2012-03-15T11:15:17-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 391662636 VILLAGE ON THE SQUARE INC VILL 2629652111 410 N MAIN STREET DOUSMAN WI 531189348 DAVE OINES 2629652111 2012-03-03 1 6123764500 2010 2016-02-24 21:20:13Z MARK STRAUTMAN 410 N MAIN STREET DOUSMAN WI 531189348 2146949 0 X WWW.THREEPILLARS.ORG X 1989 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING QUALITY HOUSING. 3 1 38 100 0 0 20830 16865 1683450 1831649 197964 298435 0 0 1902244 2146949 0 0 0 0 808355 755651 0 0 0 1727437 1803001 2535792 2558652 -633548 -411703 15447278 16388062 18173074 18537289 -2725796 -2149227 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 SERVICES AND ACCESS. 0 0 2146207 1831649 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 85. 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, 128 RESIDENTS LIVED AT VILLAGE ON THE SQUARE. 2146207 1 1 0 0 0 0 0 0 1 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 38 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 X DAVE OINES 2629657203 410 N MAIN ST DOUSMAN WI 531189348 X MONTE STEIBER 1.00 X X 0 0 0 DAVID OINES 6.00 X X 15216 86226 15963 MARK STRAUTMAN 12.00 X X 50202 117138 36432 WAYNE JOHNSON 1.00 X X 0 0 0 65418 203364 52395 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 260520 1 16865 16865 SERVICES TO RESIDENTS 623990 1831649 1831649 1831649 245605 245605 52830 52830 52830 52830 2146949 1831649 0 298435 75521 75521 536137 403276 132861 7076 4665 2411 111661 73620 38041 25256 16652 8604 782 782 10027 10027 24187 24187 88882 79159 9723 46501 46501 97320 72682 24638 11979 11979 259322 259322 12305 11110 1195 2620 2620 310893 310716 177 612796 601869 10927 34563 34563 DINING SERVICES 234165 234165 MISCELLANEOUS EXPENSES 56659 44408 12251 2558652 2146207 412445 0 148465 125970 3743 11183 76800 82200 6842 6842 25152 16402 14050066 6576428 7781724 7473638 7289250 8578576 115302 93251 15447278 16388062 273554 222288 417331 1358068 6441844 6195245 11040345 10761688 18173074 18537289 X -2725796 -2149227 -2725796 -2149227 15447278 16388062 X -411703 988272 X 0 1 1 X 0 X 8715 16201 19678 20830 16865 82289 1625092 1663295 1675681 1683451 1831649 8479168 1633807 1679496 1695359 1704281 1848514 8561457 0 0 0 8561457 389631 385261 328271 204353 245605 1553121 389631 385261 328271 204353 245605 1553121 2050 2050 2023438 2064757 2025680 1908634 2094119 10116628 0.84630 0.84440 0.15350 0.15540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10169271 55672 702470 10927413 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 12749345 5774484 6974861 426729 288140 138589 654126 357582 296544 219866 156222 63644 7473638 POOLED INVESTMENTS 8578576 F 8578576 REFUNDABLE RESIDENCY FEES 5392055 REFUNDABLE ADVANCE FEES 40457 RELATED-PARTY PAYABLE TO WISCONSIN MASONIC HOME 5329176 10761688 2146949 2558652 -411703 988272 988272 576569 2130084 0 2130084 16865 16865 2146949 2558652 0 2558652 0 2558652 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 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 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL,AND STATE AUTHORITIES. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM RELATED ORGANIZATION 16,865. X 0 0 0 0 0 0 0 0 0 0 0 MARK STRAUTMAN 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 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, 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. 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 2004-12-29 1000000 2004B THREE PILLARS SR LIVING COMMUNITIES- RENOVATION OF COMMON AREAS 0 0 0 1308856 6844844 532702 6177732 134410 2003 1 0 1 1 345991 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. 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 ANNUALLY. 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 VILLAGE ON THE SQUARE ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SHARING 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 988,272. 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 7 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 PER NOTICE 2012-4 THE IRS MODERNIZED EFILE(MEF) SYSTEM WAS NOT AVAILABLE FROM JANUARY 1, 2012 THROUGH JANUARY 29, 2012 FOR ELECTRONIC FILING OF EXEMPT ORGANIZATION RETURNS.