2012-07-02T14:35:21-05:00 2011-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH STREET PO BOX 5125 SIOUX FALLS SD 571175125 990 2011-01-01 481209650 Cedar Lake Village Inc CEDA 6053623100 4800 W 57th Street PO Box 5038 Sioux Falls SD 571175038 Joseph Herdina 6053623100 2012-07-02 1 Laurie Hanson P00851848 6053391999 2012-07-02 2011 2016-02-24 21:20:13Z Joseph Herdina 4800 W 57th Street PO Box 5038 Sioux Falls SD 571175038 14558681 0 X www.cedarlakevillage.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 0 140 0 0 22776 41732 7874637 9962191 210111 -139455 0 0 8107524 9864468 0 0 0 0 2333334 2875233 0 0 34849 5054335 6019022 7387669 8894255 719855 970213 33162998 33262695 24909132 24278636 8253866 8984059 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 7280912 9962191 Providing 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. 7280912 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 0 1 32 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 91804 0 11176 91804 0 11176 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 3850500 A L Huber Construction 10770 El Monte Overland Park KS 66211 General Contractor 901314 Summit Care Inc 6830 W 121 Overland Park KS 66209 Therapy Services 714458 3 586 41146 14369 41732 Room Revenue & Ancilla 623000 9875553 9875553 Meals, Guest Rooms, an 623000 86638 86638 9962191 82006 82006 4472162 590 4199557 494656 272605 -494066 -221461 -221461 0 586 0 0 9864468 9962191 0 -139455 103787 103787 2756039 2602251 126555 27233 15407 4978 10417 12 439159 439159 1425 1425 440009 440009 986244 907198 78181 865 79999 79999 718430 608470 109957 3 5698 5698 648338 604437 43901 19417 14444 4782 191 916945 916945 1192636 1192636 47498 47498 Supplies 426705 423899 2806 Employee, Public & Resi 58843 1761 57082 Taxes and Licenses 17034 17034 Bad Debt 13000 13000 7642 3893 10 3739 8894255 7280912 1578494 34849 853704 355456 557493 718180 567196 632626 29101 41553 4673 4739 35186267 7232157 27539838 27954110 3496543 3472142 114450 83889 33162998 33262695 1056585 834254 10120000 9790000 3466669 3306071 10265878 10348311 24909132 24278636 X 8232370 8968188 9494 3869 12002 12002 8253866 8984059 33162998 33262695 X 970213 -240020 X 0 1 0 X 0 X 32154 34434 17789 22776 41732 148885 7012916 7381684 7771733 7874637 9962191 40003161 7045070 7416118 7789522 7897413 10003923 40152046 0 174958 174958 174958 174958 39977088 87474 90977 56321 67172 82006 383950 87474 90977 56321 67172 82006 383950 7132544 7507095 7845843 7964585 10085929 40535996 0.98620 0.98160 0.00950 0.01020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12202 12202 12202 12202 12202 12202 12202 12202 1.00000 1 0 1701595 1701595 28248468 5926562 22321906 2073828 751687 1322141 3162376 553908 2608468 27954110 Funded Depreciation 2788003 F Other Investment 11798 C Housing Entry Fees 672341 C 3472142 Special Assessments Payable 301809 Housing Entry Fees and Other Liabilities 2431836 Secured Mortgages and Notes Payable to Related Parties 7471666 Security Deposits 143000 10348311 9864468 8894255 970213 -234395 -5625 -240020 730193 9630073 -234395 -234395 9864468 0 9864468 8894255 0 8894255 0 8894255 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. 0 0 0 0 0 0 0 0 0 JoAnna Randall 67736 0 0 0 24068 0 6366 0 5617 0 103787 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. City of Olathe Kansas 483064756 679390FB5 2004-12-16 11300000 Proceeds for nonrefunding and credit enhancement. 0 0 0 1180000 11300000 162019 23500 11114481 2006 0 0 1 1 0 0 0 0 1 0 1 0 0 0 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. Changes in Net Assets or Fund Balances: 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. 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 $2,644,184 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.