2021-02-25T19:14:53-06:00 2020-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-07-01 208034409 MAGNOLIA MANOR OF COLUMBUS INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2021-02-25 1 AMY BIBBY P00445891 8282542254 2021-02-25 2019 2022-09-23 18:48:47Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 28401444 0 X WWW.MAGNOLIAMANOR.COM X 2007 GA THE CORPORATE IS ORGANIZED TO PROVIDE LONG-TERM CARE AND PERSONAL CARE SERVICES TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF 376 LONG-TERM CARE BEDS AND 44 PERSONAL CARE BEDS ON A SINGLE CAMPUS LOCATED IN COLUMBUS, GEORGIA. 11 11 436 43 0 0 0 0 26043243 27589784 61666 65229 784920 746431 26889829 28401444 0 0 0 0 11460123 11536581 0 0 0 10848254 10478982 22308377 22015563 4581452 6385881 32022956 43243767 20958545 26096370 11064411 17147397 THE CORPORATION IS ORGANIZED TO PROVIDE LONG-TERM CARE AND PERSONAL CARE SERVICES TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF 376 LONG-TERM CARE BEDS AND 44 PERSONAL CARE BEDS ON A SINGLE CAMPUS LOCATED IN COLUMBUS, GEORGIA. 0 0 19286183 27793210 PROVIDED LONG-TERM CARE AND PERSONAL CAR SERVICES IN A SPIRITUAL SETTING. THE CORPORATION HAS TWO NURSING FACILITIES WITH A COMBINED 376 BEDS, ALONG WITH A 44-BED PERSONAL CARE FACILITY. THE CORPORATION PROVIDED APPROXIMATELY 104,000 DAYS OF SERVICE DURING THE YEAR. 19286183 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 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 17 0 1 436 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 1 1 1 1 1 1 1 0 1 1 GA X SCOTT ADKINS 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 10.00 50.00 X 0 325094 19881 SCOTT ADKINS CFO 10.00 50.00 X 0 189065 30589 DARON BUTLER COLUMBUS WEST ADMINISTRATOR 40.00 X 123325 0 9835 DEBBIE STUDDARD COLUMBUS EAST ADMINISTRATOR 40.00 X 120114 0 12184 MALEDIA QUINN RN SUPERVISOR 40.00 X 101480 0 7873 344919 514159 80362 3 0 1 0 GLOBAL PERSONNEL SERVICES 1127 BROWN AVENUE COLUMBUS GA 31906 NURSING SERVICES 309663 ATC HEALTHCARE SERVICES 75 REMITTANCE DRIVE DEPT 6773 CHICAGO IL 606756773 NURSING SERVICES 186388 2 MEDICARE/MEDICAID PAYMENTS 623000 22711898 22711898 ROUTINE ROOM/BOARD 623000 4428114 4428114 STIMULUS REVENUE 900099 449772 449772 27589784 65116 65116 113 0 113 113 113 SHARE OF PHARMACY VENTURE INCOME 900099 361119 361119 MISCELLANEOUS INCOME 900099 181886 181886 MANAGEMENT SERVICE FEES 623000 163111 163111 40315 40315 746431 28401444 27793210 0 608234 9420316 8794391 625925 117775 106255 11520 1338979 1276452 62527 659511 613094 46417 1271975 163111 1108864 44688 44688 1551440 1408792 142648 29794 29794 328081 160434 167647 10744 10744 690498 690498 29474 8161 21313 1157792 1157792 686944 686944 493229 67071 426158 MEDICAID PROVIDER FEE 1450923 1450923 RAW FOOD 841626 841626 MEDICAL SUPPLIES 778446 778446 DRUGS 487998 487998 625330 594195 31135 22015563 19286183 2729380 0 101022 550011 6498 1483319 1014246 920350 21541 11912 1664 4829 21719022 5702985 16466425 16016037 273557 245275 136884 128541 13538544 24346068 32022956 43243767 1175613 1414445 962284 13746852 3620763 6033914 5663951 14430500 2166 4427 20958545 26096370 X 11064411 17147397 11064411 17147397 32022956 43243767 X 6385881 12707 -315602 X X 0 1 X 1 0 X 20883839 23581491 25194042 26247456 27793210 123700038 20883839 23581491 25194042 26247456 27793210 123700038 0 0 0 123700038 72389 72800 63943 61530 65116 335778 72389 72800 63943 61530 65116 335778 255565 331653 457306 580707 543005 2168236 21211793 23985944 25715291 26889693 28401331 126204052 0.98020 0.98150 0.00270 0.00290 X 1904912 1904912 17233652 4207267 13026385 2498667 1475758 1022909 81791 19960 61831 16016037 DEFERRED LOAN COSTS 385806 DUE FROM RELATED ORGANIZATION 22461048 INDENTURE AGREEMENT 1499214 24346068 SECURITY DEPOSITS 167 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 4260 4427 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, 2020 AND 2019. X 0 0 X 0 0 0 0 0 0 0 0 0 MARK TODD CEO 0 325094 0 0 0 0 0 11785 0 8096 0 344975 0 0 SCOTT ADKINS CFO 0 188558 0 0 0 507 0 7953 0 22636 0 219654 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. A AMERICUS AND SUMTER COUNTY HOSPITAL AUTHORITY 586000058 030695DL1 2013-05-15 35385246 REFINANCING EXISTING DEBT 0 0 0 A 14567044 1472158 570386 187209 13829295 2013 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 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 SECTION 501(C)(3) 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 ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE IN AMERICUS, GEORGIA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE IN AMERICUS, GEORGIA. THE ORGANIZATION DOES NOT RECEIVE SEPARATE AUDITED FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS -315,602. FORM 990. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MAGNOLIA MANOR INC 2001 SOUTH LEE STREET AMERICUS GA 31709 580911706 MANAGEMENT AND OPERATION OF LONG-TERM CARE AND RETIREMENT FACILITIES 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 SIMMONS 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 A RETIREMENT 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 440 INDUSTRIAL BOULEVARD HAWKINSVILLE GA 31036 261918757 PROVIDES PHARMACY RELATED PRODUCTS AND SERVICES TO MAGNOLIA MANOR RESIDENTS GA MAGNOLIA MANOR INC RELATED 2919666 1012848 0 0 0.34450 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0