2014-11-14T14:23:02-06:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 391662636 VILLAGE ON THE SQUARE INC VILL 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK CFO 2629652111 2014-11-13 1 KIMBERLY ANDERSON CPA P00188889 6123764500 2013 2015-11-30 17:44:51Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 3239153 0 X WWW.THREEPILLARS.ORG X 1989 WI VILLAGE ON THE SQUARE, INC. SPONSORED BY THE MASONIC FRATERNITY, TAKES PRIDE IN MEETING THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS THROUGH HIGH QUALITY INDEPENDENT HOUSING AND SERVICES, INCLUDING HOUSEKEEPING, DINING, FITNESS, AND COMPUTER SERVICE AND ACCESS. 3 1 31 102 0 0 14717 45897 2289995 2364034 311839 829222 0 0 2616551 3239153 0 0 0 0 800820 850265 0 0 0 1919889 1792493 2720709 2642758 -104158 596395 16482604 17522167 18886160 18889320 -2403556 -1367153 X VILLAGE ON THE SQUARE, INC. SPONSORED BY THE MASONIC FRATERNITY, TAKES PRIDE IN MEETING THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS THROUGH HIGH QUALITY INDEPENDENT HOUSING AND SERVICES, INCLUDING HOUSEKEEPING, DINING, FITNESS, AND COMPUTER SERVICE AND ACCESS. 0 0 2163262 2364034 VILLAGE ON THE SQUARE PROVIDES AN INDEPENDENT LIVING COMPLEX ON A CONTINUING CARE RETIREMENT CAMPUS FOR ADULTS AGED 55 AND OLDER, ALTHOUGH THE AVERAGE AGE OF RESIDENTS IS 84. SERVICES INCLUDE DINING AVAILABLILITY, PARKING, SOCIAL AND RECREATIONAL ACTIVITIES, WELLNESS SERVICES, AND ACCESS TO HIGHER LEVELS OF CARE. THIS SUPPORTIVE ENVIRONMENT ALLOWS INDEPENDENCE THAT MAY NOT OTHERWISE BE POSSIBLE IN THEIR OWN HOMES. ON AVERAGE DURING THE YEAR, 140 RESIDENTS LIVED AT VILLAGE ON THE SQUARE. 2163262 1 1 0 0 0 0 0 0 0 0 1 1 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 31 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 X JEAN FREUCK 2629657203 410 N MAIN ST DOUSMAN WI 531189348 X PAUL TOURVILLE CHAIRMAN 1.00 X 0 0 0 DAVID OINES FORMER SECRETARY/TREASURER 6.00 X 0 0 0 MARK STRAUTMAN PRESIDENT & CEO 6.00 34.00 X X 25547 156932 25656 JEAN FREUCK SECRETARY/TREASURER & CFO 6.00 34.00 X X 17800 100862 21459 43347 257794 47115 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 239164 1 9564 36333 45897 SERVICES TO RESIDENTS 623990 2364034 2364034 2364034 255328 255328 570144 3750 0 0 570144 3750 573894 573894 3239153 2364034 0 829222 50244 50244 636676 454944 181732 1141 1141 139458 96943 42515 22746 15218 7528 10437 10437 5801 5801 24816 24816 107582 80931 26651 39050 39050 111594 86512 25082 7947 7947 321121 303038 18083 15331 12065 3266 224123 224066 57 613102 613102 12381 12381 DINING SERVICES 253723 253723 GROUNDSKEEPING 17414 17414 LICENSES AND PERMITS 3830 3830 24241 4165 20076 2642758 2163262 479496 0 79301 80248 17886 4843 50200 46000 6842 8121 29235 52260 15634021 8274565 7561394 7359456 8628614 9867089 109132 104150 16482604 17522167 152389 211477 1337207 1461130 5426826 5407929 11969738 11808784 18886160 18889320 X -2403556 -1367153 -2403556 -1367153 16482604 17522167 596395 440008 0 X X 0 1 X 1 0 X 20830 16865 18893 14717 45897 117202 1683451 1831649 2071189 2289995 2364034 10240318 1704281 1848514 2090082 2304712 2409931 10357520 0 30586 30586 30586 30586 10326934 204353 245605 325486 230499 255328 1261271 204353 245605 325486 230499 255328 1261271 1908634 2094119 2415568 2535211 2665259 11618791 0.88880 0.87550 0.10860 0.12150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13885567 7200104 6685463 1052253 575765 476488 696201 498696 197505 7359456 POOLED INVESTMENTS 9867089 F 9867089 REFUNDABLE RESIDENCY FEES 7456587 REFUNDABLE ADVANCE FEES 55808 RELATED-PARTY PAYABLE TO WISCONSIN MASONIC HOME 4296389 11808784 X 3229589 0 3229589 9564 9564 3239153 2642758 0 2642758 0 2642758 PART X, LINE 2: THE VILLAGE 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 VILLAGE'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION IN THE U.S. FEDERAL, STATE, AND LOCAL AUTHORITIES. THE VILLAGE 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 4B - OTHER ADJUSTMENTS: TRANSFER FROM RELATED ORGANIZATION 9,564. 0 0 0 0 0 0 0 0 0 MARK STRAUTMAN PRESIDENT & CEO 24644 151385 0 0 903 5547 1050 6448 2542 15616 29139 178996 0 0 PART I, LINE 3 VILLAGE ON THE SQUARE 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. VILLAGE ON THE SQUARE 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 5066725 REFUNDING REVENUE BONDS SERIES 2013 (THREE PILLARS SENIOR LIVING COMM.) 0 0 0 A 5895364 328165 5454555 112771 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE K, PART II, COLUMN A THE TOTAL PROCEEDS OF 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, AND EQUITY CONTRIBUTION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF VILLAGE ON THE SQUARE, 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 VILLAGE ON THE SQUARE, INC. THESE POWERS INCLUDE: 1) ELECTION OF THE BOARD OF DIRECTORS 2) ACTIONS REQUIRING APPROVAL BY A MEMBER BY LAW 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 MANAGEMENT REVIEWS THE 990, THEN THE BOARD REVIEWS. 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 ANNUALLY. IF A CONFLICT EXISTS WITH A MEETING'S AGENDA, THAT DIRECTOR OR OFFICER WILL ABSTAIN FROM DISCUSSION AND VOTING. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE GOVERNANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15A THE GOVERNANCE 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. THE CFO'S SALARY WAS DETERMINED INTERNALLY, BASED ON MARKET COMPARISONS TO CONFIRM THAT TOTAL COMPENSATION TO BE PAID WAS REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THIS PROCESS IS COMPLETED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF VILLAGE ON THE SQUARE 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 REHAB, INC. - 16 HOUR, VILLAGE ON THE SQUARE - 6 HOURS. 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. MASONIC CENTER FOR HEALTH AND REHAB INC 410 N MAIN STREET DOUSMAN WI 531189348 391506910 SKILLED NURSING AND REHABILITATION SERVICES WI 501(C)(3) LINE 9 WISCONSIN MASONIC HOME 1 WISCONSIN MASONIC HOME INC 410 N MAIN STREET DOUSMAN WI 531189348 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 531189348 390129695 FRATERNAL ORGANIZATION WI 501(C)(8) & (C)(10) N/A 0 WISCONSIN MASONIC FOUNDATION 36275 SUNSET DRIVE DOUSMAN WI 531189348 396044637 SCHOLARSHIP PROVIDER WI 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 WISCONSIN MASONIC HOME INC O 122092 DIRECT ALLOCATION MASONIC CENTER FOR HEALTH AND REHAB INC O 230146 DIRECT ALLOCATION