for citing)
Total Reportable Comp From Org91804TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation11176TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
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 S3850500
A L Huber Construction
10770 El MonteOverland ParkKS66211General Contractor901314
Summit Care Inc
6830 W 121Overland ParkKS66209Therapy Services714458
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Fundraising Events586FundraisingEvents
All Other Contributions41146AllOtherContributions
Noncash Contributions14369NoncashContributions
Total Contributions41732TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Room Revenue & Ancilla62300098755539875553
Meals, Guest Rooms, an6230008663886638
FieldValueIRS element (for citing)
Total Program Service Revenue9962191TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column82006TotalRevenueColumn
Exclusion$82,006ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4472162Securities
Other590Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4199557Securities
Other494656Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities272605Securities
Other-494066Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-221461TotalRevenueColumn
Exclusion-$221,461ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events586CntrbtnsRprtdFundraisingEvents
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 Column9864468TotalRevenueColumn
Related Or Exempt Function Income9962191RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$139,455ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total103787Total
Management And General103787ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total2756039Total
Program Services2602251ProgramServices
Management And General126555ManagementAndGeneral
Fundraising27233Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total15407Total
Program Services4978ProgramServices
Management And General10417ManagementAndGeneral
Fundraising12Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total439159Total
Management And General439159ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1425Total
Management And General1425ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total440009Total
Management And General440009ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total986244Total
Program Services907198ProgramServices
Management And General78181ManagementAndGeneral
Fundraising865Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total79999Total
Management And General79999ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total718430Total
Program Services608470ProgramServices
Management And General109957ManagementAndGeneral
Fundraising3Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5698Total
Management And General5698ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total648338Total
Program Services604437ProgramServices
Management And General43901ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total19417Total
Program Services14444ProgramServices
Management And General4782ManagementAndGeneral
Fundraising191Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total916945Total
Program Services916945ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1192636Total
Program Services1192636ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total47498Total
Management And General47498ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
Supplies4267054238992806
Employee, Public & Resi58843176157082
Taxes and Licenses1703417034
Bad Debt1300013000

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7642Total
Program Services3893ProgramServices
Management And General10ManagementAndGeneral
Fundraising3739Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8894255Total
Program Services7280912ProgramServices
Management And General1578494ManagementAndGeneral
Fundraising34849Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY853704BOY
EOY355456EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY557493BOY
EOY718180EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY567196BOY
EOY632626EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY29101BOY
EOY41553EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4673BOY
EOY4739EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35186267LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7232157LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27539838BOY
EOY27954110EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3496543BOY
EOY3472142EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY114450BOY
EOY83889EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33162998BOY
EOY33262695EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1056585BOY
EOY834254EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY10120000BOY
EOY9790000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3466669BOY
EOY3306071EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10265878BOY
EOY10348311EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY24909132BOY
EOY24278636EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8232370BOY
EOY8968188EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY9494BOY
EOY3869EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY12002BOY
EOY12002EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8253866BOY
EOY8984059EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33162998BOY
EOY33262695EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses970213ReconcilationRevenueExpenses
Reconcilation Other Changes-240020ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Years32154CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years34434CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years17789CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22776CurrentTaxYearMinus1Year
Current Tax Year41732CurrentTaxYear
Total148885Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7012916CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7381684CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7771733CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7874637CurrentTaxYearMinus1Year
Current Tax Year9962191CurrentTaxYear
Total40003161Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7045070CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7416118CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7789522CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7897413CurrentTaxYearMinus1Year
Current Tax Year10003923CurrentTaxYear
Total40152046Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years174958CurrentTaxYearMinus4Years
Total174958Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years174958CurrentTaxYearMinus4Years
Total174958Total
FieldValueIRS element (for citing)
Public Support Total50939977088PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years87474CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years90977CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56321CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67172CurrentTaxYearMinus1Year
Current Tax Year82006CurrentTaxYear
Total383950Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years87474CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years90977CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56321CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67172CurrentTaxYearMinus1Year
Current Tax Year82006CurrentTaxYear
Total383950Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7132544CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7507095CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7845843CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7964585CurrentTaxYearMinus1Year
Current Tax Year10085929CurrentTaxYear
Total40535996Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98620PublicSupportPercentage509
Prior Year Support Percentage0.98160PriorYearSupportPercentage
Investment Income Percentage0.00950InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01020PriorYrInvestIncomePercentage
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 Balance12202BeginningOfYearBalance
End Of Year Balance12202EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance12202BeginningOfYearBalance
End Of Year Balance12202EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12202BeginningOfYearBalance
End Of Year Balance12202EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12202BeginningOfYearBalance
End Of Year Balance12202EndOfYearBalance
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 Basis28248468OtherCostOrOtherBasis
Depreciation5926562Depreciation
Book Value22321906BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2073828OtherCostOrOtherBasis
Depreciation751687Depreciation
Book Value1322141BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3162376OtherCostOrOtherBasis
Depreciation553908Depreciation
Book Value2608468BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings27954110TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Funded Depreciation2788003F
Other Investment11798C
Housing Entry Fees672341C
FieldValueIRS element (for citing)
Total Of Book Value Securities3472142TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Special Assessments Payable$301,809
Housing Entry Fees and Other Liabilities$2,431,836
Secured Mortgages and Notes Payable to Related Parties$7,471,666
Security Deposits$143,000
FieldValueIRS element (for citing)
Total Of Amounts10348311TotalOfAmounts
Total Revenue9864468TotalRevenue
Total Expenses8894255TotalExpenses
Excess Or Deficit For Year970213ExcessOrDeficitForYear
Net Unrealized GL On Investments-234395NetUnrealizedGLOnInvestments
Other-$5,625OtherAmount
Total Adjustments-240020TotalAdjustments
Excess Or Deficit Per FS730193ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9630073TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-234395NetUnrealizedGainsInvestments
Revenue Not Rptd F990-234395RevenueNotRptdF990
Revenue Subtotal9864468RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9909864468TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8894255TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal8894255ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908894255TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (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 Boards designation, absent donor restrictions.
Description of Uncertain Tax Positions Under FIN 48:Part X:The Organization evaluates its tax exempt positions on an annual basis. Management has determined there are no uncertain tax positions as of December 31, 2011, or 2010, that meet the criteria for recognition in the financial statements. As of December 31, 2011, the unrecognized tax benefit was zero. The Organization will recognize future accrued interest and penalties related to unrecognized taxes in income tax expense if incurred. The Organization is subject to Federal and State tax examinations by tax authorities.
Part XI, Line 8 - Other Adjustments:Net asset contributions (released from restr in excess of gifts rcvd) -5,625.

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
Base Compensation Filing Org67736BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org24068OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org6366DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org5617NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org103787TotalCompensationFilingOrg
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

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)
Amount Retired1180000AmountRetired
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)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 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 XI, line 5:Net unrealized losses on investments: -234,395. Net asset contributions (released from restr in excess of gifts rcvd) -5,625. Total to Form 990, Part XI, Line 5: -240,020.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 $2,644,184 with related accumulated depreciation of $553,908 and construction and development of $518,192 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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