2022-04-18T07:45:31-05:00 2021-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-07-01 201220860 MAGNOLIA MANOR OF MARION COUNTY INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2022-04-18 1 MARK TODD XXX-XX-XXXX AMY BIBBY P00445891 8282542254 2022-04-18 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 6595259 0 X WWW.MAGNOLIAMANOR.COM X 2004 GA THE CORPORATION IS ORGANIZED TO PROVIDE LONG-TERM CARE TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF A 70-BED SKILLED NURSING FACILITY LOCATED IN BUENA VISTA, GEORGIA. 11 11 103 0 0 0 0 0 6890423 6530469 9294 674 92462 64116 6992179 6595259 0 0 0 0 2927340 2833849 0 0 0 1933601 2152508 4860941 4986357 2131238 1608902 8416004 9966386 3044280 2778559 5371724 7187827 THE CORPORATION IS ORGANIZED TO PROVIDE LONG-TERM CARE TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF A 70-BED SKILLED NURSING FACILITY LOCATED IN BUENA VISTA, GEORGIA. 0 0 4251992 6533989 PROVIDED LONG-TERM CARE FOR THE SICK AND ELDERLY IN A SPIRITUAL SETTING IN A 70-BED SKILLED NURSING FACILITY. THE ORGANIZATION PROVIDED 19,058 PATIENT DAYS OF SERVICE DURING THE YEAR. 4251992 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 103 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 0 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 CHAI 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 RUSS CARREKER BOARD TRUSTEE 1.00 5.00 X 0 0 0 JAMES BUCHANAN 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 MARK TODD CEO 4.00 56.00 X 0 323829 21093 SCOTT ADKINS CFO 4.00 56.00 X 0 191813 33528 JACKIE SAMPSON-LOCKHART LPN SUPERVISOR 40.00 X 125582 0 9925 125582 515642 64546 1 0 1 0 0 MEDICARE/MEDICAID PAYM 623000 5669881 5669881 STIMULUS REVENUE 623000 532357 532357 ROUTINE ROOM/BOARD 623000 328231 328231 6530469 674 674 SHARE OF AFFILATE INVE 900099 48408 48408 MISCELLANEOUS INCOME 900099 12188 12188 CAFETERIA SALES 623000 3520 3520 64116 6595259 6533989 0 61270 2290738 2171875 118863 40419 36069 4350 339480 324061 15419 163212 153779 9433 324508 324508 14652 14652 432315 366809 65506 7569 7569 123596 57193 66403 22317 22317 213835 213835 10420 1354 9066 82259 82259 180516 180516 87728 23817 63911 MEDICAID PROVIDER FEE 304071 304071 RAW FOOD 143504 143504 MEDICAL SUPPLIES 85912 85912 DRUGS 63324 63324 55982 43614 12368 4986357 4251992 734365 0 216282 145882 2034642 2035260 355508 1948182 4506 6375 2085 676 4664218 864363 3952005 3799855 132787 132195 1718189 1897961 8416004 9966386 379759 372630 241910 2422611 2405929 3044280 2778559 X 5371724 7187827 5371724 7187827 8416004 9966386 X 1608902 207201 X X 0 1 X 1 0 X 5660763 5855700 6526047 6895773 6533989 31472272 5660763 5855700 6526047 6895773 6533989 31472272 0 0 0 31472272 1883 9130 16306 9294 674 37287 1883 9130 16306 9294 674 37287 78007 90931 86814 87112 60596 403460 5740653 5955761 6629167 6992179 6595259 31913019 0.98620 0.98630 0.00120 0.00130 X 3646760 448670 3198090 639610 335775 303835 377848 79918 297930 3799855 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 67123 DUE FROM RELATED ORGANIZATIONS 1816600 OTHER RECEIVABLES 14238 1897961 X 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, 2021 AND 2020. X 0 0 X 0 0 0 0 0 0 0 0 0 MARK TODD CEO 0 323829 0 0 0 0 0 12100 0 8993 0 344922 0 0 SCOTT ADKINS CFO 0 191813 0 0 0 0 0 8123 0 25405 0 225341 0 0 PART I, LINE 1A ONE KEY EMPLOYEE IS ALSO A MEMBER OF THE CLERGY. AS PART OF THEIR COMPENSATION AGREED UPON THROUGH THE SOUTH GA CONFERENCE, HOUSING ALLOWANCE IS INCLUDED. 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 CEO IS PAID ENTIRELY FROM A RELATED TAX-EXEMPT ORGANIZATION. 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 IT FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST AT THE MAGNOLIA MANOR, INC. CORPORATE OFFICE IN AMERICUS, GEORGIA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE MAGNOLIA MANOR, INC. CORPORATE OFFICE IN AMERICUS, GEORGIA. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS 207,201. FORM 990. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MAGNOLIA MANOR INC 2001 S LEE STREET AMERICUS GA 31709 580911706 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF ST SIMONS INC 2255 FREDENCA RD ST SIMMONS ISLAND GA 31522 201364957 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON SUPPORTIVE HOUSING INC 190 PIERCE AVE MACON GA 31204 311651955 ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF COLUMBUS INC 2010 WARM SPRINGS RD COLUMBUS GA 31904 208034409 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON INC 190 PIERCE AVE MACON GA 31204 261311379 ASSISTED LIVING 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 PROVISION OF PHARMACY-RELATED PRODUCTS AND SERVICES GA N/A 0 0 MMI ASSURANCE LTD 2001 S LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0