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 390813463 Wisconsin Masonic Home Inc WISC 2629652111 410 N Main Street Dousman WI 531189348 Dave Oines 2629652111 2011-05-12 1 6123764500 2009 2016-02-24 21:20:13Z Mark Staurtman 410 N Main Street Dousman WI 531189348 4906945 0 X www.threepillars.org X 1953 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS THROUGH QUALITY HOUSING. 13 13 126 45 0 0 266210 311203 3867096 3986055 1128455 605208 0 5261761 4902466 19580 20630 0 2409123 2391110 0 93613 2697164 2767351 5125867 5179091 135894 -276625 54093246 58678791 14899232 14886692 39194014 43792099 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 0 2686111 20630 3000344 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. A meals on wheels program is also available to the non resident community. On average, 74 residents are served on a daily basis, and 7% of the residents are able to continue living with a spouse. 850741 0 706584 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, in a more secure environment. Several of the 16 residents are likely to have memory care needs. 473537 0 279127 MASONWOODS - An independent living option is availabe for persons 55 and older. Social interaction and security are important to the 53 resideNts living in the facility on an average daily basis, and 62% of the units are occupied by couples. 4010389 1 1 0 0 0 0 0 0 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 0 0 1 35 0 1 126 1 0 0 0 0 0 0 0 0 0 13 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X Dave Oines 2629652111 410 N Main St Dousman WI 531189348 JEFF BRYDEN 1.00 X 0 0 0 ROBERT GORSUCH 1.00 X 0 0 0 GARY KRAUSE 1.00 X 0 0 0 JOE HARKER 1.00 X 0 0 0 ALLAN ILDING 1.00 X 0 0 0 A WILLIAM HUELSMAN 1.00 X 0 0 0 ROBERT MOORE 1.00 X 0 0 0 KRIS ENGBRING 1.00 X 0 0 0 GARY STANG 1.00 X 0 0 0 DENNIS SIEWERT 1.00 X 0 0 0 MONTE STEIBER 1.00 X 0 0 0 FRANK STRUBLE 1.00 X 0 0 0 DAVEY WHITE 1.00 X 0 0 0 MARK STRAUTMAN 40.00 X 65469 88577 26856 DAVID OINES 40.00 X 39075 47758 19679 104544 136335 46535 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 386223 1 311203 311203 RESIDENT SCV REVENUE 623000 3986055 3986055 3986055 609687 609687 4479 -4479 -4479 -4479 4902466 3986055 0 605208 20630 20630 114083 114083 1798778 1486019 312759 45276 35173 10103 240360 186725 53635 192613 149633 42980 28488 28488 11677 11677 60989 60989 55042 55042 36639 36639 355648 289694 65954 6125 6125 6287 6287 484024 483731 293 875183 735874 139309 74267 20098 54169 DINING SERVICES 377070 377070 PURCHASED SERVICES 191426 57540 40273 93613 SUPPLIES 140410 104126 36284 OTHER MISCELLANEOUS 32243 32243 UNCOLLECTIBLE ACCOUNTS 31833 31833 5179091 4010389 1075089 93613 1175748 1096954 380798 303242 106248 63035 37544 60878 20913515 5184891 16121672 15728624 18689825 20975216 10697987 13153526 6883424 7297316 54093246 58678791 693217 851403 12728015 12367289 1478000 1668000 14899232 14886692 X 23380923 25733558 5112159 7285600 10700932 10772941 39194014 43792099 54093246 58678791 X 0 1 1 X 0 X 1166038 1018945 543412 266210 311203 3305808 1166038 1018945 543412 266210 311203 3305808 3305808 930128 1409458 1349254 997842 609687 5296369 8602177 17047747 0.38430 0.33930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 504824 504824 17263458 3554847 13708611 1880115 917004 963111 1085272 599122 486150 179846 113918 65928 15728624 POOLED INVESTMENTS 19859450 F FUNDS HELD BY TRUSTEES UNDER BOND INDENTURE AGREEMENTS 1115766 F 20975216 INVESTMENT IN NET ASSETS OF WISCONSIN MASONIC FOUNDATION 13153526 F 13153526 DEFERRED FINANCE CHARGE 242804 Related Party Receivable 7054512 7297316 REFUNDABLE RESIDENCY FEES 1668000 1668000 4902466 5179091 -276625 1565227 3309483 4874710 4598085 5961790 1059324 1059324 4902466 0 4902466 5158461 0 5158461 20630 20630 5179091 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 XI, Line 8 - Other Adjustments: CHANGE IN INTEREST IN NET ASSETS OF WISCONSIN MASONIC FOUNDATION: 3268353. Restricted Contributions: 9000. Change in Value of Contributions Receivable: -7137. Change in Value of Perpetual Trust: 39267. Part XII, Line 2d - Other Adjustments: net assets released from restriction: 1059324. Part XIII, Line 4b - Other Adjustments: TRANSFER TO AFFILIATE: 20630. 1 village on the square 410 n main street dousman WI 53118 391662636 501(c)(3) 20630 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 62199 84152 0 0 3270 4425 6316 8546 5097 6897 76882 104020 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 2003-10-14 3869942 WHEFA 2003 SERIES (THREE PILLARS SENIOR LIVING COMM.) REFINANCE 1996 BONDS 0 0 WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REV BDS SERIES 2004A 391337855 97670FAA9 2004-12-29 5125000 WHEFA 2004A (THREE PILLARS SENIOR LIVING COMM.) CONSTRUCTION COMPASS POINT 0 0 WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REV BDS SERIES 2004b 2 391337855 97670FAM3 2004-12-29 6500000 WHEFA 2004B (THREE PILLARS SENIOR LIVING COMM.) CONSTRUCTION COMPASS POINT 0 0 3861166 300496 3484850 75820 2003 1 0 1 1 5077307 351806 101546 4623955 2006 0 0 1 1 6500000 118309 6381691 2006 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 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 4 In May of 2010, the following changes were made to the bylaws of Wisconsin Masonic Home: -Increased the number of Directors from 15 to 16. -Added the Grand Master of Masons of Wisconsin as an ex-officio director. -Changed authority for filling a vacancy from Directors in office to an election of the Members from persons recommended by the Grand Master of Masons of Wisconsin. -Identified the Grand Master of Masons of Wisconsin or his designee, who must be a Board member, as the Chairman of the Board of Directors. -Eliminated the Vice Chair as a Board Officer and adds a President and Vice President as Board Officers. -Added requirement of consent from the Members for certain duties of the President of the Corporation, including, but not limited to, signing contracts and incurring debt. -Eliminated ability of the Board to alter or amend the bylaws and replaces the authority with the Members. 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 MEMBERS OF THE CORPORATION ELECT 12 MEMBERS OF THE BOARD OF DIRECTORS. THE GRAND MASTER OF MASONS OF WISCONSIN APPOINTS THE REMAINING THREE MEMBERS OF THE BOARD OF DIRECTORS. 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 A COPY OF THE FORM 990 OF WISCONSIN MASONIC HOME, INC. WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. 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 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. Form 990, Part VII, Line 1 Shared 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 53118 391506910 REHABILITATION SERVICES WI 501(c)(3) Line 9 N/A VILLAGE ON THE SQUARE INC 410 N MAIN STREET DOUSMAN WI 53118 391662636 SENIOR ASSISTED LIVING WI 501(c)(3) Line 9 N/A GRAND LODGE FREE & ACCEPTED MASONS OF WISCONSIN 36275 SUNSET DRIVE DOUSMAN WI 53118 390129695 FRATERNAL ORGANIZATION WI 501(c)(8) & (c)(10) N/A Wisconsin Masonic Foundation 36275 SUNSET DRIVE DOUSMAN WI 53118 396044637 SCHOLARSHIP PROVIDER WI 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0