2017-02-07T16:22:41-06:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2015-07-01 391506910 MASONIC CENTER FOR HEALTH AND REHAB INC MASO 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK CFO 2629652111 2017-02-06 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2017-02-06 2015 2021-01-29 14:40:06Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 8976417 0 X WWW.THREEPILLARS.ORG X 1984 WI MASONIC CENTER FOR HEALTH AND REHAB, INC., SPONSORED BY THE MASONIC FRATERNITY, MEETS THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING HIGH QUALITY HOUSING AND SERVICES IN A SKILLED NURSING FACILILTY. 3 1 194 35 0 0 3255 4950 7993011 8943677 534 1558 27828 26232 8024628 8976417 0 0 0 0 5059819 5633615 0 0 0 3790950 3518447 8850769 9152062 -826141 -175645 9940176 9551559 13124646 12911674 -3184470 -3360115 MASONIC CENTER FOR HEALTH AND REHAB, INC., SPONSORED BY THE MASONIC FRATERNITY, MEETS THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING HIGH QUALITY HOUSING AND SERVICES IN A SKILLED NURSING FACILILTY. 0 0 7879926 8884150 SKILLED NURSING AND REHABILITATION SERVICES - THE ORGANIZATION PROVIDES SKILLED NURSING AND REHABILITATION SERVICES FOR THE FRAIL AND ELDERLY, INCLUDING SOCIAL AND ACTIVITY THERAPY IN A MEDICARE AND MEDICAID CERTIFIED FACILITY. DURING THE YEAR, AN AVERAGE OF 75.60 RESIDENTS PER DAY FOR A TOTAL OF 27,595 DAYS OF CARE WERE PROVIDED. 58521 59527 WELLNESS SERVICES - WE OFFER SPECIALIZED PROGRAMMING AND EQUIPMENT DESIGNED FOR FITNESS AND WELLNESS FOR ACTIVE ADULTS AGED 55 AND UP. 7938447 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 1 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 1 0 0 0 1 0 0 194 1 0 0 0 0 0 0 0 0 X 3 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X X JEAN FREUCK 2629657203 410 N MAIN ST DOUSMAN WI 53118 X ARBY HUMPHREY BOARD CHAIR 1.00 X X 0 0 0 MARK STRAUTMANN PRESIDENT & CEO 17.00 23.00 X X 74776 99120 27038 JEAN FREUCK SECRETARY/TREASURER & CFO 16.00 24.00 X X 53309 83381 25451 128085 182501 52489 0 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 671119 OMNICARE PHARMACY PO BOX 78000 DETROIT MI 48278 DRUGS AND SUPPLIES 293729 PAT'S HEATING 1833 EXECUTIVE DRIVE OCONOMOWOC WI 53066 HVAC 141514 PATHWAY HEALTH SERVICES 2025 FOURTH STREET WHITE BREAK LAKE MN 55110 STAFF REPLACEMENT 105948 KREISERS INC PO BOX 776422 CHICAGO IL 60677 MEDICAL SUPPLIES 100427 5 4950 4950 SKILLED NURSING SERVIC 623000 8884150 8884150 WELLNESS CENTER 623000 59527 59527 8943677 1558 1558 MEAL REVENUES 623000 26232 26232 26232 8976417 8943677 0 27790 X 150463 150463 4152600 3646818 505782 47907 45680 2227 990808 857894 132914 291837 248601 43236 9724 9724 31145 31145 425 425 1032442 982068 50374 20278 20278 149908 97531 52377 46142 46142 214831 177831 37000 16262 7956 8306 306221 306192 29 632277 632277 84266 18224 66042 PHARMACY / DRUGS 310129 310129 MISCELLANEOUS 237892 237892 MEDICAL SUPPLIES 215181 215181 MEDICAID BED TAX 171360 171360 39964 -17187 57151 9152062 7938447 1213615 0 310558 256717 22861 1660 0 963205 733359 11283 5462 58958 22584 14055600 6129937 8000748 7925663 454787 455368 138977 129545 9940176 9551559 607799 706306 7347276 7201980 2571 873 5167000 5002515 13124646 12911674 X -3188814 -3360115 4344 0 -3184470 -3360115 9940176 9551559 -175645 0 X X 0 1 X 1 0 X 184165 17794 15093 3255 4950 225257 7825899 8213675 7941341 8003268 8943677 40927860 37811 43067 39268 27828 26232 174206 8047875 8274536 7995702 8034351 8974859 41327323 0 1888924 1894250 1727105 2096414 2216548 9823241 1888924 1894250 1727105 2096414 2216548 9823241 31504082 641 757 550 534 1558 4040 641 757 550 534 1558 4040 8048516 8275293 7996252 8034885 8976417 41331363 0.76220 0.76280 0.00010 0.00010 X 0 1 X 2910 2910 11070661 4426871 6643790 2387112 1462994 924118 594917 240072 354845 7925663 INTERCOMPANY ACCOUNT - WMH 5002515 5002515 8976417 0 8976417 0 8976417 9152062 0 9152062 0 9152062 PART IV, LINE 2B: RESIDENT FUNDS ARE REQUIRED TO BE ESTABLISHED AND ARE HELD FOR SAFEKEEPING BY THE CENTER. THESE AMOUNTS CAN BE WITHDRAWN AT ANY TIME BY THE RESIDENTS, AND ARE HELD IN ONE BANK ACCOUNT. X X X 0 0 0 0 0 0 0 0 0 MARK STRAUTMANN PRESIDENT & CEO 71899 95307 0 0 2877 3813 3314 4393 8312 11019 86402 114532 0 0 JEAN FREUCK SECRETARY/TREASURER & CFO 50700 79300 0 0 2609 4081 2387 3733 7539 11792 63235 98906 0 0 PART I, LINE 3 MASONIC CENTER FOR HEALTH AND REHAB IS RELATED TO THREE PILLARS, A GROUP OF NON-PROFIT ORGANIZATIONS. WISCONSIN MASONIC HOME IS A RELATED PARTY, WHICH PAYS THE CFO AND CEO OF THREE PILLARS. MASONIC CENTER FOR HEALTH AND REHAB THEN REIMBURSES WISCONSIN MASONIC HOME FOR THEIR PORTION OF THE SALARY EXPENSE. IN ORDER TO DETERMINE COMPENSATION, A GOVERNANCE COMMITTEE OF WISCONSIN MASONIC HOME'S BOARD DETERMINES THE SALARY OF THE CEO USING A COMPENSATION SURVEY. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGLY AND TIMELY DOCUMENTED. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DBH8 2013-06-07 6780381 REFUND WHEF SERIES 2003, 2004A, 2004B, AND 2009 REVENUE BONDS 0 0 0 A 240250 6780381 455368 7555994 156218 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, SCHEDULE K, PART II, COLUMN A: TOTAL PROCEEDS OF THE ISSUANCE FOR THE REFUNDING REVENUE BONDS SERIES 2013 INCLUDED IN SCHEDULE K, PART II, COLUMN A, LINE 3 IS DIFFERENT FROM THE ISSUE PRICE INCLUDED IN SCHEDULE K, PART I, COLUMN B, LINE A DUE TO A NET ORIGINAL ISSUE PREMIUM, RELEASED FUNDS FROM RETIRED BONDS, AND AN EQUITY CONTRIBUTION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF MASONIC CENTER FOR HEALTH AND REHAB, INC. IS WISCONSIN MASONIC HOME, INC. FORM 990, PART VI, SECTION A, LINE 7A WISCONSIN MASONIC HOME, INC. ELECTS THE OUTSIDE DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER HAS CERTAIN RESERVED POWERS OVER THE DECISIONS MADE BY THE BOARD OF DIRECTORS OF MASONIC CENTER FOR HEALTH AND REHAB, INC. THESE POWERS INCLUDE: 1) ELECTION OF THE BOARD OF DIRECTORS 2) ACTIONS REQUIRING APPROVAL BY A MEMBER BY LAY OR AS SET FORTH IN THESE BYLAWS, AND 3) AMENDMENTS TO THE BYLAWS AND ARTICLES OF INCORPORATION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE POSTED TO THE ORGANIZATION'S BOARD PORTAL AND HARD COPIES WILL BE MADE AVAILABLE ON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES SIGN A WRITTEN CONFLICT OF INTEREST FORM AT THE ANNUAL MEETING. IF A CONFLICT EXISTS WITH A MEETING'S AGENDA, THAT DIRECTOR OR OFFICER WILL ABSTAIN FROM DISCUSSION AND VOTING. FORM 990, PART VI, SECTION B, LINE 15A AN EXECUTIVE COMMITTEE OF THE MEMBER'S BOARD DETERMINES THE SALARY OF THE CEO USING EXTERNAL SOURCES AS INDICATED ON SCHEDULE J. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF MASONIC CENTER FOR HEALTH AND REHAB, INC. ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, LINE 1 MARK STRAUTMAN, CEO, DEVOTES APPROXIMATELY 40 HOURS PER WEEK AS FOLLOWS: WISCONSIN MASONIC HOME - 17 HOURS, MASONIC CENTER FOR HEALTH AND REHAB, INC - 17 HOURS, VILLAGE ON THE SQUARE - 6 HOURS. JEAN FREUCK, CFO, DEVOTES APPROXIMATELY 40 HOURS PER WEEK AS FOLLOWS: WISCONSIN MASONIC HOME - 18 HOURS, MASONIC CENTER FOR HEALTH AND REHAB, INC - 16 HOURS, VILLAGE ON THE SQUARE - 6 HOURS. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 982,068. MANAGEMENT AND GENERAL EXPENSES 50,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,032,442. FORM 990, PART XII, LINE 2C: NO CHANGES HAVE BEEN MADE FROM THE PRIOR YEAR REGARDING THE COMMITTEE OVERSEEING THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT. VILLAGE ON THE SQUARE INC 410 MAIN STREET DOUSMAN WI 53118 391662636 INDIVIDUAL LIVING FACILITIES WI 501(C)(3) LINE 9 WICONSIN MASONIC HOME 0 WISCONSIN MASONIC HOME INC 410 MAIN STREET DOUSMAN WI 53118 390813463 SENIOR ASSISTED LIVING WI 501(C)(3) LINE 9 N/A 0 GRAND LODGE FREE & ACCEPTED MASONS OF WISCONSIN 36275 SUNSET DRIVE DOUSMAN WI 53118 390129695 FRATERNAL ORGANIZATION WI 501(C)(8) & (C)(10) N/A 0 WISCONSIN MASONIC FOUNDATION 36275 SUNSET DRIVE DOUSMAN WI 53118 396044637 SCHOLARSHIP PROVIDER WI 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 WISCONSIN MASONIC HOME INC O 511835 DIRECT ALLOCATION VILLAGE ON THE SQUARE INC O 157718 DIRECT ALLOCATION GRAND LODGE FREE & ACCEPTED MASONS OF WISCONSIN M 120000 BOOK