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 208034409 MAGNOLIA MANOR OF COLUMBUS 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 09:49:31 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-09-23 17:36:50Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 26889829 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. 12 12 452 80 0 0 0 0 24999781 26043243 64088 61666 651567 784920 25715436 26889829 0 0 0 0 10755636 11460123 0 0 0 10170921 10848254 20926557 22308377 4788879 4581452 28124293 32022956 21634667 20958545 6489626 11064411 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 19662975 0 26247456 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. 19662975 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 21 0 1 452 1 0 0 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 SHEFFILED TRUSTEE 1.00 5.00 X 0 0 0 ED COLLIER TRUSTEE 1.00 5.00 X 0 0 0 MARK TODD PRESIDENT/CEO 10.00 50.00 X 0 303782 16280 SCOTT ADKINS SVP FINANCE 10.00 50.00 X 0 181316 26753 DARON BUTLER ADMINSTRATOR 40.00 X 118209 0 9281 DEBORAH LAWHORN ADMINSTRATOR 40.00 X 117979 0 10466 MALEDIA QUINN RN SUPERVISOR 40.00 X 103066 0 3091 339254 485098 65871 3 0 1 0 GLOBAL PERSONNEL SERVICES 1127 BROWN AVENUE COLUMBUS GA 31906 NURSING SERVICES 385655 ATC HEALTHCARE SERVICES 75 REMITTANCE DRIVE DEPT 6773 CHICAGO IL 606756773 NURSING SERVICES 242686 2 MEDICARE/MEDICAID PAYMENTS 623000 21030653 21030653 ROUTINE ROOM/BOARD 623000 5012590 5012590 26043243 61530 61530 136 0 136 136 136 SHARE OF PHARMACY VENTURE INCOME 900099 338336 338336 MISCELLANEOUS INCOME 900099 242371 242371 MANAGEMENT SERVICE FEES 623000 152731 152731 51482 51482 784920 26889829 26247456 0 642373 9364867 8772492 592375 122455 110847 11608 1309273 1249221 60052 663528 618874 44654 1282377 152732 1129645 43589 43589 1868342 1725607 142735 40463 40463 304990 129324 175666 18229 18229 621653 621653 29289 8243 21046 148 148 1118691 1118691 675567 675567 394556 59820 334736 MEDICAID PROVIDER FEE 1493751 1493751 RAW FOOD 791739 791739 MEDICAL SUPPLIES 729314 729314 BAD DEBT EXPENSE 694510 694510 741046 710590 30456 22308377 19662975 2645402 0 67308 101022 1744786 1483319 13070 21541 1163 1664 21508710 5042285 16988530 16466425 478421 273557 145324 136884 8685691 13538544 28124293 32022956 1299068 1175613 13942694 13746852 6390822 6033914 2083 2166 21634667 20958545 X 6489626 11064411 6489626 11064411 28124293 32022956 X 4581452 -6667 X X 0 1 X 1 0 X 21094178 20883839 23581491 25194042 26247456 117001006 21094178 20883839 23581491 25194042 26247456 117001006 0 0 0 117001006 69563 72389 72800 63943 61530 340225 69563 72389 72800 63943 61530 340225 237647 255565 331653 457306 580707 1862878 21401388 21211793 23985944 25715291 26889693 119204109 0.98150 0.98360 0.00290 0.00300 X 1904912 1904912 17139119 3705660 13433459 2388956 1323918 1065038 75723 12707 63016 16466425 DEFERRED LOAN COSTS 412054 DUE FROM RELATED ORGANIZATION 11668790 OTHER RECEIVABLE 4100 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 18121 INDENTURE AGREEMENT 1435479 13538544 SECURITY DEPOSITS 2166 2166 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, 2019 AND 2018. 0 0 0 0 0 0 0 0 0 MARK TODD PRESIDENT/CEO 0 303782 0 0 0 0 0 8558 0 7722 0 320062 0 29462 SCOTT ADKINS SVP FINANCE 0 181316 0 0 0 0 0 5756 0 20997 0 208069 0 8699 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 0.00000 0.00000 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 -6,667. 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 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 0 0 0.34450 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1