2017-11-15T14:21:51-06:00 2016-12-31 311543240 CBIZ MHM LLC 401 PLYMOUTH ROAD SUITE 200 PLYMOUTH MEETING PA 19462 990 2016-01-01 721304946 Magnolia Healthcare Inc MAGN 2257530864 PO Box 40018 Baton Rouge LA 70835 RICHARD T DASPIT SR president 2257530864 2017-11-15 1 Joseph G Sullivan P00360476 6108622249 96.90.32.117 2017-11-15 07:54:48 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 20087036E5B3FD96C17AC6BE1EF3A98CB42C38E1 2016 2017-02-10 21:41:12Z RICHARD T DASPIT SR 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 19318402 0 X WWW.MHIHEALTH.ORG X 1995 MS TO PROVIDE COMPREHENSIVE NURSING CARE SERVICES. 4 0 475 0 0 0 0 0 20424428 19074849 72186 103411 143114 140142 20639728 19318402 0 0 0 0 10380015 10158777 0 0 0 10196387 9056798 20576402 19215575 63326 102827 13051234 12520761 22596857 21963557 -9545623 -9442796 TO SERVE THE HEALTH AND REHABILITATION NEEDS OF THE COMMUNITY AND TO IMPROVE THE QUALITY OF LIFE FOR EACH PATIENT, RESIDENT, FAMILY MEMBER, VISITOR AND CO-WORKER. 0 0 17060001 19074849 OWN AND OPERATE FOUR NURSING HOMES TOTALING 289 BEDS IN VARIOUSLOCATIONS. IN 2016, THERE WERE APPROXIMATELY 81,300 RESIDENT DAYS. 17060001 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 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 19 0 1 475 1 0 0 0 0 0 0 0 0 0 0 X 4 0 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 LA X X Richard Daspit Sr 2257530864 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 RICHARD T DASPIT SR PRESIDENT 10.00 40.00 X X 0 193683 1500 STUART G MURPHY III TREASURER 10.00 30.00 X X 0 6000 0 LOUIS HERRERO SECRETARY 10.00 40.00 X X 0 6000 0 A D Buffington Vice President 10.00 0.00 X X 0 0 0 LONNIE PEELER chief operating officer 10.00 40.00 X 0 163668 10500 CYNTHIA PITTMAN CFO 10.00 40.00 X 0 135465 1500 Gwendolyn Brown Nurse Consultant 40.00 0.00 X 103462 0 0 marjorie guthrie Administrator 40.00 0.00 X 104114 0 0 MICHAEL Peeler-SMITH chief compliance officer 10.00 40.00 X 0 146390 1500 207576 651206 15000 2 0 1 0 RELIANT MANAGEMENT GROUP RELIANT REHABILITATION 6860 DALLAS PLANO TX 75024 THERAPY 1259114 US FOOD 3682 Collection Center Drive CHICAGO IL 60693 FOOD SUPPLY 502435 APOTHECARE LLC PO BOX 919 MEADVILLE MS 39653 PHARMACY SERVICE 402812 MCKESSON MEDICAL PO Box 630693 CINCINNATI OH 45263 MEDICAL SUPPLIES 372438 DIRECT SUPPLY BOX 88201 MILWAUKEE WI 53288 MEDICAL SUPPLIES 111401 5 RESIDENT SERVICES 623000 19074849 19074849 19074849 103411 103411 miscellaneous income 623000 140142 140142 140142 19318402 19074849 0 243553 X 8387299 7536925 850374 1134853 1019115 115738 636625 572668 63957 27656 27656 19791 19791 3437233 2919979 517254 63799 63799 1022748 973011 49737 1877283 1616544 260739 60992 3983 57009 1634 1634 448328 398073 50255 provider fees - bed tax 1123978 1123978 OTHER RESIDENT CARE SER 532095 532095 BAD DEBT 92354 92354 Other Activity & Soc 81684 81684 267223 189592 77631 19215575 17060001 2155574 0 456138 721594 1505738 985832 332595 129616 10299936 7873720 2674406 2426216 4102720 4135232 3054468 3054468 925169 1067803 13051234 12520761 2408498 2715080 10125000 9495000 645942 619859 5577414 5585853 3840003 3547765 22596857 21963557 X -9545623 -9442796 -9545623 -9442796 13051234 12520761 102827 0 X X 0 1 X 1 0 X 21948407 20576268 20253504 20424428 19074849 102277456 21948407 20576268 20253504 20424428 19074849 102277456 0 0 0 102277456 127305 391066 53647 72186 103411 747615 127305 391066 53647 72186 103411 747615 293779 24035 564734 143114 140142 1165804 22369491 20991369 20871885 20639728 19318402 104190875 0.98160 0.98310 0.00720 0.00710 X PART III, sECTION B LINE # 12 2012 MISCELLANEOUS INCOME : $293,779 2013 MISCELLANEOUS INCOME : $24,035 2014 MISCELLANEOUS INCOME : $564,734 2015 MISCELLANEOUS INCOME : $143,114 2016 MISCELLANEOUS INCOME : $140,142 201199 201199 7083721 5514997 1568724 642092 569383 72709 2372924 1789340 583584 2426216 ASSETS WHOSE USE IS LIMITED 3995221 C Investment in LTC Employers Ins Co 140011 C 4135232 deposits 5291 est third part settlements 833776 accountS receivable-other 228736 1067803 DUE TO RELATED PARTIES 115346 SUBORDINATED ACCRUED INTEREST 3347226 other payable 85193 3547765 X 30708255 11389853 11389853 19318402 0 19318402 30499475 11283900 11283900 19215575 0 19215575 Part X, Line 2: MHI is a not-for-profit corporation and has been recognized as tax-exempt pursuant to Section 501(c)(3) of the Internal Revenue Code and, accordingly, no provision for income taxes has been provided. MHI accounts for the effects of any uncertain tax positions based on a "more likely than not" threshold to the recognition of the tax positions being sustained based on the technical merits of the position under scrutiny by the applicable taxing authority. If a tax position or positions are deemed to result in uncertainties of those positions, the unrecognized tax benefit is estimated based on a "cumulative probability assessment" that aggregates the estimated tax liability for all uncertain tax positions. Interest and penalties assessed, if any, are accrued as income tax expense. MHI has identified its tax status as a tax-exempt entity as a tax position; however, MHI has determined that such tax position does not result in an uncertainty requiring recognition. MHI believes it is no longer subject to income tax examinations for years prior to December 31, 2013. Part XI, Line 2d - Other Adjustments: REVENUES EARNED BY OTHER ORGANIZATIONS COMBINED WITH THE ORGANIZATION FOR FINANCIAL STATEMENT PURPOSES 12,788,007. LESS ELIMINATING ENTRIES INCLUDED IN FINANCIAL STATEMENTS -1,398,154. Part XII, Line 2d - Other Adjustments: EXPENSES INCURRED BY OTHER ORGANIZATIONS COMBINED WITH THE ORGANIZATION FOR FINANCIAL STATEMENT PURPOSES 13,777,708. LESS ELIMINATING ENTRIES INCLUDED IN FINANCIAL STATEMENTS -2,493,808. 0 0 0 0 0 0 0 0 0 RICHARD T DASPIT SR PRESIDENT 0 193683 0 0 0 0 0 0 0 1500 0 195183 0 0 LONNIE PEELER chief operating officer 0 163668 0 0 0 0 0 0 0 10500 0 174168 0 0 Form 990, Schedule J, Part II WAGES WERE PAID BY FOUNDATION HEALTH SERVICES, INC. TO THE FOLLOWING: - RICHARD T. DASPIT, SR.: $193,683 - LONNIE L. PEELER : $163,668 Form 990, Part VI, Section A, line 2 lonnie peeler, chief operating officer, and michael peeler-smith, chief compliance officer, are married. Form 990, Part VI, Section A, line 3 MAGNOLIA HEALTHCARE has an agreeement with foundation health services, inc., sole member of MAGNOLIA HEALTHCARE, TO provide management services including financial and accounting support services. Form 990, Part VI, Section B, line 11b The Form 990 is completed annually and copies are provided to the entire governing board as well as the president of the organization. At that time the president reviews the Form 990 with the board members. Any necessary changes are then updated on the form. Once all necessary changes are made and the president is in agreement with the board members on the finished Form 990, it is signed by the PRESIDENT, dated and submitted by the filing deadline. A copy of the approved Form 990 is provided to all of the officers, directors and trustees before the return is filed. Form 990, Part VI, Section B, line 12c The organization promulgates its Conflict of Interest policy to assure continued commitment to the integrity of its exempt purpose. To provide enforcement of the policy, a written disclosure of the policy is distributed to the employees and board. Form 990, Part VI, Section B, line 15 The compensation of the person is reviewed and approved by independent compensation committee of the Organization, made up of independent board members. Form 990, Part VI, Section C, line 19 The organization will provide, upon in-person verbal or written request, documents relating to the governance, conflicts of interest and financial statements available to the public. Form 990, Part IX, line 11g Other professional fees: Program service expenses 2,919,979. Management and general expenses 517,254. Fundraising expenses 0. Total expenses 3,437,233. FORM 990, PART XII, LINE 2C For the current year, there has been no change to the audit oversight process or the selection of independent accountants. Foundation Health Services Inc PO BOX 40213 BATON ROUGE LA 70835 581745788 HEALTHCARE LA 501(c)(3) Line 10 N/A 0 BLUEBONNET HEALTHCARE INC PO Box 40018 Baton Rouge LA 70835 721187099 HEALTHCARE LA 501(c)(3) Line 10 FHS 0 ROCK GLEN HEALTHCARE INC PO Box 40018 BATON ROUGE LA 70835 721277793 HEALTHCARE MD 501(c)(3) Line 10 FHS 0 AMERICAN FAMILY SERVICES INC PO Box 40018 BATON ROUGE LA 70835 721150472 HEALTHCARE LA 501(c)(3) Line 10 FHS 0 HUNTINGDON NURSING CENTER INC PO Box 40018 BATON ROUGE LA 70835 541759925 HEALTHCARE VA 501(c)(3) Line 10 FHS 0 Carrollwood Health Foundation Inc PO Box 40018 Baton Rouge LA 70825 721241847 Financial Services/Healthcare FL 501(c)(3) Line 12a, I FHS 0 COLONIAL HEALTHCARE INC PO Box 40018 BATON ROUGE LA 70835 721432537 INACTIVE MA 501(c)(3) Line 10 FHS 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0