2014-11-14T14:23:56-06:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 391506910 MASONIC CENTER FOR HEALTH AND REHAB INC MASO 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK CFO 2629652111 2014-11-10 1 KIMBERLY ANDERSON CPA P00188889 6123764500 2013 2015-11-30 17:44:51Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 7996502 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 1 208 43 0 0 17794 15093 8213675 7941341 757 800 43067 39268 8275293 7996502 0 0 0 0 5144708 5096079 0 0 0 4014976 3618309 9159684 8714388 -884391 -717886 10374865 10078616 12015308 12436945 -1640443 -2358329 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 7560939 7866596 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. 54760 74745 WELLNESS SERVICES - WE OFFER SPECIALIZED PROGRAMMING AND EQUIPMENT DESIGNED FOR FITNESS AND WELLNESS FOR ACTIVE ADULTS AGED 55 AND UP. 7615699 1 1 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 1 208 1 0 0 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 78467 104014 25656 JEAN FREUCK SECRETARY/TREASURER & CFO 16.00 24.00 X X 46277 72383 21459 124744 176397 47115 0 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 684495 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 383795 OMNICARE PHARMACY PO BOX 713400 CINCINNIATI OH 45271 DRUGS AND SUPPLIES 263237 KREISERS INC PO BOX 2758 SIOUX FALLS SD 57101 MEDICAL SUPPLIES 124481 4 15093 15093 SKILLED NURSING SVCS 623000 7866596 7866596 WELLNESS CENTER 623000 74745 74745 7941341 550 550 250 0 250 250 250 MEAL REVENUE 623000 39268 39268 39268 7996502 7941341 0 40068 X 144438 144438 4018210 3591144 427066 62279 57822 4457 605013 537767 67246 266139 230697 35442 40703 40703 22037 22037 1131 1131 1300124 1218107 82017 40139 40139 168370 123918 44452 41462 41462 207296 186213 21083 19837 9071 10766 310233 310137 96 592119 592119 66003 66003 PHARMACY & DRUGS 280781 280781 MEDICAID BED TAX 171360 171360 MEDICAL SUPPLIES 160335 160335 UNCOLLECTIBLE ACCOUNTS 94695 94695 101684 51533 50151 8714388 7615699 1098689 0 216516 231812 51085 27860 874634 876189 8820 10193 35623 81427 13358613 5108772 8581041 8249841 454417 454599 152729 146695 10374865 10078616 644760 720662 7517659 7491482 1552 2418 3851337 4222383 12015308 12436945 X -1707705 -2396886 67262 38557 -1640443 -2358329 10374865 10078616 -717886 0 X X 0 1 X 1 0 X 194447 189839 184165 17794 15093 601338 6479062 6931371 7825899 8213675 7941341 37391348 10438 25087 37811 43067 39268 155671 6683947 7146297 8047875 8274536 7995702 38148357 0 1362444 1758527 1888924 1894250 1727105 8631250 1362444 1758527 1888924 1894250 1727105 8631250 29517107 586 2047 641 757 550 4581 586 2047 641 757 550 4581 6684533 7148344 8048516 8275293 7996252 38152938 0.77370 0.77700 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2910 2910 10510276 3720901 6789375 2275339 1206934 1068405 570088 180937 389151 8249841 DUE TO AFFILIATES 4222383 4222383 X 7993847 2345 2345 7991502 5000 5000 7996502 8714388 0 8714388 0 8714388 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: NET ASSETS RELEASED FROM RESTRICTIONS 2,345. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMP RESTRICTED CONTRIBUTIONS 5,000. X X 0 0 0 0 0 0 0 0 0 MARK STRAUTMANN PRESIDENT & CEO 75693 100337 0 0 2774 3677 3224 4274 7808 10350 89499 118638 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 OTHER FEES: PROGRAM SERVICE EXPENSES 1,218,107. MANAGEMENT AND GENERAL EXPENSES 82,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,300,124. 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 327902 DIRECT ALLOCATION VILLAGE ON THE SQUARE INC O 101451 DIRECT ALLOCATION