2023-06-28T10:13:00-05:00 2022-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS RD STE 1500 RALEIGH NC 27609 990 2022-01-01 421566974 PENNSYLVANIA ACACIA INSURANCE COMPANY LTD PENN 8028601958 159 BANK STREET FOURTH FLOOR BURLINGTON VT 05401 WILLIAM L KINGSBURY PRESIDENT 8028601958 2023-06-27 1 WILLIAM KINGSBURY 999009999 0 J CALVIN MARKS P01226973 9197196400 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z WILLIAM KINGSBURY ONE MASONIC DRIVE ELIZABETHTOWN PA 17022 236191 0 X N/A X 2002 VT TO PROVIDE HEALTHCARE PROFESSIONAL LIABILITY, EMPLOYEE BENEFITS LIABILITY, SEXUAL MISCONDUCT LIABILITY AND GENERAL LIABILITY COVERAGE TO MASONIC VILLAGES 7 3 0 4 0 0 0 0 25000 25000 1288204 211191 0 0 1313204 236191 0 0 0 0 0 0 0 0 975 130963 161724 130963 161724 1182241 74467 16896427 14474796 603706 655520 16292721 13819276 THE ORGANIZATION WAS FORMED TO PROVIDE HEALTHCARE PROFESSIONAL LIABILITY, EMPLOYEE BENEFITS LIABILITY, SEXUAL MISCONDUCT LIABILITY AND GENERAL LIABILITY COVERAGE TO MASONIC VILLAGES, A NOT FOR PROFIT 501(C)(3) UNIT OF THE GRAND LODGE. 0 0 56196 25000 THE COMPANY PROVIDES HEALTHCARE PROFESSIONAL LIABILITY, EMPLOYEE BENEFITS LIABILITY, SEXUAL MISCONDUCT LIABILITY AND GENERAL LIABILITY COVERAGE TO A NOT-FOR-PROFIT AFFILIATE, MASONIC VILLAGES. 56196 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 1 0 X STRATEGIC RISK SOLUTIONS 8028601958 159 BANK STREET FOURTH FLOOR BURLINGTON VT 05401 WILLIAM KINGSBURY PRESIDENT/DIRECTOR 1.00 40.00 X X 0 485052 31934 PAMELA S FORMICA TREASURER/DIRECTOR 1.00 40.00 X X 0 317487 26598 DEBRA BROCKMAN VP/DIRECTOR 1.00 40.00 X X 0 238251 26046 PATRICK SAMPSELL DIRECTOR (FROM OCT '22) 1.00 X 0 224611 29341 ROBERT SNYDER II CHAIRPERSON/DIRECTOR 1.00 20.00 X X 0 0 0 STEPHANIE MAPES SECRETARY/DIRECTOR 1.00 X X 0 0 0 MICHAEL MAGLARAS ASST SECRETARY/DIRECTOR 2.00 X X 0 0 0 0 1265401 113919 0 0 1 0 0 PREMIUMS EARNED 524126 25000 25000 25000 211191 211191 236191 25000 0 211191 X 40425 40425 9428 9428 22209 22209 31836 31836 LOSSES AND LAE EXPENSES 40000 40000 DUES AND REGULATORY FEE 10360 9385 975 VERMONT PREMIUM TAX 7500 7500 PREMIUM DEFICIENCY -689 -689 655 655 161724 56196 104553 975 20056 60145 143061 234048 10106 10106 16694722 14146810 28482 23687 16896427 14474796 51978 64481 10417 10417 541311 580622 603706 655520 X 0 0 2500000 2500000 13792721 11319276 16292721 13819276 16896427 14474796 74467 -2547912 0 X 0 1 X 1 0 X X 1 MASONIC VILLAGES 230846955 10 1 0 161724 1 0 161724 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 GRAND LODGE OF PENNSYLVANIA CONSOLIDATED FUND 14146810 F 14146810 LOSSES AND LOSS ADJUSTMENT EXPENSES 537249 PREMIUM RESERVE 43373 580622 X -2311721 -2547912 -2547912 236191 0 236191 161724 0 161724 0 161724 PART X, LINE 2: MANAGEMENT HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2022 AND 2021. 0 0 0 0 0 0 0 0 0 WILLIAM KINGSBURY PRESIDENT/DIRECTOR 0 485052 0 0 0 0 0 13967 0 17967 0 516986 0 0 PAMELA S FORMICA TREASURER/DIRECTOR 0 317487 0 0 0 0 0 15468 0 11130 0 344085 0 0 DEBRA BROCKMAN VP/DIRECTOR 0 238251 0 0 0 0 0 12076 0 13970 0 264297 0 0 PATRICK SAMPSELL DIRECTOR (FROM OCT '22) 0 224611 0 0 0 0 0 11374 0 17967 0 253952 0 0 PART I, LINE 3 THE CEO OF THE PARENT COMPANY (MASONIC VILLAGES) SERVES AS PRESIDENT OF PENNSYLVANIA ACACIA INSURANCE COMPANY. THE COMPENSATION OF MASONIC VILLAGES' CEO IS BASED UPON COMPENSATION SURVEYS AND IS APPROVED BY THE MASONIC VILLAGES' BOARD OF DIRECTORS. MICHAEL MAGLARAS ASSISTANT SECRETARY 18336 CONSULTING 0 FORM 990, PART VI, SECTION A, LINE 3 STRATEGIC RISK SOLUTIONS (SRS) OF VERMONT PROVIDES DAY TO DAY MANAGEMENT SERVICES TO THE COMPANY. FORM 990, PART VI, SECTION A, LINE 6 THE COMPANY HAS ONE MEMBER, THE MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA (THE PARENT). FORM 990, PART VI, SECTION A, LINE 7A MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA (SOLE MEMBER) MAY ELECT MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED AND SIGNED BY EITHER THE RW GRAND TREASURER OR PRESIDENT OF THE PARENT (MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA), FINANCE OFFICE STAFF, AND THE TREASURER OF PA ACACIA. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED ANNUALLY BY EACH OF THE OFFICERS AND DIRECTORS. THESE STATEMENTS ARE REVIEWED AND APPROVED AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 15B THE COMPANY HAS NO EMPLOYEES. HOWEVER, PAYMENTS FOR INSURANCE AND LEGAL CONSULTING SERVICES PROVIDED TO CERTAIN OFFICERS AND DIRECTORS ARE REVIEWED AND APPROVED BY THE TREASURER OR PRESIDENT OF THE COMPANY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 18,336. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,336. ACTUARIAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 13,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,500. MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA ONE MASONIC DRIVE ELIZABETHTOWN PA 17022 230846955 HEALTHCARE / CONTINUING CARE RETIREMENT COMMUNITIES PA 501 (C) (3) LINE 10 GRAND LODGE 0 GRAND LODGE OF FREE AND ACCEPTED MASONS OF PENNSYLVANIA ONE NORTH BROAD STREET PHILADELPHIA PA 19107 236407467 OVERSEE ACTIVITIES OF MASONIC ENTITIES & PROMOTE MASONIC CULTURE PA 501 (C)(10) N/A N/A 0 MASONIC CHARITIES FUND ONE MASONIC DRIVE ELIZABETHTOWN PA 17022 232720910 DISTRIBUTE CHARITABLE DONATIONS TO QUALIFYING CHARITABLE ORGANIZATIONS PA 501 (C) (3) LINE 7 GRAND LODGE 0 PENNSYLVANIA MASONIC YOUTH FOUNDATION 1244 BAINBRIDGE ROAD ELIZABETHTOWN PA 17022 232188997 PROVIDE GUIDANCE TO MASONICALLY RELATED YOUTH GROUPS PA 501 (C) (3) LINE 7 GRAND LODGE 0 MASONIC LIBRARY AND MUSEUM OF PENNSYLVANIA ONE NORTH BROAD STREET PHILADELPHIA PA 19107 232608317 MAINTAIN & OPERATE THE LIBRARY & MUSEUM IN THE MASONIC TEMPLE PA 501 (C) (3) LINE 7 GRAND LODGE 0 ACACIA SERVICES LLC ONE MASONIC DRIVE ELIZABETHTOWN PA 17022 260802515 OPERATE RESTAURANT AND CATERING SERVICES PA MASONIC VILLAGES UNRELATED 0 0 ASHLAR CREATIVE SOLUTIONS LLC ONE MASONIC DRIVE ELIZABETHTOWN PA 17022 463066105 CONSULTING, MANAGEMENT AND DEVELOPMENT SERVICES PA MASONIC VILLAGES UNRELATED 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0