2016-11-28T15:00:38-06:00 2016-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2015-07-01 201364957 Magnolia Manor of St Simons Inc MAGN 2299249352 2001 South Lee Street Americus GA 31709 Mark Todd President 2299249352 2016-11-22 1 Linda Corty P00221297 4784648000 2016-11-22 X 2015 2017-02-10 21:41:12Z Mark Todd 2001 South Lee Street Americus GA 31709 11011926 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. 12 12 199 45 0 0 0 0 10991276 10940983 683 592 56257 70351 11048216 11011926 0 0 0 0 4398644 4375660 0 0 0 6645593 6828047 11044237 11203707 3979 -191781 1489582 1133540 3267267 3167588 -1777685 -2034048 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 9679164 11011334 The Corporation provided residential services to the sick and aged through the operation of a 125-bed long term care facililty and a 94-bed retirement community located in St. Simons, Georgia. The Corporation provided approximately 70,000 patient days of service during the year. 9679164 1 0 0 0 0 0 0 0 0 0 1 0 1 0 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 31 0 1 199 1 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 0 GA X The Organization 2299249352 2001 South Lee Street Americus GA 31709 James R Buchanan Jr Trustee 0.00 X 0 0 0 Ann Harris Trustee 0.00 X 0 0 0 Mark Johnson Chairman 0.00 X X 0 0 0 Edie Vinson Trustee 0.00 X 0 0 0 Russ Carreker Trustee 0.00 X 0 0 0 Schley Gatewood Jr Trustee 0.00 X 0 0 0 Jean Wheeler Secretary 0.00 X X 0 0 0 Chuck Reeves Vice Chairman 0.00 X X 0 0 0 Will Peterson Trustee 0.00 X 0 0 0 Hal Weathers Trustee 0.00 X 0 0 0 Robert Beckum Trustee 0.00 X 0 0 0 Cindy Higdon Trustee 0.00 X 0 0 0 Mark Todd President/CEO 6.00 34.00 X 0 220531 7970 Scott Adkins SVP Finance 6.00 34.00 X 0 137919 8205 Hillery Fort SVP Operations 6.00 34.00 X 0 166053 8467 Diane Harrison SVP of Human Resources 6.00 34.00 X 0 145513 5600 Jackie Crisp Administrator 40.00 X 102117 0 9040 102117 670016 39282 1 0 1 0 Metz Culinary Managment Two Woodland Dr Dallas PA 18612 Dietary Management 1255040 Magnolia Manor Rehabilitation 1013 Riverburch Parkway Dalton GA 30721 Therapy services 286556 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceutical and Consultation 193267 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72919 Therapy services 136575 4 Medicare/Medicaid Payments 623000 6108749 6108749 Routine Room/Board 623000 4832196 4832196 Miscellaneous 623000 38 38 10940983 592 592 Share of earning in GPV 900099 52373 52373 Food Sale Revenue 623000 11701 11701 Beauty Shop Revenue 623000 6052 6052 225 225 70351 11011926 11011334 0 592 X 3455767 3077353 378414 32450 25299 7151 613223 570150 43073 274220 244235 29985 110000 110000 21588 21588 1503688 1462440 41248 51205 51205 66244 66244 7 7 2180251 2180251 12881 5422 7459 77939 77939 156380 156380 Supplies 759504 728255 31249 Medicaid provider fee 626373 626373 Management Fees 537960 537960 Raw Food 515588 515588 208439 165859 42580 11203707 9679164 1524543 0 71085 38202 785496 481975 13770 12965 145072 128558 1045551 651755 394488 393796 79671 78044 1489582 1133540 1039416 851857 2227851 2315731 3267267 3167588 X -1777685 -2034048 -1777685 -2034048 1489582 1133540 X -191781 -64582 X X 0 1 X 1 0 X 9687096 10799223 10423247 10991276 10940983 52841825 9687096 10799223 10423247 10991276 10940983 52841825 0 0 0 52841825 542 651 916 683 592 3384 542 651 916 683 592 3384 53963 68790 66563 56257 70351 315924 9741601 10868664 10490726 11048216 11011926 53161133 0.99400 0.99380 0.00010 0.00010 X 486693 363572 123121 558858 288183 270675 393796 Investment in GA Pharmacy 78044 C 78044 Intercompany Payable 2315731 2315731 X Part X, Line 2: The Corporation and certain of its affiliates are not-for-profit corporations and have been recognized as tax-exempt persuant to Sec. 501(c)(3) of the Internal Revenue Code. Georgia Pharmacy Ventures, LLC files as a Partnership. The Corporation files its Forms 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 Organization believes that it has appropriate support for all tax positions taken and, as such, does not have any uncertain tax positions that are material to the financial statements. Management believes that all positions taken in those returns would be sustained if examined by taxing authorities. X 0 0 0 0 0 0 0 0 0 Mark Todd President/CEO 0 220531 0 0 0 0 0 3434 0 4536 0 228501 0 0 Hillery Fort SVP Operations 0 166053 0 0 0 0 0 2723 0 5744 0 174520 0 0 Diane Harrison SVP of Human Resources 0 145513 0 0 0 0 0 0 0 5600 0 151113 0 0 Form 990, Part VI, Section B, line 11 The Form 990 was reviewed by the Organization's CEO and Senior Vice President for Finance prior to filing. The contents of the Form 990 were presented and explained to the members of the Executive Committee for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c Board members in general and the Finance Committee in particular are aware of potential conflicts of interest and consider these potential conflicts in making decisions. 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 Dietary Contracted Services : Program service expenses 670,493. Management and general expenses 0. Fundraising expenses 0. Total expenses 670,493. Laundry and Housekeeping Contract Services : Program service expenses 11,106. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,106. Plant Contract Services : Program service expenses 279,548. Management and general expenses 0. Fundraising expenses 0. Total expenses 279,548. Resident Care Contract Services : Program service expenses 501,293. Management and general expenses 0. Fundraising expenses 0. Total expenses 501,293. Administrative Contract Services : Program service expenses 0. Management and general expenses 41,248. Fundraising expenses 0. Total expenses 41,248. Form 990, Part XI, line 9: Transfer to related party - forgiveness of debt -64,582. Form 990, Part XII, Line 2c Review of financial statements - The process for the review of the audited financial statements 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 Captive 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 Magnolia Manor Inc Related 52373 134158 0 0 0.15000 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 Magnolia Manor Inc M 537960 Amount charged