2012-03-15T11:14:59-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 390813463 WISCONSIN MASONIC HOME INC WISC 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 6419241 0 X WWW.THREEPILLARS.ORG X 1953 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS THROUGH QUALITY HOUSING. 14 14 137 45 0 0 311203 182930 3986055 4327205 605208 897042 0 11971 4902466 5419148 20630 16865 0 0 2391110 2578318 0 0 98021 2767351 2843894 5179091 5439077 -276625 -19929 58678791 63072233 14886692 14437364 43792099 48634869 X WISCONSIN MASONIC HOME, INC., SPONSORED BY THE MASONIC FRATERNITY, PROVIDES FOR THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS THROUGH HIGH QUALITY HOUSING AND SERVICES. 0 1 2933106 16865 3154652 COMPASS POINT - AN ASSISTED LIVING OPTION IS AVAILABLE FOR PERSONS AGED 55 AND OLDER IN A RESIDENTIAL CARE APARTMENT COMPLEX. THIS PROGRAM PROVIDES ASSISTED LIVING SERVICES, INCLUDING MEALS, WELLNESS SERVICES, SOCIAL ASSISTANCE, HOUSEKEEPING, AND ASSISTANCE WITH ACTIVITIES OF DAILY LIVING AND MEDICAL NEEDS. ON AVERAGE, 76 RESIDENTS ARE SERVED ON A DAILY BASIS, AND 9% OF THE RESIDENTS ARE ABLE TO CONTINUE LIVING WITH A SPOUSE. A MEALS ON WHEELS PROGRAM IS ALSO AVAILABLE TO THE NON RESIDENT COMMUNITY, AND PROVIDED 3,926 MEALS DURING THE YEAR. 827551 894641 RIVERSIDE LODGE - AN ASSISTED LIVING OPTION IS AVAILABLE FOR PERSONS AGED 55 AND OLDER IN A COMMUNITY BASED RESIDENTIAL FACILITY. THIS PROGRAM PROVIDES SERVICES SIMILAR TO THE ASSISTED LIVING IDENTIFIED ABOVE, WITH A FOCUS ON MEMORY CARE IN A SECURE ENVIRONMENT. ON AN AVERAGE DAY, 17 RESIDENTS ARE SERVED. 460303 277912 MASONWOODS - AN INDEPENDENT LIVING OPTION IS AVAILABE FOR PERSONS 55 AND OLDER. SOCIAL INTERACTION AND SECURITY ARE IMPORTANT TO THE 52 RESIDENTS LIVING IN THE FACILITY ON AN AVERAGE DAILY BASIS, AND 65% OF THE UNITS ARE OCCUPIED BY COUPLES. 4220960 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 46 0 137 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X DAVE OINES 2629657203 410 N MAIN ST DOUSMAN WI 531189348 X JEFF BRYDEN 1.00 X 0 0 0 TERRY BROWN 1.00 X 0 0 0 KRIS ENGBRING 1.00 X 0 0 0 WILLIAM FRAZIER 1.00 X 0 0 0 JOE HARKER 1.00 X 0 0 0 A WILLIAM HUELSMAN 1.00 X 0 0 0 ALLAN IDING 1.00 X 0 0 0 BARBARA RITCHIE 1.00 X 0 0 0 DENNIS SIEWERT 1.00 X 0 0 0 DAN SLAVIK 1.00 X 0 0 0 MONTE STEIBER 1.00 X 0 0 0 FRANK STRUBLE 1.00 X 0 0 0 TOM WALTON 1.00 X 0 0 0 DAVEY WHITE 1.00 X 0 0 0 ROBERT GORSUCH 1.00 X 0 0 0 GARY KRAUSE 1.00 X 0 0 0 ROBERT MOORE 1.00 X 0 0 0 GARY STANG 1.00 X 0 0 0 MARK STRAUTMAN 16.00 X 66936 100404 36431 DAVID OINES 18.00 X 45649 55793 15963 112585 156197 52394 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 406867 VJS CONSTRUCTION SERVICES INC W233 N2847 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 CONSTRUCTION SERVICES 229476 2 182930 182930 RESIDENT SCV REVENUE 623000 4327205 4327205 4327205 644354 644354 1252781 1000093 252688 252688 252688 MISCELLANEOUS NON-OPER 623000 11971 11971 11971 5419148 4327205 0 909013 16865 16865 129622 129622 1984266 1590560 393706 82284 66666 15618 189365 155064 34301 192781 146456 46325 2219 2219 17104 17104 70391 70391 698033 555655 44357 98021 38429 38429 89351 78883 10468 18514 18514 343903 251848 92055 6294 2853 3441 16160 16160 502816 502629 187 829885 740750 89135 77197 19926 57271 OTHER MISCELLANEOUS 127519 86726 40793 DINING SERVICES 6079 6079 5439077 4220960 1120096 98021 1096954 501721 303242 283110 63035 67865 9151 9151 51727 35393 21368958 5902197 15728624 15466761 20975216 22756251 13153526 14430682 7297316 9521299 58678791 63072233 851403 912490 12367289 11995874 1668000 1529000 14886692 14437364 X 25733558 29179280 7285600 8528176 10772941 10927413 43792099 48634869 58678791 63072233 X -19929 4862699 X 0 1 1 X 0 X 1018945 543412 266210 311203 182930 2322700 1018945 543412 266210 311203 182930 2322700 2322700 1409458 1349254 997842 609687 644354 5010595 11971 11971 7345266 19228327 0.31620 0.38430 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS NON-OPERATING INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10169271 55672 702470 10927413 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 504824 504824 18603414 4453906 14149508 914276 603215 311061 1152196 705602 446594 194248 139474 54774 15466761 POOLED INVESTMENTS 21637530 F FUNDS HELD BY TRUSTEES UNDER BOND INDENTURE AGREEMENTS 1118721 F 22756251 INVESTMENT IN NET ASSETS OF WISCONSIN MASONIC FOUNDATION 14430682 F 14430682 DEFERRED FINANCE CHARGE 222535 RELATED PARTY RECEIVABLE 8453120 TRUST & ESTATES RECEIVABLE 845644 9521299 REFUNDABLE RESIDENCY FEES 1529000 1529000 5419148 5439077 -19929 2699768 2162931 4862699 4842770 6184906 765758 765758 5419148 0 5419148 5422212 0 5422212 16865 16865 5439077 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 HOME'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION IN THE U.S. FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOME 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 XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF WISCONSIN MASONIC FOUNDATION 2,052,009. CHANGE IN VALUE OF CONTRIBUTIONS RECEIVABLE 12,122. CHANGE IN VALUE OF PERPETUAL TRUST 98,800. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 765,758. PART XIII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER TO AFFILIATE 16,865. 1 VILLAGE ON THE SQUARE 410 N MAIN STREET DOUSMAN WI 53118 391662636 501(C)(3) 16865 INCOME ON RESTRICTED FUND PAID TO VILLAGE ON THE SQUARE, INC. IN SUPPORT OF CERTAIN CATEGORIES OF EXPENSES. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ON AN ANNUAL BASIS, THE AUDIT AND FINANCE COMMITTEE OF THE ORGANIZATION REVIEWS THE FINANCIAL STATEMENTS AND GENERAL LEDGER OF THE DONEE, A RELATED ORGANIZATION, TO CONFIRM THAT THE GRANTS ARE USED FOR THE SPECIFIC PURPOSES AS INTENDED. X 0 0 X X X 0 0 0 0 0 0 0 0 0 MARK STRAUTMAN 61534 92302 2000 3000 3402 5102 3186 4780 11386 17079 81508 122263 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. WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REV BDS SERIES 2003 391337855 97710VPR9 2003-10-01 3869942 WHEFA 2003 SERIES (THREE PILLARS SENIOR LIVING COMM.) REFINANCE 1996 BONDS 0 0 0 WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REV BDS SERIES 2004B 2 391337855 97670FAA9 2004-12-10 5125000 WHEFA 2004A (THREE PILLARS SENIOR LIVING COMM.) CONSTRUCTION COMPASS POINT 0 0 0 WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REV BDS SERIES 2004B 2 391337855 97670FAM3 2004-12-10 6500000 WHEFA 2004B (THREE PILLARS SENIOR LIVING COMM.) CONSTRUCTION COMPASS POINT 0 0 0 738326 3861166 300496 3484850 75820 2003 1 0 1 1 475000 5077307 351806 101546 4623955 2006 0 0 1 1 2249009 6500000 118309 6381691 2006 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 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 THE TOTAL PROCEEDS OF ISSUANCE FOR THE SERIES 2004 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. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 RIVERSIDE LODGE IS A 20 UNIT COMMUNITY BASED RESIDENTIAL FACILITY. HISTORICALLY, IT HAS SERVED RESIDENTS PRIMARILY HAVING MEDICAL NEEDS BUT WITH INCREASING FREQUENCY OF THOSE WITH MEMORY CARE NEEDS. DURING THE YEAR, THE FOCUS CHANGED TO A MEMORY CARE UNIT, WITH REVISED PHYSICAL SURROUNDINGS AND SPECIALLY TRAINED STAFF. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE ORGANIZATION ARE THE MEMBERS OF THE WISCONSIN MASONIC BENEVOLENT ACTIVITIES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL CONSIST OF 12 MEMBERS WHO ARE ELECTED BY THE MEMBERS AND 4 MEMBERS WHO SERVE POSITIONS IN THE MASONIC FRATERNITY. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS HAVE CERTAIN RESERVE POWERS OVER THE DECISIONS OF THE BOARD OF DIRECTORS. 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. FORM 990, PART VI, SECTION B, LINE 15A AN EXECUTIVE COMMITTEE OF THE BOARD DETERMINED 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 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. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF WISCONSIN MASONIC HOME, 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,699,768. CHANGE IN INTEREST IN NET ASSETS OF WISCONSIN MASONIC FOUNDATION 2,052,009. CHANGE IN VALUE OF CONTRIBUTIONS RECEIVABLE 12,122. CHANGE IN VALUE OF PERPETUAL TRUST 98,800. TOTAL TO FORM 990, PART XI, LINE 5: 4,862,699. MASONIC CENTER FOR HEALTH AND REHAB INC 410 N MAIN STREET DOUSMAN WI 53118 391506910 REHABILITATION SERVICES WI 501(C)(3) LINE 9 WISCONSIN MASONIC HOME INC 1 VILLAGE ON THE SQUARE INC 410 N MAIN STREET DOUSMAN WI 53118 391662636 SENIOR ASSISTED LIVING WI 501(C)(3) LINE 9 WISCONSIN MASONIC HOME INC 1 GRAND LODGE FREE & ACCEPTED MASONS OF WISCONSIN 36275 SUNSET DRIVE DOUSMAN WI 53118 390129695 FRATERNAL ORGANIZATION WI 501(C)(8) & (C)(10) LINE 7 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 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 MASONIC CENTER FOR HEALTH AND REHAB INC N 857595 DIRECT ALLOCATION VILLAGE ON THE SQUARE INC N 147491 DIRECT ALLOCATION PER NOTICE 2012-4 THE IRS MODERNIZED EFILE(MEF) SYSTEM WAS NOT AVAILABLE FROM JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012 FPR ELECTRONIC FILING OF EXEMPT ORGANIZATION RETURNS.