2012-03-15T11:15:50-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 391506910 MASONIC CENTER FOR HEALTH AND REHAB INC MASO 2629657203 410 N MAIN STREET DOUSMAN WI 531189348 DAVID OINES 2629657203 2012-03-03 1 6123764500 2010 2016-02-24 21:20:13Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 7148344 0 X WWW.THREEPILLARS.ORG X 1985 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING QUALITY HOUSING. 3 1 193 30 0 0 194447 189839 6479062 6931371 586 2047 10438 25087 6684533 7148344 0 0 0 0 4079964 4470036 0 0 0 2657322 3411422 6737286 7881458 -52753 -733114 7186300 10863429 6647813 11058056 538487 -194627 X 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. 1 1 7012999 6901451 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 75 RESIDENTS PER DAY FOR A TOTAL OF 27,408 DAYS OF CARE WERE PROVIDED. 36908 29920 THE ORGANIZATION OFFERS PROGRAMMING AND EQUIPMENT DESIGNED FOR FITNESS AND WELLNESS FOR ACTIVE ADULTS AGED 55 AND UP. 7049907 1 1 0 0 0 0 0 1 1 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 0 193 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 0 0 0 WI X DAVE OINES 2629657203 410 N MAIN ST DOUSMAN WI 531189348 X GARY KRAUSE 1.00 X X 0 0 0 DAVID OINES 16.00 X X 40577 60865 15962 MARK STRAUTMANN 12.00 X X 50202 117138 36432 VIRGINIA ROMAINE 1.00 X X 0 0 0 90779 178003 52394 2 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 472672 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 418154 VJS CONSTRUCTION SERVICES INC W233 N2847 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 CONSTRUCTION SERVICES 160716 3 189839 189839 SKILLED NURSING SVCS 623000 6901451 6901451 WELLNESS CENTER 623000 29920 29920 6931371 2047 2047 MEAL REVENUE 623000 24673 24673 OTHER MISCELLANEOUS 623000 414 414 25087 7148344 6931371 0 27134 104448 104448 3523928 3115192 408736 62998 58139 4859 545039 480107 64932 233623 201474 32149 8500 8500 20201 20201 1238715 1190511 48204 25137 25137 271844 240591 31253 40783 40783 191204 191204 13574 8697 4877 8478 8478 168132 168132 479356 472346 7010 64119 50420 13699 UNCOLLECTIBLE ACCOUNTS 407212 407212 DRUGS 213797 213797 MEDICAID BED TAX 171360 171360 MISCELLANEOUS 89010 80725 8285 7881458 7049907 831551 0 210318 249505 51868 120233 924055 896349 10403 8733 43123 26873 12620327 3419052 5573508 9201275 196370 197763 176655 162698 7186300 10863429 2357586 568213 1377883 7363111 6375 2788 1089602 1816367 3123944 6647813 11058056 X 344775 -317859 193712 123232 538487 -194627 7186300 10863429 -733114 0 X 0 1 1 X 0 X 2997 8848 5977 194447 189839 402108 5418389 5749853 6372974 6479062 6931371 30951649 5421386 5758701 6378951 6673509 7121210 31353757 0 981923 969364 1241623 1632444 1687044 6512398 981923 969364 1241623 1632444 1687044 6512398 24841359 7663 5218 601 586 2047 16115 7663 5218 601 586 2047 16115 9787 9610 10195 10438 25087 65117 5438836 5773529 6389747 6684533 7148344 31434989 0.79020 0.80430 0.00050 0.00070 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 10169271 55672 702470 10927413 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 2910 2910 10154878 2626716 7528162 1955222 697889 1257333 507317 94447 412870 9201275 DUE TO AFFILIATES 3123944 3123944 7148344 7881458 -733114 0 -733114 6959660 0 6959660 188684 188684 7148344 7881458 0 7881458 0 7881458 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 INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS INCLUDE THE FOLLOWING: WISCONSIN MASONIC FOUNDATION - HOME ENDOWMENT FUND: THESE FUNDS ARE HELD BY THE RELATED ORGANIZATION, WISCONSIN MASONIC FOUNDATION. THE INTEREST IN THE NET ASSETS OF THE FOUNDATION IS REFLECTED ON THE BALANCE SHEET OF WISCONSIN MASONIC HOME. THESE FUNDS AVAILABLE FOR USE BY WISCONSIN MASONIC HOME ARE USED FOR GENERAL OPERATING PURPOSES, AND SUPPORT THE CHARITABLE MISSION OF WISCONSIN MASONIC HOME. THE OHDE FUND: THIS FUND IS INCLUDED IN THE NET ASSETS OF WISCONSIN MASONIC HOME. THE FUNDS UNDER THE OHDE ENDOWMENT ARE TO BE USED FOR PRESENT AND FUTURE RESIDENTS OF THE WISCONSIN MASONIC HOME, COMPASS POINT AND THE RIVERSIDE LODGE, WHO CANNOT AFFORD TO PAY FOR THEIR OWN CARE. THE CUMMINGS FUND: THIS FUND IS INCLUDED IN THE NET ASSETS OF WISCONSIN MASONIC HOME. THE FUNDS UNDER THE CUMMINGS ENDOWMENT ARE TO BE USED TO PROVIDE SERVICES WHICH WILL IMPROVE RESIDENT QUALITY OF LIFE. EXAMPLES OF THESE SERVICES INCLUDE (1) MEDICAL ASSESSMENT AND CARE, (2) SPIRITUAL ACTIVITY, AND (3) ACTIVITIES, LEADERSHIP AND COMMUNITY EVENTS. ACTIVITIES, LEADERSHIP AND COMMUNITY EVENTS WOULD INCLUDE STAFF AND PROGRAMS THAT WOULD PROVIDE ATTENTION TO EDUCATION, ENTERTAINMENT, TRANSPORTATION, PERSONAL DEVELOPMENT, AND OTHER ACTIVITIES RELATING TO RESIDENT PREFERENCES. THE BUTLER PERPETUAL TRUST: THE BUTLER PERPETUAL TRUST HAS BEEN ESTABLISHED FROM AN ESTATE, AND IS CURRENTLY REFLECTED ON THE BALANCE SHEET OF WISCONSIN MASONIC HOME AS PART OF RESTRICTED NET ASSETS. WISCONSIN MASONIC HOME EXERTS NO INFLUENCE OR CONTROL OVER THE INVESTMENTS. THIS ENDOWMENT WILL BE USED TO SUPPORT THE CHARITABLE MISSION OF WISCONSIN MASONIC HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XII, LINE 4B - OTHER ADJUSTMENTS: CARING TO GROW PLEDGES 188,684. X 0 0 0 0 0 0 0 0 0 0 0 MARK STRAUTMANN 46151 107685 1500 3500 2551 5953 2390 5576 8540 19926 61132 142640 0 0 PART I, LINE 1A HEALTH CLUB FEES FOR THE CEO ARE INCLUDED IN HIS COMPENSATION. THESE FEES ARE INCLUDED AS A REVIEWED ITEM IN THE COMPENSATION PROCESS. 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, AN EXECUTIVE 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 312818 1635937 127316 1476496 32124 2003 1 0 1 1 72000 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 ARE ONLY ISSUED AS THE CONSTRUCTION DRAWS ARE SUBMITTED. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 A WELLNESS CENTER WAS ADDED. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 THE ORGANIZATION'S PHYSICAL REHABILITATION SERVICES WERE ENHANCED BY THE CONSTRUCTION OF A NEW AREA TO HOUSE 14 PRIVATE BEDS AND A THERAPY GYM. 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. APPOINTS THE CHAIR AND OTHER MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF WISCONSIN MASONIC HOME, INC HAS CERTAIN RESERVE POWERS OVER THE DECISIONS MADE BY THE BOARD OF DIRECTORS OF MASONIC CENTER FOR HEALTH AND REHAB, INC. 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. MANAGEMENT REVIEWS THE 990, THEN THE BOARD REVIEWS. 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 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 DEVOTES APPROXIMATELY 40 HOURS PER WEEK AS FOLLOWS: WISCONSIN MASONIC HOME - 16 HOURS, MASONIC CENTER FOR HEALTH AND REHAB, INC - 12 HOURS, VILLAGE ON THE SQUARE - 12 HOURS. DAVE OINES 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. 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 7 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 PER NOTICE 2012-4 THE IRS MODERNIZED EFILE(MEF) SYSTEM WAS NOT AVAILABLE FROM JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012 FOR ELECTRONIC FILING OF EXEMPT ORGANIZATION RETURNS.