Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 29,436 | 30,009 | 27,267 | 28,025 | 24,610 | 139,347 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 21,196 | 21,831 | 24,271 | 23,513 | 25,594 | 116,405 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | 50,632 | 51,840 | 51,538 | 51,538 | 50,204 | 255,752 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 29,436 | 30,009 | 27,267 | 28,025 | 24,610 | 139,347 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 29,436 | 30,009 | 27,267 | 28,025 | 24,610 | 139,347 |
| 8 | Public support (Subtract line 7c from line 6.) | 116,405 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 50,632 | 51,840 | 51,538 | 51,538 | 50,204 | 255,752 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 42 | 20 | 19 | 19 | 19 | 119 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 42 | 20 | 19 | 19 | 19 | 119 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 50,674 | 51,860 | 51,557 | 51,557 | 50,223 | 255,871 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1 | WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES SO THEY MAY EXPERIENCE A LIFE OF ABUNDANT POSSIBILITIES. WE BELIEVE IN THE GOD-GIVEN WORTH OF PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AND COMMIT TO ADVOCATE FOR THEIR FULL RIGHTS; WE BELIEVE OUR NONPROFIT, FAITH-BASED AGENCY CAN OPERATE EFFICIENTLY AND EFFECTIVELY THROUGH PUBIC, COMMUNITY AND CORPORATE PARTNERSHIPS; WE BELIEVE PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES SHOULD HAVE AS MUCH CONTROL OVER THEIR LIVES AS POSSIBLE AND BE OFFERED OPPORTUNITIES TO EXPRESS PERSONAL CHOICES; WE BELIEVE IN OFFERING RESIDENTIAL AND COMMUNITY SERVICES WITH EXCELLENCE, TO MAXIMIZE THE UNIQUE ABILITIES, SAFETY, HEALTH, WELFARE AND SELF-ESTEEM OF EACH PERSON WE SERVE; WE BELIEVE A JOINT COMMITMENT WITH FAMILIES/GUARDIANS IS ESSENTIAL IN ORDER TO ACT RESPONSIBLY IN ADDRESSING THE CURRENT AND FUTURE NEEDS OF THOSE WE SERVE. WE BELIEVE A WELL-TRAINED STAFF, COMMITTED TO THE MISSION AND VISION OF CEDAR LAKE, WILL SUCCESSFULLY OFFER A HIGH LEVEL OF COMPASSIONATE, CAPABLE CARE, RESPONSIVE TO THE NEEDS OF THE MIND, BODY, AND SPIRIT OF THE PEOPLE WE SERVE. CEDAR LAKE IS FORMALLY RECOGNIZED BY THE LUTHERAN CHURCH-MISSOURI SYNOD AND HAS A LONG AND PROUD AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE DRAFT OF THE FORM 990 WILL BE REVIEWED BY THE CFO AND DIRECTOR OF FINANCE PRIOR TO SUBMISSION TO THE IRS. THE FORM 990 WILL BE REVIEWED BY THE BOARD OF DIRECTORS AT THE FIRST MEETING POSSIBLE FOLLOWING THE COMPLETION OF THE RETURN, WHICH MAY BE AFTER THE SUBMISSION OF THE RETURN TO THE IRS. THE REVIEW OF THE 990 BY THE BOARD OF DIRECTORS WILL BE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND COMMITTEE MEMBERS ARE OBLIGATED TO REPORT ANY POTENTIAL CONFLICT OF INTEREST TO ANY OFFICER OF THE CORPORATION FOR REFERRAL, CONSIDERATION AND RESOLUTION BY THE EXECUTIVE COMMITTEE. IF THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES THAT A BOARD MEMBER, OFFICER OR COMMITTEE MEMBER HAS FAILED TO PROPERLY DISCLOSE AN ACTUAL OR A POSSIBLE CONFLICT OF INTEREST, THE EXECUTIVE COMMITTEE IS OBLIGATED TO TAKE APPROPRIATE ACTION CONCERNING THE TRANSACTION AND INDIVIDUAL. |
| FORM 990, PART VI, SECTION B, LINE 15 | 1. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE ORGANIZATION PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THE REVIEW AND APPROVAL. 2. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. |
| FORM 990, PART VI, SECTION C, LINE 19 | STANDARD PRACTICE IS TO REFER THOSE SEEKING TO REVIEW ANY CEDAR LAKE 990 TO VISIT WWW.GUIDESTAR.ORG TO ACCESS THAT INFORMATION. CEDAR LAKE'S POLICIES, GOVERNING AND FINANCIAL DOCUMENTS ARE MADE AVAILABLE FOR "PUBLIC REVIEW" DURING BUSINESS HOURS UPON REQUEST BUT UNDER OUR CONTROL AND SUPERVISION; THEY ARE NOT DISTRIBUTED FREELY BECAUSE MANY ARE PROPRIETARY IN NATURE. AN ANNUAL REPORT IS MADE WIDELY AVAILABLE TO THE PUBLIC AND PROVIDES SIGNIFICANT AND MEANINGFUL DISCLOSURE FOR THE PUBLIC. |
| FORM 990, PART XI, LINE 2C, OVERSIGHT OF AUDITORS: | THE PRESIDENT, CFO AND DIRECTOR OF FINANCE REVIEW A DRAFT OF THE AUDIT REPORT IN DETAIL. THE DRAFT COPY OF THE AUDIT REPORT IS PRESENTED TO THE BOARD CHAIR AND TREASURER AND DISCUSSED IN DETAIL WITH THESE REPRESENTATIVES AND MANAGEMENT. AFTER THE DRAFT AUDIT REPORT HAS BEEN APPROVED, THE FINAL AUDIT REPORT IS PRESENTED TO THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VII AND SCHEDULE J, PART II | THE PRESIDENT AND CFO ARE EMPLOYEES OF CEDAR LAKE WORKFORCE, LLC. THE ONLY COMPENSATION TO THESE INDIVIDUALS IS PAID TO CEDAR LAKE WORKFORCE, LLC THROUGH CEDAR LAKE LODGE, INC. THE INDIVIDUALS PROVIDE SERVICES TO CEDAR LAKE FOUNDATION, INC., CEDAR LAKE RESIDENCES, INC. AND CEDAR LAKE - HUD FACILITIES VIA A MANAGEMENT CONTRACT WITH CEDAR LAKE LODGE, INC. |
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