2013-01-24T10:44:40-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 391506910 MASONIC CENTER FOR HEALTH AND REHAB INC MASO 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK 2629652111 2013-01-18 1 CORY RUTLEDGE P01329381 6123764500 2011 2016-02-25 16:41:14Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 8048516 0 X WWW.THREEPILLARS.ORG X 1984 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING QUALITY HOUSING. 3 1 195 40 0 0 189839 184165 6931371 7825899 2047 641 25087 37811 7148344 8048516 0 0 0 0 4470036 4817683 0 0 0 3411422 3792258 7881458 8609941 -733114 -561425 10863429 10550433 11058056 11306485 -194627 -756052 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 7485028 0 7766416 SKILLED NURINGS REHABILITATION - 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 76.72 RESIDENTS PER DAY FOR A TOTAL OF 27,818 DAYS OF CARE WERE PROVIDED. 51392 59483 WELLNESS SERVICES - THE ORGANIZATION OFFERS PROGRAMMING AND EQUIPMENT DESIGNED FOR FITNESS AND WELLNESS FOR ACTIVE ADULTS AGED 55 AND UP. 7536420 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 0 1 0 0 195 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 531189348 X TOM WALTON 1.00 X X 0 0 0 DAVID OINES 16.00 X X 33808 52879 6854 MARK STRAUTMANN 17.00 X X 65322 86590 14032 JEAN FREUCK 16.00 X X 0 0 0 99130 139469 20886 0 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 666973 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 419503 2 160047 24118 184165 SKILLED NURSING SVCS 623000 7766416 7766416 WELLNESS CENTER 623000 59483 59483 7825899 641 641 MEAL REVENUE 623000 37811 37811 37811 8048516 7825899 0 38452 112114 112114 3695360 3288903 406457 109730 98154 11576 631383 553761 77622 269096 233140 35956 17175 17175 22860 22860 1064 1064 1390752 1357622 33130 58427 58427 231685 30519 201166 76425 76425 161333 161333 14323 10061 4262 5715 5715 250990 250793 197 595145 595145 62507 62507 DRUGS 299044 299044 UNCOLLECTIBLE ACCOUNTS 257441 257441 MEDICAID BED TAX 171360 171360 MISCELLANEOUS 112767 103392 9375 63245 63245 8609941 7536420 1073521 0 249505 234243 120233 80555 896349 931271 8733 8820 26873 33473 12856345 3944517 9201275 8911828 197763 199183 162698 151060 10863429 10550433 568213 580849 7363111 7236536 2788 1247 3123944 3487853 11058056 11306485 X -317859 -847155 123232 91103 -194627 -756052 10863429 10550433 -561425 0 X 0 1 1 X 0 X 8848 5977 194447 189839 184165 583276 5749853 6372974 6479062 6931371 7825899 33359159 5758701 6378951 6673509 7121210 8010064 33942435 0 969364 1241623 1362444 1758527 1888925 7220883 969364 1241623 1362444 1758527 1888925 7220883 26721552 5218 601 586 2047 641 9093 5218 601 586 2047 641 9093 9610 10195 10438 25087 37811 93141 5773529 6389747 6684533 7148344 8048516 34044669 0.78490 0.79020 0.00030 0.00050 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 2910 2910 10314129 2986219 7327910 1988253 834782 1153471 551053 123516 427537 8911828 DUE TO AFFILIATES 3487853 3487853 8048516 8609941 -561425 -561425 8030188 4450 4450 8025738 22778 22778 8048516 8609941 0 8609941 0 8609941 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 CENTERS'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 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 4,450. PART XII, LINE 4B - OTHER ADJUSTMENTS: TEMP RESTRICTED CONTRIBUTIONS 22,778. 0 0 0 0 0 0 0 0 0 MARK STRAUTMANN 58931 78118 0 0 6391 8472 2187 2898 3847 5100 71356 94588 0 0 SUPPLEMENTAL INFORMATION PART III 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. WISCONSIN HEALTH AND EDUCATIONAL FACILITIES 391337855 97710VPF9 2003-10-01 1639656 2003 THREE PILLARS SENIOR LIVING COMMUNITIES 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES 391337855 2009-12-01 6300000 CONSTRUCTION DRAW DOWN BOND FOR ADDITIONAL REHABILITATION CENTER 0 0 0 365445 1635937 127316 1476496 32124 2003 0 0 1 1 180000 6148344 4934 6143410 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 FORM 990, SCHEDULE K, PART II, COLUMN A TOTAL PROCEEDS VS. ISSUE PRICE THE TOTAL PROCEEDS OF ISSUANCE FOR THE SERIES 2003 BOND INCLUDED IN SCHEDULE K, PART II, LINE 1 IS DIFFERENT FROM THE ISSUE PRICE INCLUDED IN SCHEDULE K, PART I, LINE A, COLUMN E DUE TO A BOND DISCOUNT. FORM 990, SCHEDULE K, PART II, COLUMN B TOTAL PROCEEDS VS. ISSUE PRICE TOTAL PROCEEDS OF THE ISSUANCE FOR THE SERIES 2009 BOND INCLUDED IN SCHEDULE K, PART II, LINE 1 IS DIFFERENT FROM THE ISSUE PRICE INCLUDED IN SCHEDULE K, PART I, LINE B, COLUMN E BECAUSE IT IS A CONSTRUCTION BOND AND THE PROCEEDS WERE ONLY ISSUED AS THE CONSTRUCTION DRAWS WERE SUBMITTED AND THE PROJECT WAS COMPLETED FOR LESS THAN THE BOND ISSUANCE. 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 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 AT THE ANNUAL MEETING. 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 ON AN ANNUAL BASIS 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 MASONIC CENTER FOR HEALTH AND REHAB, INC. ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SHARED HOURS 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. DAVE OINES, FORMER 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. 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. VILLAGE ON THE SQUARE INC 410 MAIN STREET DOUSMAN WI 53118 391662636 INDIVIDUAL LIVING FACILITIES WI 501(C)(3) LINE 9 WICONSIN MASONIC HOME 1 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 1 0 1 0 0 0 0