2018-05-01T06:12:31-05:00 2017-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-07-01 201364957 MAGNOLIA MANOR OF ST SIMONS INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2018-05-01 1 Amy Bibby P00445891 8282542254 12.25.12.224 2018-05-01 06:04:14 ED P 083993E8E059FCB3C563BE1594239D73DD9572BD 3C4A73C7F70BFF54BAAC11A85090BDFB39FC8B01 2016 2021-01-29 14:40:06Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 11282820 0 X WWW.MAGNOLIAMANOR.COM X 2004 GA THE CORPORATION IS ORGANIZED TO PROVIDE RESIDENTIAL AND LONG-TERM CARE SERVICES TO THE SICK AND ELDERLY IN A SPIRTUAL SETTING. THE MISSION IS ACCOMPLISHED THROUGH THE OPERATION OF A 125-BED LONG TERM CARE FACILITY AND A 94-UNIT RETIREMENT COMMUNITY LOCATED ON ST. SIMON'S ISLAND, GEORGIA. 10 10 206 50 0 0 0 0 10940983 11104834 592 872 70351 177114 11011926 11282820 0 0 0 0 4375660 5004457 0 0 0 6828047 6377785 11203707 11382242 -191781 -99422 1133540 1419852 3167588 2969498 -2034048 -1549646 X THE CORPORATION IS ORGANIZED TO PROVIDE RESIDENTIAL AND LONG-TERM CARE SERVICES TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING. THE MISSION IS ACCOMPLISHED THROUGH THE OPERATION OF A 125-BED LONG-TERM CARE FACILITY AND A 94-UNIT RETIREMENT COMMUNITY LOCATED ON ST. SIMON'S ISLAND, GEORGIA. 0 0 9893141 11152136 THE CORPORATION PROVIDED RESIDENTIAL SERVICES TO THE SICK AND AGED THROUGH THE OPERATION OF A 125-BED LONG TERM CARE FACILITY AND A 94-BED RETIREMENT COMMUNITY LOCATED IN ST. SIMONS, GEORGIA. THE CORPORATION PROVIDED APPROXIMATELY 70,000 PATIENT DAYS OF SERVICE DURING THE YEAR. 9893141 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 1 206 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 GA X SCOTT ADKINS 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK JOHNSON CHAIRMAN 1.00 X X 0 0 0 CHUCK REEVES VICE CHAIRMAN 1.00 X X 0 0 0 JEAN WHEELER SECRETARY 1.00 X X 0 0 0 HAL WEATHERS TRUSTEE 1.00 X 0 0 0 EDIE VINSON TRUSTEE 1.00 X 0 0 0 WILL PETERSON TRUSTEE 1.00 X 0 0 0 ANN HARRIS TRUSTEE 1.00 X 0 0 0 SCHLEY GATEWOOD JR TRUSTEE 1.00 X 0 0 0 RUSS CARREKER TRUSTEE 1.00 X 0 0 0 JAMES BUCHANAN JR TRUSTEE 1.00 X 0 0 0 MARK TODD PRESIDENT/CEO 2.00 38.00 X 0 263763 12415 SCOTT ADKINS SVP FINANCE 2.00 38.00 X 0 164633 23024 0 428396 35439 0 0 1 0 METZ CULINARY MANAGEMENT TWO WOODWARD DRIVE DALLAS PA 18612 DIETARY SERVICES 1270878 MAGNOLIA MANOR REHABILITATION 1013 RIVERBURCH PARKWAY DALTON GA 30721 THERAPY SERVICES 431140 PRO INSPECTION CONSULTING SERVICES 120 RIVERVIEW DR ST SIMONS ISLAND GA 31522 MAINTENANCE/REPAIRS SERVICES 100350 3 ROUTINE ROOM/BOARD 623000 5583044 5583044 MEDICARE/MEDICAID PAYMENTS 623000 5521790 5521790 11104834 872 872 SHARE OF GPV INTEREST 900099 129020 129020 RESIDENT FEES 623000 32500 32500 CAFETERIA SALES 623000 11562 11562 4032 3240 792 177114 11282820 11152136 0 130684 X 4120634 3722248 398386 40223 33331 6892 560556 511451 49105 283044 251967 31077 579864 579864 22534 22534 1207262 1165532 41730 45896 45896 214817 101111 113706 382 382 1858344 1858344 12509 8825 3684 386 386 4870 4870 71569 71569 455429 297572 157857 MEDICAID PROVIDER FEE 602553 602553 RAW FOOD 517665 517665 SUPPLIES 310127 272525 37602 DRUGS 230543 230543 243035 243035 11382242 9893141 1489101 0 38202 44454 481975 693560 12965 7821 128558 29758 1103839 723324 393796 380515 78044 161944 0 101800 1133540 1419852 851857 655297 2315731 2314201 3167588 2969498 X -2034048 -1549646 -2034048 -1549646 1133540 1419852 X -99422 583824 X X 0 1 X 1 0 X 10799223 10423247 10991276 10940983 11152136 54306865 10799223 10423247 10991276 10940983 11152136 54306865 0 0 0 54306865 651 916 683 592 872 3714 651 916 683 592 872 3714 68790 66563 56257 70351 129812 391773 10868664 10490726 11048216 11011926 11282820 54702352 0.99280 0.99400 0.00010 0.00010 X 305301 231016 74285 600206 337855 262351 198332 154453 43879 380515 INVESTMENT IN GA PHARM VENTURES LLC 135796 C INVESTMENT IN MAGNOLIA MANOR REHAB 26148 C 161944 SECURITY DEPOSITS 101800 101800 DUE TO RELATED ORGANIZATION 2314201 2314201 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, 2017 and 2016. 0 0 0 0 0 0 0 0 0 MARK TODD PRESIDENT/CEO 0 263763 0 0 0 0 0 5172 0 7243 0 276178 0 15600 SCOTT ADKINS SVP FINANCE 0 164633 0 0 0 0 0 3549 0 19475 0 187657 0 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, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE IN AMERICUS, GEORGIA. Form 990, Part IX, line 11g CONTRACT SERVICES: Program service expenses 1,119,859. Management and general expenses 19,970. Fundraising expenses 0. Total expenses 1,139,829. OUTSIDE SERVICES: Program service expenses 45,673. Management and general expenses 21,760. Fundraising expenses 0. Total expenses 67,433. Form 990, Part XI, line 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS 583,824. 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 9 0 MAGNOLIA MANOR OF COLUMBUS INC 2001 SOUTH LEE STREET AMERICUS GA 31709 208034409 OPERATION OF TWO (2) NURSING FACILITIES AND A RETIREMENT FACILITY GA 501(c)(3) Line 9 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 9 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 9 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 9 0 MMI ASSURANCE LTD 2001 SOUTH LEE STREET AMERICUS GA 31709 981082342 CAPITVE INSURANCE COMPANY CJ MAGNOLIA MANOR INC 1 GEORGIA PHARMACY VENTURES LLC 440 INDUSTRIAL BOULEVARD HAWKINSVILLE GA 31036 261918757 PROVIDES PHARMACY RELATED PRODUCTS AND SERVICES TO MAGNOLIA MANOR RESIDENTS GA RELATED 90868 168037 0 0 0.12820 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1