2016-02-02T09:08:25-06:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2014-07-01 391506910 MASONIC CENTER FOR HEALTH AND REHAB INC MASO 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK CFO 2629652111 2016-01-22 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2016-01-22 2014 2016-04-25 22:37:26Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 8024628 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 1 221 38 0 0 15093 3255 7941341 7993011 800 534 39268 27828 7996502 8024628 0 0 0 0 5096079 5059819 0 0 0 3618309 3790950 8714388 8850769 -717886 -826141 10078616 9940176 12436945 13124646 -2358329 -3184470 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 7694660 7928525 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 77.70 RESIDENTS PER DAY FOR A TOTAL OF 28,362 DAYS OF CARE WERE PROVIDED. 64486 WELLNESS SERVICES - WE OFFER SPECIALIZED PROGRAMMING AND EQUIPMENT DESIGNED FOR FITNESS AND WELLNESS FOR ACTIVE ADULTS AGED 55 AND UP. 7694660 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 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 0 221 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 JEAN FREUCK 2629657203 410 N MAIN ST DOUSMAN WI 53118 X TOM WALTON BOARD CHAIR 1.00 X X 0 0 0 MARK STRAUTMANN PRESIDENT & CEO 17.00 23.00 X X 77119 102228 27038 JEAN FREUCK SECRETARY/TREASURER & CFO 16.00 24.00 X X 51544 80621 25247 128663 182849 52285 0 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 613605 UNIDINE 1000 WASHINGTON STREET 510 BOSTON MA 02118 FOOD SERVICES 545765 OMNICARE PHARMACY PO BOX 713400 CINCINNIATI OH 45271 DRUGS AND SUPPLIES 257789 KREISERS INC PO BOX 2758 SIOUX FALLS SD 57101 MEDICAL SUPPLIES 123152 4 3255 3255 SKILLED NURSING SERVIC 623000 7928525 7928525 WELLNESS CENTER 623000 64486 64486 7993011 534 534 MEAL REVENUES 623000 27828 27828 27828 8024628 7993011 0 28362 X 148481 148481 4033521 3577238 456283 50556 47332 3224 559935 494931 65004 267326 229786 37540 8373 8373 22039 22039 1125 1125 1162462 1042720 119742 33870 33870 153411 112512 40899 41835 41835 206975 177558 29417 14736 6547 8189 308164 308140 24 618567 618567 66114 66114 MISCELLANEOUS 315721 315721 PHARMACY / DRUGS 260060 260060 MEDICAID BED TAX 171360 171360 MEDICAL SUPPLIES 164989 164989 241149 167199 73950 8850769 7694660 1156109 0 231812 310558 27860 1660 876189 963205 10193 11283 81427 58958 13506143 5505395 8249841 8000748 454599 454787 146695 138977 10078616 9940176 720662 607799 7491482 7347276 2418 2571 4222383 5167000 12436945 13124646 X -2396886 -3188814 38557 4344 -2358329 -3184470 10078616 9940176 -826141 0 X X 0 1 X 1 0 X 189839 184165 17794 15093 3255 410146 6931371 7825899 8213675 7941341 8003268 38915554 25087 37811 43067 39268 27828 173061 7146297 8047875 8274536 7995702 8034351 39498761 0 1758527 1888924 1894250 1727105 2096414 9365220 1758527 1888924 1894250 1727105 2096414 9365220 30133541 2047 641 757 550 534 4529 2047 641 757 550 534 4529 7148344 8048516 8275293 7996252 8034885 39503290 0.76280 0.77370 0.00010 0.00010 X 0 1 X 2910 2910 10666053 4021527 6644526 2247238 1279346 967892 589942 204522 385420 8000748 INTERCOMPANY ACCOUNT - WMH 5167000 5167000 X 8026699 2071 2071 8024628 0 8024628 8850769 0 8850769 0 8850769 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. PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION IN THE U.S. FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CENTER IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES OR MAY JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASED FROM RESTRICTIONS 2,071. X X 0 0 0 0 0 0 0 0 0 MARK STRAUTMANN PRESIDENT & CEO 71060 94196 3182 4219 2877 3813 3314 4393 8312 11019 88745 117640 0 0 JEAN FREUCK SECRETARY/TREASURER & CFO 48935 76540 0 0 2609 4081 2307 3609 7539 11792 61390 96022 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 7018747 REFUND WHEF SERIES 2003, 2004A, 2004B, AND 2009 REVENUE BONDS 0 0 0 A 8166631 454599 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 PT MEDICARE PART A : PROGRAM SERVICE EXPENSES 184,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,316. PT MEDICARE PART B : PROGRAM SERVICE EXPENSES 92,906. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,906. PT MEDICARE HMO B : PROGRAM SERVICE EXPENSES 19,376. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,376. PT EVERCARE A : PROGRAM SERVICE EXPENSES 7,649. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,649. PT EVERCARE B : PROGRAM SERVICE EXPENSES 4,395. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,395. PT OTHER B : PROGRAM SERVICE EXPENSES 17,624. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,624. PHYSICAL THERAPY SERVICES : PROGRAM SERVICE EXPENSES 116. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116. OT MEDICARE PART A : PROGRAM SERVICE EXPENSES 141,136. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 141,136. OT MEDICARE PART B : PROGRAM SERVICE EXPENSES 63,264. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,264. OT MEDICARE HMO PART B : PROGRAM SERVICE EXPENSES 17,208. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,208. OT EVERCARE A : PROGRAM SERVICE EXPENSES 10,380. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,380. OT OTHER B : PROGRAM SERVICE EXPENSES 12,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,120. ST MEDICARE A : PROGRAM SERVICE EXPENSES 30,178. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,178. ST MEDICARE B : PROGRAM SERVICE EXPENSES 4,300. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,300. ST MEDICARE HMO B : PROGRAM SERVICE EXPENSES 1,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,700. ST EVERCARE A : PROGRAM SERVICE EXPENSES 3,285. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,285. ST OTHER B : PROGRAM SERVICE EXPENSES 1,720. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,720. MEDICAID ANCILLARY/SUPPLIES CONT AL : PROGRAM SERVICE EXPENSES -1,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -1,260. X-RAY PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 8,243. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,243. MEDICARE A OUTSIDE SERV EXPENSE : PROGRAM SERVICE EXPENSES 124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124. BEAUTY SHOP PURCHASED SERVICE EXPEN : PROGRAM SERVICE EXPENSES 21,439. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,439. NURSING SUB-CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 735. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 735. RN SUB-CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 11,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,406. LPN SUB-CONTRACT SERVICES : PROGRAM SERVICE EXPENSES 42,124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,124. CNA SUB-CONTRACT SERVICES : PROGRAM SERVICE EXPENSES 51,495. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,495. PHYSICIAN SERVICES : PROGRAM SERVICE EXPENSES 7,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,500. WELLNESS CONNECTION SUB-CONTRACT : PROGRAM SERVICE EXPENSES 6,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,583. WELLNESS CONNECTION SUB-CONTRACT : PROGRAM SERVICE EXPENSES 3,646. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,646. LIFESTYLES CONTRACTS/CONSULTANTS : PROGRAM SERVICE EXPENSES 4,405. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,405. DINING SERVICES SUB-CONTRACTED SERV : PROGRAM SERVICE EXPENSES 233,968. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 233,968. MAINTENANCE SUB-CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 38,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,627. HOUSEKEEPING SUBCONTRACTED : PROGRAM SERVICE EXPENSES 1,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,900. VOLUNTEER SERVICES PURCHASED SERVIC : PROGRAM SERVICE EXPENSES 112. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 112. CONSULTANT EXPENSE - GENERAL : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 96,426. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,426. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,348. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,348. OTHER FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,949. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,949. MARKETING PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19. 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 369231 DIRECT ALLOCATION VILLAGE ON THE SQUARE INC O 114237 DIRECT ALLOCATION