2011-10-17T11:17:14-05:00 2010-12-31 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2010-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 JOSEPH HERDINA 6053623100 2011-10-03 1 N DEAN BUCKNEBERG 6053391999 2011-10-03 2010 2016-03-07 17:11:31Z JOSEPH HERDINA 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 8108363 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 53 0 0 17789 22776 7806341 7874637 -1824 210111 0 0 7822306 8107524 0 0 0 0 16620 2333334 0 0 36718 7103310 5054335 7119930 7387669 702376 719855 29079348 33162998 21840066 24909132 7239282 8253866 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 6041439 7874637 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 12,092 ASSISTED LIVING RESIDENT DAYS, 34,872 SENIOR HOUSING RESIDENT DAYS, AND 5,070 SKILLED NURSING RESIDENT DAYS IN 2010. 6041439 1 1 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 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 0 1 1 1 0 0 X JOSEPH HERDINA 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 X ALAN HIEB 1.00 X X 0 0 0 JAMES R HUBBARD 1.00 X X 0 0 0 RAYE NAE NYLANDER 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 40.00 X 107495 0 13396 107495 0 13396 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 2874059 SUMMIT CARE INC 6830 W 121 OVERLAND PARK KS 66209 THERAPY SERVICES 433705 2 315 22461 22776 ROOM REVENUE & ANCILLA 623000 7765065 7765065 MEALS, GUEST ROOMS, AN 623000 109572 109572 7874637 67172 67172 143778 839 143778 -839 142939 142939 0 315 0 0 8107524 7874637 0 210111 132536 132536 2178828 2093444 59117 26267 21970 6854 15108 8 351710 351710 1880 1880 352707 352707 587146 543841 42222 1083 68803 68803 102704 29923 72765 16 19200 19200 502816 460950 41866 23040 18741 4299 1043347 1043347 1048040 1048040 66523 66523 SUPPLIES 809500 786518 13638 9344 EMPLOYEE, PUBLIC & RESI 58112 7215 50897 TAXES AND LICENSES 8226 8226 BAD DEBT 8000 8000 2581 2566 15 7387669 6041439 1309512 36718 400196 853704 352160 557493 491947 567196 26985 29101 17844 4673 33654527 6114689 25360641 27539838 2290685 3496543 138890 114450 29079348 33162998 318408 1056585 10440000 10120000 824471 3466669 10257187 10265878 21840066 24909132 X 7226377 8232370 703 9494 12202 12002 7239282 8253866 29079348 33162998 X 719855 294729 X 0 1 0 X 0 X 20583 32154 34434 17789 22776 127736 4387800 7012916 7381684 7771733 7874637 34428770 4408383 7045070 7416118 7789522 7897413 34556506 0 110449 174958 285407 110449 174958 285407 34271099 55897 87474 90977 56321 67172 357841 55897 87474 90977 56321 67172 357841 4464280 7132544 7507095 7845843 7964585 34914347 0.98160 0.97040 0.01020 0.01770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12202 12202 12202 12202 12202 12202 1.00000 0 0 1432032 1432032 23471510 5032485 18439025 1678733 630982 1047751 7072252 451222 6621030 27539838 FUNDED DEPRECIATION 3495872 F OTHER INVESTMENT 671 C 3496543 SPECIAL ASSESSMENTS PAYABLE 323367 HOUSING ENTRY FEES AND OTHER LIABILITIES 2068765 SECURED MORTGAGES AND NOTES PAYABLE TO RELATED PARTIES 7749546 SECURITY DEPOSITS AND SWAP ADJUSTMENTS 124200 10265878 8107524 7387669 719855 294729 294729 1014584 8402253 294729 294729 8107524 0 8107524 7387669 0 7387669 0 7387669 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS ADOPTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS CODIFICATION TOPIC ASC 740-10 ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ON JANUARY 1, 2009. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE FINANCIAL STATEMENTS. THE ORGANIZATION FILES AN ANNUAL FEDERAL FORM 990, EXEMPT ORGANIZATION RETURN, AND IS NO LONGER SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007. 0 0 0 0 0 0 0 0 0 JOANNA RANDALL 82754 0 0 0 24741 0 7465 0 6891 0 121851 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. COMPENSATION PAID TO JOANNA BY THE UNRELATED MANAGEMENT COMPANY FOR SERVICES RENDERED TO THE ORGANIZATION DURING THE YEAR WAS $107,495 OF REPORTABLE COMPENSATION AND $25,041 OF OTHER COMPENSATION. JOANNA IS CONSIDERED AN OFFICER OF THE ORGANIZATION BY VIRTUE OF HER ROLE AS THE EXECUTIVE DIRECTOR WHICH IS THE TOP MANAGEMENT OFFICIAL. THE AMOUNT REPORTED AS COMPENSATION IN PART VII AND SCHEDULE J INCLUDES 100% OF HER COMPENSATION. APPROXIMATELY 75% OF HER TIME IS DEVOTED TO HER POSITION AS THE EXECUTIVE DIRECTOR AT CEDAR LAKE VILLAGE, INC. 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 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 12 THE ORGANIZATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY THAT COVERS OFFICERS AND DIRECTORS. THE ORGANIZATION IS ADOPTING A CHANGE IN POLICY IN 2011 THAT WILL PROVIDE FOR ANNUAL UPDATES TO THE CONFLICT OF INTEREST AND DISCLOSURE CERTIFICATION. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR 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. COLUMN (B), AVERAGE HOURS PER WEEK FORM 990, PART VII JOANNA RANDALL IS COMPENSATED BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, AND APPROXIMATELY 75% OF HER TIME IS DEVOTED TO HER POSITION AS THE EXECUTIVE DIRECTOR AT CEDAR LAKE VILLAGE, INC. THE AMOUNT REPORTED AS COMPENSATION IN PART VII AND SCHEDULE J INCLUDES 100% OF HER COMPENSATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 294,729. 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 $2,419,127 WITH RELATED ACCUMULATED DEPRECIATION OF $451,222 AND CONSTRUCTION AND DEVELOPMENT OF $4,653,125 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.