2023-11-14T08:20:42-06:00 2022-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2022-01-01 481209650 CEDAR LAKE VILLAGE INC CEDA 6053331000 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 JOEL FLUIT VP FINANCE 6053331000 2023-11-14 1 JOEL FLUIT XXX-XX-XXXX 0 JESS WAGENER P01622613 3128792000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NATHAN SCHEMA 4800 W 57TH STREET SIOUX FALLS SD 57117 14166310 0 X WWW.SANFORDHEALTH.ORG X 1998 KS HOUSING, PROGRAMS AND SERVICES FOR ELDERLY PERSONS AND OTHER IN NEED 6 6 0 41 0 0 191518 153693 12484080 13570512 291909 135185 8409 5052 12975916 13864442 0 0 0 0 0 0 0 0 0 13053892 14111942 13053892 14111942 -77976 -247500 38142658 34146235 29141515 25222336 9001143 8923899 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 12005337 0 13570512 PROVIDING HOUSING, PROGRAMS, AND SERVICES IN AN EFFORT TO IMPROVE THE QUALITY OF LIFE FOR OLDER PERSONS AND OTHERS IN NEED. 20,535 ASSISTED LIVING RESIDENT DAYS, 38,586 SENIOR HOUSING RESIDENT DAYS AND 8,411 SKILLED NURSING RESIDENT DAYS IN 2022. 12005337 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 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 KS X JOEL FLUIT 6053623100 4800 W 57TH STREET SIOUX FALLS SD 571175038 X NATHAN SCHEMA TRUSTEE, CHAIR, PRESIDENT 1.00 0.00 X X 0 0 0 JAMES HUBBARD TRUSTEE, VICE CHAIR, VP - END 12/22 1.00 0.00 X X 0 0 0 ERIC VANDEN HULL TRUSTEE, TREASURER 1.00 0.00 X X 0 0 0 AIMEE MIDDLETON TRUSTEE, SECRETARY 1.00 0.00 X X 0 0 0 J MACK BOWEN TRUSTEE - END 12/22 1.00 0.00 X 0 0 0 VINCE DONOFRIO TRUSTEE - END 12/22 1.00 0.00 X 0 0 0 JOANNA RANDALL EXECUTIVE DIRECTOR - END 7/22 45.00 0.00 X 0 0 0 0 0 0 0 0 0 1 THE EVANGELICAL LUTHERAN GOOD SAMARITAN 4800 W 57TH STREET SIOUX FALLS SD 57108 MNGMT FEES & SHARED EMPLOYEES 7337533 SELECT REHABILITATION INC PO BOX 71985 CHICAGO IL 606941985 CONTRACT THERAPY SERVICES 544948 ZACH GROUP 6600 COLLEGE BLVD STE 300 OVERLAND PARK KS 66211 CONTRACT SERVICES 249810 3 26134 127559 153693 ROOM REV, ANCILL SVCS 623000 13548911 13548911 MEALS, GUEST RM, OTHER 623000 21601 21601 13570512 222249 222249 214804 202451 99417 12353 -99417 -87064 -87064 EMPLOYEE MEALS 722514 5052 5052 5052 13864442 13570512 0 140237 739599 739599 38910 38910 9249 9249 670388 372180 298208 87110 68304 18806 117161 37894 79267 958985 958985 20322 3719 16603 31575 26043 5532 763090 763090 1556661 1556661 215581 215581 CONTRACT SERVICES 6600951 5989244 611707 MEDICAL SUPPLIES 1235806 1224707 11099 PURCHASED SERVICES - SH 591733 591733 UNCOLLECTIBLE EXPENSE 196668 196668 278153 197196 80957 14111942 12005337 2106605 0 1933400 402285 573862 555898 6563 43466 193279 5388 49396991 22309595 28599130 27087396 6648097 5094154 188327 957648 38142658 34146235 521925 394047 92484 76879 14485304 13704075 14041802 11047335 29141515 25222336 X 8765351 8691265 235792 232634 9001143 8923899 38142658 34146235 X -247500 -1622296 1792552 X 0 1 X 1 0 X 7251 41737 584497 191518 153693 978696 11389121 11906674 11684248 12492489 13575564 61048096 11396372 11948411 12268745 12684007 13729257 62026792 0 0 0 62026792 154630 68915 238709 253076 222249 937579 154630 68915 238709 253076 222249 937579 11551002 12017326 12507454 12937083 13951506 62964371 0.98510 0.98640 0.01490 0.01360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 112123 -289 111834 177093 -64970 112123 170538 6555 177093 174356 -3818 170538 165876 8480 174356 0.00000 1.00000 0.00000 1 0 1957128 1957128 41062532 18219982 22842550 3357887 2306129 1051758 3019444 1783484 1235960 27087396 HOUSING ENTRY FEES 5094154 F 5094154 SPECIAL ASSESSMENTS PAYABLE 64674 SEC MORT & NOTE PAY TO MEMB 5163161 SECURITY DEPOSITS 284700 HOUSING ENTRY FEES AND OTHER 5534800 11047335 X 13782129 -1622296 1742380 120084 13662045 -12581 214978 202397 13864442 14002111 99417 99417 13902694 12581 196667 209248 14111942 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. 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. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES WERE INCURRED. THE ORGANIZATION IS SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST SWAP 1,742,380. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN/LOSS SALE OF ASSETS 99,417. CONTRIBUTION WITH DONOR RESTRICTIONS 115,593. OTHER INCOME -32. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS SALE OF ASSETS 99,417. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER EXPENSE -1. BAD DEBT EXPENSE 196,668. 0 0 0 0 0 0 0 0 0 990, PART VII, SECTION A, LINE 5 THE ORGANIZATION HAS DELEGATED MANAGEMENT DUTIES TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, A MEMBER OF THE ORGANIZATION. JOANNA RANDALL, THE ADMINISTRATOR FOR THE ORGANIZATION, RECEIVED COMPENSATION OF $102,305 PLUS EMPLOYER PAID BENEFITS OF $10,750 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2022. A CITY OF OLATHE KANSAS 486034756 000000000 2015-05-15 19200000 SEE PART V 0 0 0 A 5429000 19200000 270367 7509781 11419852 2015 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 CENTER STATE BANK 20.600000000000 0 0 0 0 1 A 1 SCHEDULE K, PART I, COLUMN (F) DESCRIPTION OF PURPOSE: 2015: CONSTRUCT ADDITIONAL FACILITIES, PAY COSTS RELATED TO BOND ISSUANCE, REFUND OF CITY OF OLATHE, KS BOND ISSUE DATED 12/16/04, CUSIP 679390FB5, AND REFUND OF BANK OF AMERICA LINE OF CREDIT. FORM 990, PART V, LINES 1A AND 2A FORM 1099 AND W-2 PROCESSING IS COMPLETED BY THE MANAGEMENT COMPANY, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, A MEMBER OF THE ORGANIZATION. AS SUCH, PART V LINES 1A AND 2A REPORT NO 1099'S OR W-2'S FOR THE ORGANIZATION. 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. JOANNA RANDALL, THE ADMINISTRATOR FOR THE ORGANIZATION, RECEIVED COMPENSATION OF $102,305 PLUS EMPLOYER PAID BENEFITS OF $10,750 FOR SERVICES PROVIDED TO CEDAR LAKE VILLAGE, INC. DURING 2022. 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 11B AN 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 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. FORM 990, PART XI, LINE 9: SWAP VALUATION CHANGE 1,742,380. AMORTIZATION OF DE-RECOGNITION OF INTEREST RATE SWAP 56,412. CHANGE IN BENEFICIAL INTEREST -6,240.