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 580911706 MAGNOLIA MANOR 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 36072528 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. 11 11 570 0 0 0 892585 787932 27426561 24637014 1210748 4325424 5390358 6261034 34920252 36011404 0 0 0 0 16488935 16376967 0 0 702729 15964473 16664190 32453408 33041157 2466844 2970247 116561990 105196135 60504779 46916241 56057211 58279894 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 24053308 30249049 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. 24053308 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 0 0 0 0 0 1 1 1 0 0 1 91 0 1 570 1 0 1 CJ 0 0 0 0 0 0 0 0 0 0 X 11 11 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 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 40.00 20.00 X 323829 0 21093 HILLERY FORT COO 40.00 20.00 X 230445 0 35074 SCOTT ADKINS CFO 40.00 X 191813 0 33528 DIANE HARRISON VP OF HUMAN RESOURCES 40.00 X 181924 0 29269 SUSAN FUSSELL FACILITY ADMINISTRATOR 40.00 X 134063 0 11044 STEPHEN VINSON VP OF COMMUNICATIONS 40.00 X 139180 0 4174 BARBARA REED VP FOR RISK MANAGEMENT 40.00 X 132405 0 6404 BARBARA MITCHELL VP FOR CLINICAL 40.00 X 113618 0 13685 LORI PORTFLEET VP FOR OPERATIONS 40.00 X 120721 0 12293 1567998 0 166564 10 0 1 0 PIEDMONT CONSTRUCTION 107 GATEWAY DR SUITE B MACON GA 31210 CONSTRUCTION SERVICES 4195630 CHRIS R SHERIDAN & CO PO BOX 4441 MACON GA 31208 MAINTENANCE/CONSTRUCTION 2871150 ACCOUNTABLE HEALTHCARE STAFFING PO BOX 732800 DALLAS IL 606756773 NURSING CONTRACT SERVICES 717068 PICKLE CONSTRUCTION LLC 904 S MLK BLVD SUITE A AMERICUS GA 31719 MAINTENANCE/REPAIRS/RENOVATIONS 625560 SOLUTION ADVISORS 12425 28TH STREET N SUITE 100 ST PETERSBURG FL 33716 CONSULTING 377566 10 32847 755085 5092 787932 ROUTINE ROOM/BOARD 623000 15304472 15304472 MEDICARE/MEDICAID PAYMENT 623000 8705339 8705339 STIMULUS OPERATING REVENUE 623000 627203 627203 24637014 1557028 1557028 2768146 250 0 0 2768146 250 2768396 2768396 108320 32847 60597 47723 47723 2 527 -525 -525 MANAGEMENT FEE REVENUE 900099 5148957 5148957 MISCELLANEOUS INCOME 900099 391878 391878 CAFETERIA SALES 623000 241733 241733 431268 221870 209398 6213836 36011404 30249049 0 4974423 X 1048512 1048512 12301527 9479323 2380293 441911 211694 134418 69411 7865 1901600 1476594 352676 72330 913634 659478 224065 30091 2213151 545364 1667787 133193 133193 66160 66160 3619174 3084972 532511 1691 245700 35227 191829 18644 988172 316462 600861 70849 42852 27016 15836 1787790 1787790 253759 56488 176855 20416 1248620 1248620 2408691 2408691 938785 399695 539090 RAW FOOD 1129938 1129938 SUPPLIES 975779 677822 274861 23096 MEDICAL SUPPLIES 283832 283832 DRUGS 256398 256398 72196 72196 33041157 24053308 8285120 702729 2082476 1740397 26262394 5966426 556296 5004456 1325745 1605155 47555 51947 57733 88702 84012581 49163096 30881001 34849485 35338648 43777761 511680 484556 735066 18763396 11627250 116561990 105196135 6260824 4413436 5280929 6787164 6718962 1139453 18389000 19658232 23855064 14917956 60504779 46916241 X 52786765 54856603 3270446 3423291 56057211 58279894 116561990 105196135 X 2970247 5071069 -5818634 X X 0 1 X 1 0 X 662588 613356 465143 936146 787932 3465165 31371397 31358303 31066514 27426561 24637014 145859789 93092 101443 85116 279651 32127077 32073102 31616773 28362707 25424946 149604605 0 0 0 149604605 482542 717443 724244 986923 1557028 4468180 482542 717443 724244 986923 1557028 4468180 955460 1056905 439718 534051 601276 3587410 33565079 33847450 32780735 29883681 27583250 157660195 0.94890 0.95650 0.02830 0.02190 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 48862 48862 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. 4739719 1372072 180627 5931164 4661573 261746 183600 4739719 4464076 361358 163861 4661573 13939069 13939069 12985452 953617 13939069 1.00000 0 0 2372868 2372868 56547816 35729729 20818087 13481038 11607778 1873260 11610859 1825589 9785270 34849485 INDENTURE AGREEMENT 361362 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 40169 OTHER RECEIVABLES 11211457 REFUND CONTROL 14262 11627250 DUE TO RELATED ORGANIZATIONS 14917956 14917956 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, 2021 AND 2020. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, INVESTMENTS INVESTMENT IN CAPTIVE INSURANCE 4998000 0 0 0 0 0 0 4998000 0 4998000 1 0 1 0 0 0 PART III ACCOUNTING METHOD: JOHN BATTS MEMORIAL GOLF CLASSIC 51542 10947 40595 6718 8380 4669 1770 JOHN GILL MEMORIAL QUAIL HUNT 47200 20800 26400 4428 16623 587 1723 1 42425 1100 41325 9185 500 4358 1656 141167 32847 108320 20331 25503 9614 5149 60597 47723 X 1 0 X 0 0 0 0 0 0 0 0 0 MARK TODD CEO 323829 0 0 0 0 0 12100 0 8993 0 344922 0 0 0 HILLERY FORT COO 230445 0 0 0 0 0 9669 0 25405 0 265519 0 0 0 SCOTT ADKINS CFO 191813 0 0 0 0 0 8123 0 25405 0 225341 0 0 0 DIANE HARRISON VP OF HUMAN RESOURCES 181924 0 0 0 0 0 3864 0 25405 0 211193 0 0 0 PART I, LINE 1A ONE KEY EMPLOYEE (STEPHEN VINSON) IS ALSO A MEMBER OF THE CLERGY. AS PART OF THEIR COMPENSATION AGREED UPON THROUGH THE SOUTH GA CONFERENCE, HOUSING ALLOWANCE IS PAID FOR. 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 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 3,033,460. MANAGEMENT AND GENERAL EXPENSES 223,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,257,021. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 34,655. MANAGEMENT AND GENERAL EXPENSES 308,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 343,605. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 16,857. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 1,691. TOTAL EXPENSES 18,548. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS -4,472,864. LOSS ON REFUNDING -1,345,770. 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 634889 258568 0 0 0.25960 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ MAGNOLIA MANOR INC C 1951235 4997825 1.00000 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 MMI ASSURANCE LTD R