2011-05-12T11:11:08-05:00 2010-06-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-07-01 391662636 Village on the Square Inc VILL 2629652111 410 N Main Street Dousman WI 531189348 Dave Oines 2629652111 2011-05-12 1 6123764500 2009 2016-02-24 21:20:13Z Mark Strautman 410 N Main Street Dousman WI 531189348 1908633 0 X www.threepillars.org X 1989 WI Meet the social, physical, and spiritual needs or older adults by providing quality housing. 3 1 26 100 0 0 19678 20830 1675681 1683450 328271 197964 38217 0 2061847 1902244 0 0 774720 808355 0 0 1692730 1727437 2467450 2535792 -405603 -633548 14847733 15447278 17531396 18173074 -2683663 -2725796 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. 0 0 2063196 1683450 Village on the Square provides an independent living complex on a continuing care retirement campus for adultes 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, 121 residents lived at Village on the Square. 2063196 1 1 0 0 0 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 0 0 26 1 0 0 0 0 0 0 0 0 0 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 Wayne Johnson 1.00 X X 0 0 0 David Oines 6.00 X X 13893 72940 19679 Mark Strautman 12.00 X X 35431 118615 26856 49324 191555 46535 0 0 1 0 Morrison Management Specialists PO Box 102289 Atlanta GA 30368 Dining Services 234853 1 20630 200 20830 SERVICES TO RESIDENTS 623990 1683450 1683450 1683450 204353 204353 6389 -6389 -6389 -6389 1902244 1683450 0 197964 58649 58649 590962 406776 184186 119339 79111 40228 39405 25034 14371 1578 1578 7389 7389 22887 22887 81389 60928 20461 63321 63321 24860 24860 13675 13675 234044 234044 1374 1374 1544 1544 317670 317377 293 597980 587009 10971 50718 50718 Dining Services 213127 213127 Supplies 91568 88297 3271 Miscellaneous Expenses 4313 775 3538 2535792 2063196 472596 0 100080 148465 2561 3743 76800 6842 6842 12902 25152 13756283 5974559 8096544 7781724 6500333 7289250 128471 115302 14847733 15447278 250768 273554 314815 417331 6676684 6441844 4790652 5238145 5498477 5802200 17531396 18173074 X -2683663 -2725796 -2683663 -2725796 14847733 15447278 X 0 1 1 X 0 X 5000 8715 16201 19678 20830 70424 1678289 1625092 1663295 1675681 1683451 8325808 1683289 1633807 1679496 1695359 1704281 8396232 0 0 0 8396232 237174 389631 385261 328271 204353 1544690 237174 389631 385261 328271 204353 1544690 2050 2050 1920463 2023438 2064757 2025680 1908634 9942972 0.84440 0.84070 0.15540 0.15910 X Schedule A, Part II, Line 12, Explanation of Other Income: miscellaneous income RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 12539075 5299520 7239555 421249 258140 163109 595295 289074 306221 200664 127825 72839 7781724 Pooled Investments 7289250 F 7289250 REFUNDABLE RESIDENCY FEES 5765075 REFUNDABLE ADVANCE FEES 37125 5802200 1902244 2535792 -633548 591415 591415 -42133 1881614 0 1881614 20630 20630 1902244 2535792 0 2535792 0 2535792 Part V, Line 4: Description of Intended Use of Endowment Funds: 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, the Bark River Apartments 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. Part XII, Line 4b - Other Adjustments: TRANSFER FROM RELATED ORGANIZATION: 20630. X 0 0 0 0 0 0 0 0 0 0 0 Mark Strautman 33661 112690 0 0 1770 5925 3418 11444 2759 9235 41608 139294 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 suvey. The process followed by the Committee, includeding the data relied upon and the Committee's decisions, was thorougly and timely documented. WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VPF9 2003-10-14 6860402 2003 THREE PILLARS SR LIVING COMMUNITIES- ISSUED TO REFINANCE 1996 BONDS 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 6844844 532702 6177732 134410 2003 1 0 1 1 1000000 18202 981798 2006 0 0 1 1 0 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, 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 A copy of the form 990 was reviewed by management, and made available on the board portal of the organization's web site and given to the board as hard copies for review. 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. Form 990, Part VII, Line 1 Sharing hours 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. MASONIC CENTER FOR HEALTH AND REHAB INC 410 N MAIN STREET DOUSMAN WI 531189348 391506910 REHABILITATION SERVICES WI 501(c)(3) Line 9 N/A WISCONSIN MASONIC HOME INC 410 N MAIN STREET DOUSMAN WI 531189348 390813463 SENIOR ASSISTED LIVING WI 501(c)(3) Line 7 N/A GRAND LODGE FREE & ACCEPTED MASONS OF WISCONSIN 36275 SUNSET DRIVE DOUSMAN WI 531189348 390129695 FRATERNAL ORGANIZATION WI 501(c)(8) & (c)(10) N/A Wisconsin Masonic Foundation 36275 SUNSET DRIVE DOUSMAN WI 531189348 396044637 SCHOLARSHIP PROVIDER WI 501(c)(3) Line 7 N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0