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 391506910 Masonic Center for Health and Rehab Inc MASO 2629652111 410 N Main Street Dousman WI 531189348 David Oines 2629652111 2011-05-12 1 6123764500 2009 2016-02-24 21:20:13Z Mark Strautman 410 N Main Street Dousman WI 531189348 6684533 0 X www.Threepillars.org X 1985 WI MEET THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF OLDER ADULTS BY PROVIDING QUALITY HOUSING. 3 1 73 30 0 0 5977 194447 6372974 6479062 1951 586 10195 10438 6391097 6684533 0 0 4036098 4079964 0 15107 2915049 2657322 6951147 6737286 -560050 -52753 4047591 7186300 3456350 6647813 591241 538487 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. 0 0 5950411 0 6479062 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, and average of 78 residents per day for a total of 28,596 days of care were provided. 5950411 1 1 0 0 0 0 0 1 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 1 0 0 1 73 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 WI X Dave Oines 2629652111 410 N Main St Dousman WI 531189348 VIRGINIA ROMAINE 1.00 X 0 0 0 David Oines 16.00 X X 33865 52968 19679 Mark Strautmann 12.00 X X 53146 100900 26856 87011 153868 46535 0 0 1 0 RehabCare Group Inc PO BOX 503534 ST LOUIS MO 63150 Therapy Services 424769 Morrison Management Specialists PO Box 102289 Atlanta GA 30368 Dining Services 380223 Plunkett Raysich Architects LLP 11000 West Park Place Milwaukee WI 53224 Architectural Services 320381 3 194447 194447 SKILLED NURSING SVCS 623000 6479062 6479062 6479062 586 586 other miscellaneous 541900 10438 0 10438 10438 6684533 6479062 0 11024 95057 95057 3074148 2732965 341183 29949 25827 4122 666956 575150 91806 213854 184417 29437 12609 12609 32182 32182 27000 27000 28036 28036 26915 26915 60725 60725 143920 143920 3574 3574 5364 5364 73728 73672 56 285167 282862 2305 44118 31486 12632 Purchased Services 1058730 1038674 20056 Supplies 445918 445088 830 Uncollectible Accounts 378359 378359 Miscellaneous 30977 10991 4879 15107 6737286 5950411 771768 15107 159431 210318 51868 948854 924055 10316 10403 22870 43123 8520213 2946705 2678123 5573508 195668 196370 32329 176655 4047591 7186300 485411 2357586 1428751 1377883 8620 6375 1089602 1533568 1816367 3456350 6647813 X 591241 344775 193712 591241 538487 4047591 7186300 X 1 1 1 X 0 X 5231 2997 8848 5977 194447 217500 5204724 5418389 5749853 6372974 6479062 29225002 5209955 5421386 5758701 6378951 6673509 29442502 0 1223876 981923 969364 1241623 1295599 5712385 1223876 981923 969364 1241623 1295599 5712385 23730117 5233 7663 5218 601 586 19301 5233 7663 5218 601 586 19301 540 9787 9610 10195 10438 40570 5215728 5438836 5773529 6389747 6684533 29502373 0.80430 0.99800 0.00070 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 10136529 32742 10169271 9802031 334498 10136529 1.00000 1 1 1 2910 2910 4849164 2341795 2507369 990739 432773 557966 2677400 172137 2505263 5573508 Due to Affiliates 1816367 1816367 6684533 6737286 -52753 0 -52753 6490821 0 0 0 0 6490821 193712 193712 6684533 6737287 0 0 0 0 6737287 0 0 6737287 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. 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. X 0 0 0 0 0 0 0 0 0 0 0 Mark Strautmann 50491 95860 0 0 2655 5040 5127 9735 4138 7856 62411 118491 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 suvey. The process followed by the Committee, includeding 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 Wisconsin Health and Educational Facilities 391337855 2010-02-01 6300000 Draw down on private placement loan 0 0 1635937 127317 1476496 32124 2003 1 0 1 1 1089602 16104 1073498 2010 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 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. elects the outside director. 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 was reviewed by management, then posted to the organization's Board portal and hard copies were made available to board members for review. 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. 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. VILLAGE ON THE SQUARE INC 410 MAIN STREET DOUSMAN WI 53118 391662636 INDIVIDUAL LIVING FACILITIES WI 501(c)(3) Line 9 N/A WISCONSIN MASONIC HOME INC 410 MAIN STREET DOUSMAN WI 53118 390813463 SENIOR ASSISTED LIVING WI 501(c)(3) Line 7 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 501(c)(3) Line 7 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0