2013-01-24T10:44:55-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 391662636 VILLAGE ON THE SQUARE INC VILL 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 JEAN FREUCK 2629652111 2013-01-17 1 CORY RUTLEDGE P01329381 6123764500 2011 2016-02-25 16:41:14Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 2459620 0 X WWW.THREEPILLARS.ORG X 1989 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING QUALITY HOUSING. 3 1 29 95 0 0 16865 18893 1831649 2071189 298435 369538 0 0 2146949 2459620 0 0 0 0 755651 790027 0 0 0 1803001 1758252 2558652 2548279 -411703 -88659 16388062 16488148 18537289 19070505 -2149227 -2582357 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. 0 0 2141786 0 2071189 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, 141 RESIDENTS LIVED AT VILLAGE ON THE SQUARE. 2141786 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 0 1 0 0 29 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 1.00 X X 0 0 0 DAVID OINES 6.00 X X 13003 73684 6854 MARK STRAUTMAN 6.00 X X 21268 130645 14033 JEAN FREUCK 6.00 X X 0 0 0 34271 204329 20887 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 262159 VJS CONSTRUCTION W233 N2847 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 CONSTRUCTION 127450 BRIAN TWEEDEN CARPENTRY W802 GOPHER HILL ROAD IXONIA WI 53036 CONSTRUCTION 110451 3 18067 826 18893 SERVICES TO RESIDENTS 623990 2071189 2071189 2071189 325486 325486 44052 0 44052 44052 44052 2459620 2071189 0 369538 38739 38739 591527 410917 180610 8935 6672 2263 122062 81801 40261 28764 18869 9895 305 305 5120 5120 25428 25428 106556 84006 22550 41260 41260 102427 85891 16536 14994 14994 260954 260954 13917 13073 844 1594 1594 299734 299531 203 586904 586904 10548 10548 DINING SERVICES 249873 249873 MISCELLANEOUS EXPENSES 38638 32747 5891 2548279 2141786 406493 0 125970 132839 11183 11564 82200 113400 6842 6842 16402 16402 14630852 7091933 7473638 7538919 8578576 8585053 93251 83129 16388062 16488148 222288 367775 1358068 1354786 6195245 5936889 10761688 11411055 18537289 19070505 X -2149227 -2582357 -2149227 -2582357 16388062 16488148 X -88659 -344471 X 0 1 1 X 0 X 16201 19678 20830 16865 18893 92467 1663295 1675681 1683451 1831649 2071189 8925265 1679496 1695359 1704281 1848514 2090082 9017732 0 0 0 9017732 385261 328271 204353 245605 325486 1488976 385261 328271 204353 245605 325486 1488976 2050 2050 2064757 2025680 1908634 2094119 2415568 10508758 0.85810 0.84630 0.14170 0.15350 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13220877 6243612 6977265 447756 301182 146574 779222 419844 359378 182997 127295 55702 7538919 POOLED INVESTMENTS 8585053 F 8585053 REFUNDABLE RESIDENCY FEES 6396535 REFUNDABLE ADVANCE FEES 46368 RELATED-PARTY PAYABLE TO WISCONSIN MASONIC HOME 4968152 11411055 2459620 2548279 -88659 -344471 -344471 -433130 2441553 0 2441553 18067 18067 2459620 2548279 0 2548279 0 2548279 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL,AND STATE AUTHORITIES. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM RELATED ORGANIZATION 18,067. 0 0 0 0 0 0 0 0 0 MARK STRAUTMAN 19187 117862 0 0 2081 12783 712 4373 1253 7695 23233 142713 0 0 SUPPLEMENTAL INFORMATION PART III 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. WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VPF9 2003-10-01 6860402 2003 THREE PILLARS SR LIVING COMMUNITIES- ISSUED TO REFINANCE 1996 BONDS 0 0 0 WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97670FAA9 2004-12-10 1000000 2004B THREE PILLARS SR LIVING COMMUNITIES- RENOVATION OF COMMON AREAS 0 0 0 1528998 6844844 532702 6177732 134410 2003 0 0 1 1 369333 1000000 18202 981798 2006 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 OR 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, 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 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 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. SHARING 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -344,471. 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 0 1 0 1 0 0 0 0