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 580911706 MAGNOLIA MANOR 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 34954276 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 11 796 390 0 0 465143 892585 26410892 27426561 1217624 1210748 5146738 5390358 33240397 34920252 0 0 0 0 16239109 16488935 0 0 664016 15162321 15964473 31401430 32453408 1838967 2466844 92366466 116561990 41826985 60504779 50539481 56057211 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 24417462 32272783 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. 24417462 1 1 0 0 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 1 103 0 1 796 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 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 40.00 20.00 X 325094 0 19881 HILLERY FORT COO 40.00 20.00 X 223391 0 31976 SCOTT ADKINS CFO 40.00 X 189065 0 30589 DIANE HARRISON VP OF HUMAN RESOURCES 40.00 X 179213 0 26425 STEPHEN VINSON VP OF COMMUNICATIONS 40.00 X 135659 0 0 BARBARA MITCHELL VP OF CLINICAL 40.00 X 134227 0 11934 SUSAN FUSSELL NURSING HOME ADMINISTRATOR 40.00 X 109483 0 10799 1296132 0 131604 7 0 1 0 PIEDMONT CONSTRUCTION 107 GATEWAY DR SUITE B MACON GA 31210 CONSTRUCTION SERVICES 360092 ACCOUNTABLE HEALTHCARE STAFFING PO BOX 732800 DALLAS IL 606756773 NURSING CONTRACT SERVICES 359005 SOLUTION ADVISORS 12425 28TH STREET N SUITE 100 ST PETERSBURG FL 33716 CONSULTING 301943 PICKLE CONSTRUCTION LLC 904 S MLK BLVD SUITE A AMERICUS GA 31719 MAINTENANCE/REPAIRS/RENOVATIONS 291455 SIMPLY ELEGANT LANDSCAPING 314 N SPRING CREEK CIRCLE COBB GA 31735 LAWN SERVICES 212766 8 77854 814731 892585 ROUTINE ROOM/BOARD 623000 16735793 16735793 MEDICARE/MEDICAID PAYMENT 623000 9801937 9801937 STIMULUS OPERATING REVENUE 623000 888831 888831 27426561 986923 986923 14790 0 14790 14790 14790 223392 433 0 0 223392 433 223825 223825 43561 77854 33476 10085 10085 501 548 -47 -47 MANAGEMENT FEE REVENUE 900099 4265486 4265486 CAFETERIA SALES 623000 333457 333457 SHARE OF PARTNERSHIP INCOME 900099 257214 257214 509373 232536 276837 5365530 34920252 32272783 0 1754884 X 1036935 1036935 12293500 9805607 2117598 370295 265598 170412 88842 6344 1976920 1591452 342431 43037 915982 681519 208676 25787 1841199 508216 1332983 153003 153003 64032 64032 4303249 3773598 524495 5156 140431 8114 117572 14745 -135838 -761158 495807 129513 48564 5680 28056 14828 1834476 1834476 274433 83107 160189 31137 1265884 1265884 2106812 2106812 759588 281058 478530 RAW FOOD 1286488 1286488 SUPPLIES 1161054 915099 222781 23174 DRUGS 396772 396772 BAD DEBT EXPENSE 244236 244236 220090 220090 32453408 24417462 7371930 664016 817583 2082476 21587937 26262394 960369 556296 1325745 48024 47555 65530 57733 77778180 46897179 23542695 30881001 34662878 35338648 501966 511680 784503 735066 9394981 18763396 92366466 116561990 6170607 6260824 19753981 5280929 2931331 6718962 18389000 12971066 23855064 41826985 60504779 X 47310117 52786765 3229364 3270446 50539481 56057211 92366466 116561990 X 2466844 423418 2627468 X X 0 1 X 1 0 X 574258 662588 613356 465143 936146 3251491 27846743 31371397 31358303 31066514 27426561 149069518 93092 101443 85116 279651 28421001 32127077 32073102 31616773 28362707 152600660 0 0 0 152600660 574965 482542 717443 724244 986923 3486117 574965 482542 717443 724244 986923 3486117 464833 955460 1056905 439718 534051 3450967 29460799 33565079 33847450 32780735 29883681 159537744 0.95650 0.94680 0.02190 0.01840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 60382 60382 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. 4661573 261746 183600 4739719 4464076 361358 163861 4661573 13939069 13939069 12985452 953617 13939069 13255498 4088 119712 345045 48801 12985452 1.00000 0 0 1713049 1713049 53590858 33980272 19610586 13145421 11132156 2013265 9328852 1784751 7544101 30881001 INDENTURE AGREEMENT 2147255 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 24365 OTHER RECEIVABLES 13156454 HUD INTERCOMPANY PAYABLES 3435322 18763396 DUE TO RELATED ORGANIZATIONS 23855064 23855064 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE HELD TO PROVIDE SUPPORT OF OPERATIONS AND PATIENT SUPPORT. FOR FY 2020, THE BEGINNING BALANCE HAS BEEN RESTATED TO MATCH CURRENT ENDOWMENT FUNDS. 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. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, INVESTMENTS INVESTMENT IN CAPTIVE INSURANCE.LIST 74 _ 2BENJAMIN.HARRISON@DHG.COM - 01/08/20 09:09 AM WORKSHEET SCHEDULE F - STATEMENT OF ACTIVITIES OUTSIDE THE U.S. AUDIT FIN - TOTAL ASSETS _ 3590736 4086031 0 0 0 0 0 0 4086031 0 4086031 1 0 1 0 0 0 PART III ACCOUNTING METHOD: JOHN BATTS MEMORIAL GOLF CLASSIC 35300 22425 12875 1750 6383 2546 2180 JOHN GILL MEMORIAL QUAIL HUNT 30450 10795 19655 545 13500 3860 3 55665 44634 11031 530 2182 121415 77854 43561 2825 19883 4728 6040 33476 10085 X 1 0 X 0 0 0 0 0 0 0 0 0 MARK TODD CEO 325094 0 0 0 0 0 11785 0 8096 0 344975 0 0 0 HILLERY FORT COO 223237 0 0 0 154 0 9340 0 22636 0 255367 0 0 0 SCOTT ADKINS CFO 188558 0 0 0 507 0 7953 0 22636 0 219654 0 0 0 DIANE HARRISON VP OF HUMAN RESOURCES 179213 0 0 0 0 0 3789 0 22636 0 205638 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 A 20818202 2138038 860334 267545 19763862 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 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 3,685,426. MANAGEMENT AND GENERAL EXPENSES 213,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,898,512. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 55,490. MANAGEMENT AND GENERAL EXPENSES 311,409. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 366,899. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 32,682. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 5,156. TOTAL EXPENSES 37,838. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS 2,627,468. 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 2919666 1012848 0 0 0.25960 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ MAGNOLIA MANOR INC C 1298040 4086031 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