2020-05-07T10:00:16-05:00 2019-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-07-01 580911706 MAGNOLIA MANOR INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2020-05-07 1 AMY BIBBY P00445891 8282542254 2020-04-27 99.47.28.203 2020-05-07 09:47:13 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-09-23 17:36:50Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 33276332 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 12 635 440 0 0 613356 465143 26989793 26410892 1436174 1217624 5482801 5146738 34522124 33240397 0 0 0 0 15709099 16239109 0 0 663749 15197663 15162321 30906762 31401430 3615362 1838967 86277758 92366466 40297984 41826985 45979774 50539481 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 23977771 0 31066514 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. 23977771 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 1 104 0 1 635 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 1 1 GA X SCOTT ADKINS 2299315907 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK JOHNSON CHAIRMAN 1.00 5.00 X X 0 0 0 CHUCK REEVES VICE CHAIRMAN 1.00 5.00 X X 0 0 0 JEAN WHEELER SECRETARY 1.00 5.00 X X 0 0 0 HAL WEATHERS TRUSTEE 1.00 5.00 X 0 0 0 EDIE VINSON TRUSTEE 1.00 5.00 X 0 0 0 WILL PETERSON TRUSTEE 1.00 5.00 X 0 0 0 ANN HARRIS TRUSTEE 1.00 5.00 X 0 0 0 SCHLEY GATEWOOD JR TRUSTEE 1.00 5.00 X 0 0 0 RUSS CARREKER TRUSTEE 1.00 5.00 X 0 0 0 JAMES BUCHANAN JR TRUSTEE 1.00 5.00 X 0 0 0 CHARLES SHEFFIELD TRUSTEE 1.00 5.00 X 0 0 0 ED COLLIER TRUSTEE 1.00 5.00 X 0 0 0 MARK TODD PRESIDENT/CEO 40.00 20.00 X 303782 0 16280 SCOTT ADKINS VP OF FINANCE/CFO 40.00 20.00 X 181316 0 26753 HILLERY FORT VP OF OPERATIONS 40.00 X 210634 0 27639 DIANE HARRISON VP OF HUMAN RESOURCES 40.00 X 176051 0 24708 BARBARA MITCHELL VP OF CLINICAL 40.00 X 100263 0 18277 SUSAN FUSSELL ADMINISTRATOR 40.00 X 134465 0 9599 1106511 0 123256 7 0 1 0 PIEDMONT CONSTRUCTION 107 GATEWAY DR SUITE B MACON GA 31210 CONSTRUCTION SERVICES 669913 PICKLE CONSTRUCTION LLC 904 S MLK BLVD SUITE A AMERICUS GA 31719 MAINTENANCE/REPAIRS/RENOVATIONS 335205 ATC HEALTHCARE SERVICES 25393 NETWORK PLACE CHICAGO IL 60673 NURSING CONTRACT SERVICES 316918 ACCOUNTABLE HEALTHCARE STAFFING PO BOX 732800 DALLAS IL 606756773 NURSING CONTRACT SERVICES 286463 SIMPLY ELEGANT LANDSCAPING PO BOX 47 AMERICUS GA 31709 LAWN SERVICES 230641 9 465143 465143 ROUTINE ROOM/BOARD 623000 16471266 16471266 MEDICARE/MEDICAID PAYMENT 623000 9939626 9939626 26410892 724244 724244 14540 0 14540 14540 14540 493263 117 0 0 493263 117 493380 493380 85116 33718 51398 51398 1811 2217 -406 -406 MANAGEMENT FEE REVENUE 900099 4028637 4028637 CAFETERIA SALES 623000 362915 362915 SHARE OF PARTNERSHIP INCOME 900099 246097 246097 443557 249936 193621 5081206 33240397 31066514 0 1708740 1167201 1167201 11938643 9790077 1795306 353260 268431 179667 83057 5707 1958767 1602574 313373 42820 906067 682742 197784 25541 1865657 522636 1343021 116466 116466 62592 62592 60740 60740 2700714 2410098 273631 16985 146504 8128 110965 27411 863803 312676 442072 109055 37050 4451 30113 2486 1792494 1792494 293569 82089 168496 42984 1893 1893 1291190 1291190 1900567 1900567 655296 252754 402542 RAW FOOD 1437081 1437081 SUPPLIES 1079847 851689 190658 37500 DRUGS 406167 406167 BAD DEBT EXPENSE 250631 250631 200060 200060 31401430 23977771 6759910 663749 599130 817583 16037973 21587937 826691 960369 53109 48024 38186 65530 68381562 44838867 25079599 23542695 33096408 34662878 588299 501966 832468 784503 9125895 9394981 86277758 92366466 9144007 6170607 20078288 19753981 6204219 2931331 4871470 12971066 40297984 41826985 X 42560634 47310117 535995 341945 2883145 2887419 45979774 50539481 86277758 92366466 X 1838967 957421 1763319 X X 0 1 X 1 0 X 682271 574258 662588 613356 465143 2997616 25974568 27846743 31371397 31358303 31066514 147617525 93092 101443 85116 279651 26656839 28421001 32127077 32073102 31616773 150894792 0 0 0 150894792 435153 574965 482542 717443 724244 2934347 435153 574965 482542 717443 724244 2934347 2621312 464833 955460 1056905 439718 5538228 29713304 29460799 33565079 33847450 32780735 159367367 0.94680 0.93470 0.01840 0.01630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 60740 60740 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. 4464076 361358 163861 4661573 13939069 13939069 12985452 953617 13939069 13255498 4088 119712 345045 48801 12985452 13316404 3860 312988 327522 50232 13255498 1.00000 0 0 1713049 1713049 46401790 32407859 13993931 12748039 10681645 2066394 7518684 1749363 5769321 23542695 INDENTURE AGREEMENT 2056167 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 17603 OTHER RECEIVABLES 4050019 HUD INTERCOMPANY PAYABLES 3271192 9394981 DUE TO RELATED ORGANIZATIONS 12971066 12971066 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE HELD TO PROVIDE SUPPORT OF OPERATIONS AND PATIENT SUPPORT. FOR FY 2019, 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, 2019 AND 2018. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, INVESTMENTS INVESTMENT IN CAPTIVE INSURANCE 3590736 0 0 0 0 0 0 3590736 0 3590736 1 0 1 0 0 0 LOGS 5K/WALK 25640 25640 50 100 3860 MACON GOLF TOURNAMENT 23595 23595 6383 2546 3930 2 35881 35881 400 10486 1500 4463 85116 85116 50 400 16869 4146 12253 33718 51398 X 1 0 X 0 0 0 0 0 0 0 0 0 MARK TODD PRESIDENT/CEO 303782 0 0 0 0 0 8558 0 7722 0 320062 0 29462 0 SCOTT ADKINS VP OF FINANCE/CFO 181316 0 0 0 0 0 5756 0 20997 0 208069 0 8699 0 HILLERY FORT VP OF OPERATIONS 210634 0 0 0 0 0 6642 0 20997 0 238273 0 22105 0 DIANE HARRISON VP OF HUMAN RESOURCES 176051 0 0 0 0 0 3711 0 20997 0 200759 0 3711 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 0.00000 0.00000 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 XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS 1,754,984. ASU 2014-09 PROVISION ADJUSTMENT 8,335. FORM 990, PART XII, LINE 2C: THE PROCESS HAS 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 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 0 0 0.25960 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ MAGNOLIA MANOR INC C 1239588 3590736 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