2023-05-11T15:48:50-05:00 2022-06-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2021-07-01 580911706 MAGNOLIA MANOR INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2023-05-11 1 MARK TODD XXX-XX-XXXX AMY BIBBY P00445891 8282542254 2023-05-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 33333241 0 X WWW.MAGNOLIAMANOR.COM X 1962 GA THE CORPORATION IS ORGANIZED TO PROVIDE AFFORDABLE HOUSING AND LONG-TERM CARE AND ASSISTED LIVING TO THE ELDERLY IN A SPIRITUAL SETTING. THE CORPORATION OPERATES A LONG-TERM CARE FACILITY, FIVE RETIREMENT COMMUNITIES AND SEVERAL MORE INDEPENDENT LIVING APARTMENT COMPLEXES THROUGHOUT SOUTH AND MIDDLE GEORGIA. 12 12 507 17 0 0 787932 995748 24637014 23189205 4325424 3865754 6261034 5222283 36011404 33272990 0 0 0 0 16376967 15604327 0 0 597170 16664190 17008277 33041157 32612604 2970247 660386 105196135 101720114 46916241 53133859 58279894 48586255 X THE CORPORATION IS ORGANIZED TO PROVIDE AFFORDABLE HOUSING AND LONG-TERM CARE AND ASSISTED LIVING TO THE ELDERLY IN A SPIRITUAL SETTING. THE CORPORATION OPERATES A LONG-TERM CARE FACILITY, FIVE RETIREMENT COMMUNITIES AND SEVERAL MORE INDEPENDENT LIVING APARTMENT COMPLEXES THROUGHOUT SOUTH AND MIDDLE GEORGIA. 0 0 23539573 27995850 THE ORGANIZATION PROVIDES RESIDENTIAL SERVICES TO THE SICK AND AGED IN A SPIRITUAL SETTING. THE ORGANIZATION PROVIDES THESE SERVICES THROUGH THE OPERATION AND LONG-TERM CARE AND ASSISTED AND INDEPENDENT LIVING FACILITIES. THE ORGANIZATION OPERATES 268 LONG-TERM SKILLED NURSING BEDS AND APPROXIMATELY 600 ASSISTED LIVING AND INDEPENDENT LIVING BEDS IN SEVERAL FACILITIES THROUGHOUT THE STATE OF GEORGIA. 23539573 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 99 0 1 507 1 0 1 CJ 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 GA X THE ORGANIZATION 2299315907 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK JOHNSON BOARD OF TRUSTEE CHAIRMAN 1.00 5.00 X X 0 0 0 CHUCK REEVES BOARD OF TRUSTEE VICE CHAIRMAN 1.00 5.00 X X 0 0 0 JEAN WHEELER BOARD OF TRUSTEE SECRETARY 1.00 5.00 X X 0 0 0 HAL WEATHERS BOARD TRUSTEE 1.00 5.00 X 0 0 0 EDIE VINSON BOARD TRUSTEE 1.00 5.00 X 0 0 0 WILL PETERSON BOARD TRUSTEE 1.00 5.00 X 0 0 0 ANN HARRIS BOARD TRUSTEE 1.00 5.00 X 0 0 0 CHARLES PRYOR BOARD TRUSTEE 1.00 5.00 X 0 0 0 GEORGE YOUMANS JR BOARD TRUSTEE 1.00 5.00 X 0 0 0 CHARLES SHEFFIELD BOARD TRUSTEE 1.00 5.00 X 0 0 0 ED COLLIER BOARD TRUSTEE 1.00 5.00 X 0 0 0 TY TURNER BOARD TRUSTEE 1.00 5.00 X 0 0 0 MARK TODD CEO 40.00 20.00 X 322190 0 9766 HILLERY FORT COO 40.00 20.00 X 236133 0 27667 SCOTT ADKINS CFO 40.00 X 196338 0 25741 DIANE HARRISON VP OF HUMAN RESOURCES 40.00 X 189355 0 17932 LORI PORTFLEET VP FOR OPERATIONS 40.00 X 159221 0 22033 MELVIN KINSLOW VP OF COMMUNICATIONS 40.00 X 157290 0 27667 SUSAN FUSSELL VP FOR RESIDENT SAFETY & ER 40.00 X 128214 0 9086 BARBARA MITCHELL VP FOR CLINICAL 40.00 X 119270 0 9836 DAVID PRINCE VP FOR INFORMATION SYSTEMS 40.00 X 104319 0 9086 JOY ROBERTS VP FOR CLINICAL REIMBURSEMENT 40.00 X 103608 0 15410 ANDREA EVANS VP OF CORPORATE SALES 40.00 X 102080 0 22458 1818018 0 196682 11 0 1 0 PIEDMONT CONSTRUCTION 107 GATEWAY DR SUITE B MACON GA 31210 CONSTRUCTION SERVICES 4391300 CHRIS R SHERIDAN & CO PO BOX 4441 MACON GA 31208 MAINTENANCE/CONSTRUCTION 2607494 ACCOUNTABLE HEALTHCARE STAFFING PO BOX 732800 DALLAS IL 606756773 NURSING CONTRACT SERVICES 1088051 SOLUTION ADVISORS 12425 28TH STREET N SUITE 100 ST PETERSBURG FL 33716 CONSULTING 373496 SIMPLY ELEGANT LANDSCAPING 170 CANTLEY DR C COBB GA 31735 GROUNDS SERVICING 216890 13 4750 990998 41685 995748 ROUTINE ROOM/BOARD 623000 13849315 13849315 MEDICARE/MEDICAID PAYMENT 623000 8149191 8149191 STIMULUS OPERATING REVENUE 623000 1190699 1190699 23189205 1400931 1400931 1045 0 1045 1045 1045 2464222 601 0 0 2464222 601 2464823 2464823 179520 4750 59442 120078 120078 809 -809 -809 MANAGEMENT FEE REVENUE 541610 4367974 4367974 CAFETERIA SALES 623000 242894 242894 MISCELLANEOUS INCOME 900099 125480 125480 365621 195541 170080 5101969 33272990 27995850 0 4281392 X 1371969 1371969 11237479 8788772 2123023 325684 225199 122637 95829 6733 1893116 1432351 396377 64388 876564 623675 230045 22844 1945368 582767 1362601 163633 163633 106820 106820 48000 48000 5339970 4917558 420927 1485 273160 44183 228871 106 -177415 -981028 689511 114102 84519 68646 15873 1830248 1830248 361027 86320 246807 27900 807937 807937 2288374 2288374 1114429 464506 649923 SUPPLIES 1135416 844482 272879 18055 RAW FOOD 1117727 1117727 MEDICAL SUPPLIES 237586 237586 DRUGS 202170 202170 129308 129308 32612604 23539573 8475861 597170 1740397 2389445 5966426 15844494 5004456 372020 1605155 1576426 51947 50922 88702 139633 89193866 51350956 34849485 37842910 43777761 30280327 484556 441346 11627250 12782591 105196135 101720114 4413436 4193480 6787164 6351036 1139453 1103868 19658232 19322111 14917956 22163364 46916241 53133859 X 54856603 44929311 3423291 3656944 58279894 48586255 105196135 101720114 X 660386 -7794259 30493 -2590259 X X 0 1 X 1 0 X 613356 465143 936146 787932 995748 3798325 31358303 31066514 27426561 30249049 27995850 148096277 101443 85116 186559 32073102 31616773 28362707 31036981 28991598 152081161 5104 5100 5600 17050 32854 0 5104 5100 5600 17050 32854 152048307 717443 724244 986923 1557028 1401976 5387614 717443 724244 986923 1557028 1401976 5387614 1056905 439718 534051 601276 281341 2913291 33847450 32780735 29883681 33195285 30674915 160382066 0.94800 0.94890 0.03360 0.02830 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 48000 48000 0 PART II-B, LINE 1: THE ORGANIZATION ENTERED INTO A CONTRACT WITH A LAW FIRM TO PERFORM LOBBYING ON THEIR BEHALF. NO DIRECT LOBBYING PAYMENTS WERE MADE TO ANY SPECIFIC CANDIDATE. 5931164 359133 1272045 5018252 4739719 1372072 180627 5931164 4661573 261746 183600 4739719 4464076 361358 163861 4661573 13939069 13939069 1.00000 0 0 2189068 2189068 62596845 37401161 25195684 13763179 12069070 1694109 10644774 1880725 8764049 37842910 INDENTURE AGREEMENT 330133 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 16829 OTHER RECEIVABLES 12435629 12782591 DUE TO RELATED ORGANIZATIONS 22163364 22163364 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE HELD TO PROVIDE SUPPORT OF OPERATIONS AND PATIENT SUPPORT. PART X, LINE 2: THE CORPORATION AND CERTAIN OF ITS AFFILIATES ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SEC. 501(C) (3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, A PROVISION FOR INCOME TAXES HAS NOT BEEN MADE ON THE FINANCIAL STATEMENTS. GEORGIA PHARMACY VENTURES, LLC FILES AS A PARTNERSHIP. THE CORPORATION FILES ITS FORM 990, RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAX, IN THE U.S. FEDERAL JURISDICTION AND WITH THE STATE OF GEORGIA. THIS FORM IS OPEN FOR PUBLIC INSPECTION. THE CORPORATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ALL TAX POSITIONS TAKEN, AND THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2022 AND 2021. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, INVESTMENTS INVESTMENT IN CAPTIVE INSURANCE.LIST 74 _ 2JOHN.MODLIN@DHG.COM - 11/30/21 09:19 AM WORKSHEET SCHEDULE F - STATEMENT OF ACTIVITIES OUTSIDE THE U.S. AFS - TOTAL ASSETS MMI ASSURAN _ 4998000 5076000 0 0 0 0 0 0 5076000 0 5076000 1 0 1 0 0 0 PART III ACCOUNTING METHOD: X X X X JOHN GILL MEMORIAL QUAIL HUNT 61250 61250 3201 18513 336 4981 EVENING WITH MAGNOLIA 59970 4750 55220 8209 500 6222 300 1629 2 63050 63050 1150 6923 4172 3306 184270 4750 179520 12560 25936 10730 300 9916 59442 120078 X 0 0 0 0 0 0 0 0 0 MARK TODD CEO 322030 0 160 0 0 0 0 0 9766 0 331956 0 0 0 HILLERY FORT COO 235974 0 159 0 0 0 0 0 27667 0 263800 0 0 0 SCOTT ADKINS CFO 196176 0 162 0 0 0 0 0 25741 0 222079 0 0 0 DIANE HARRISON VP OF HUMAN RESOURCES 189193 0 162 0 0 0 0 0 17932 0 207287 0 0 0 MELVIN KINSLOW VP OF COMMUNICATIONS 157128 0 162 0 0 0 0 0 27667 0 184957 0 0 0 LORI PORTFLEET VP FOR OPERATIONS 159059 0 162 0 0 0 0 0 22033 0 181254 0 0 0 A AMERICUS AND SUMTER COUNTY HOSPITAL AUTHORITY 586000058 030695DL1 2013-08-15 20818202 REFINANCE EXISTING DEBT 0 0 0 B AMERICUS AND SUMTER COUNTY HOSPITAL AUTHORITY 586000058 2020-08-25 37114739 REFINANCE EXISTING DEBT AND LAND 0 0 0 A 20818202 2138038 860334 267545 19763862 1 0 1 1 B 12662227 24451512 2043 1 0 0 0 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 X 3 41685 FMV 0 0 0 FORM 990, PART V, LINE 13A GA FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS ELECTRONICALLY PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C REVIEWED AT QUARTERLY COMPLIANCE COMMITTEE MEETINGS AND ANNUALLY AT BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES ESTABLISHES THE CEO'S SALARY BASED ON INDUSTRY NORMS AND COMPENSATION STUDIES FOR SIMILAR TYPE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE LOCATED IN AMERICUS, GEORGIA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE LOCATED IN AMERICUS, GEORGIA. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,846,349. MANAGEMENT AND GENERAL EXPENSES 223,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,069,366. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 55,860. MANAGEMENT AND GENERAL EXPENSES 197,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 253,770. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 15,349. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 1,485. TOTAL EXPENSES 16,834. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS -2,590,259. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MAGNOLIA MANOR OF COLUMBUS INC 2001 SOUTH LEE STREET AMERICUS GA 31709 208034409 OPERATION OF (2) NURSING FACILITIES AND A RETIREMENT FACILITY GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON SUPPORTIVE HOUSING INC 2001 SOUTH LEE STREET AMERICUS GA 31709 311651955 HUD SUPPORTIVE HOUSING FACILITY GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MARION COUNTY INC 2001 SOUTH LEE STREET AMERICUS GA 31709 201220860 LEASE AND OPERATION OF A LONG-TERM CARE FACILITY GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF ST SIMONS INC 2001 SOUTH LEE STREET AMERICUS GA 31709 201364957 LEASE AND OPERATION OF A LONG-TERM CARE FACILITY AND A RETIREMENT COMMUNITY GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON INC 2001 SOUTH LEE STREET AMERICUS GA 31709 261311379 OPERATION OF AN ASSISTED LIVING FACILITY GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF LIBERTY COUNTY INC 2001 SOUTH LEE STREET AMERICUS GA 31709 842738089 OPERATION OF A NURSING FACILITY GA 501(C)(3) LINE 10 0 GEORGIA PHARMACY VENTURES LLC 440 INDUSTRIAL BOULEVARD HAWKINSVILLE GA 31036 261918757 PROVIDES PHARMACY RELATED PRODUCTS AND SERVICES TO MAGNOLIA MANOR RESIDENTS GA MAGNOLIA MANOR INC RELATED 556008 248206 0 0 0.25960 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ MAGNOLIA MANOR INC C 1668629 5075764 1.00000 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0