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 580911706 MAGNOLIA MANOR INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 Mark Todd President 2299249352 2016-11-23 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 31187078 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 . 13 13 599 450 0 0 682271 574258 26047830 25443517 808272 1021107 2464134 2470882 30002507 29509764 0 0 0 0 13290544 14578899 0 0 349852 13653977 13703976 26944521 28282875 3057986 1226889 60251499 64465185 24530055 26922169 35721444 37543016 X The Corporation is organized to provide affordable housing and long-term care and assisted living services to the elderly in a spiritual setting. The Corporation operates a skilled nursing facility, five retirement communities and several additional independent living apartment complexes throughout South and Middle Georgia. 0 0 19517360 27866419 The Organization provides residential services to the sick and aged in a spiritual setting. The Organization provides these services through the operation of 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. 19517360 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 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 98 0 1 599 1 0 1 CJ 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 GA X The Organization 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 James R Buchanan Jr Board member 1.00 X 0 0 0 Ann Harris Board member 1.00 X 0 0 0 Mark Johnson Chairman 1.00 X X 0 0 0 Russ Carreker Board member 1.00 X 0 0 0 Edie Vinson Board member 1.00 X 0 0 0 Jean Wheeler Secretary 1.00 X X 0 0 0 Chuck Reeves Vice Chairman 1.00 X X 0 0 0 Schley Gatewood Jr Board member 1.00 X 0 0 0 Hal Weathers Board member 1.00 X 0 0 0 Robert Beckum Board member 1.00 X 0 0 0 Will Peterson Board member 1.00 X 0 0 0 Cindy Higdon Board member 1.00 X 0 0 0 Mark R Todd President/CEO 16.00 24.00 X 220531 0 7970 Scott Adkins SVP Finance 16.00 24.00 X 137919 0 8205 Hillery Fort SVP Operations 16.00 24.00 X 166053 0 8467 Susie Fussell Facility Administrator 40.00 X 109856 0 6899 Diane Harrison SVP Of Human Resources 16.00 24.00 X 145513 0 5600 779872 0 37141 5 0 1 0 Magnolia Manor Rehabilitation 1013 Riverburch Parkway Dalton GA 30721 Therapy services 533903 Southern Rehabilitation Professional In PO Box 1066 Americus GA 31709 Therapy services 433530 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultation 381696 ATC Healthcare Services 25393 Network Place Chicago IL 60673 Nursing contract services 224027 Metz Culinary Management Two Woodward Dr Dallas PA 18612 Dietary management services 211831 11 574258 574258 Routine Room/Board 623000 16886196 16886196 Medicare/Medicaid Payments 623000 8354798 8354798 Service Coordinator 623000 126955 126955 Infirmary Revenue 623000 49775 49775 Housekeeping Revenue 623000 13003 13003 12790 12790 25443517 556274 556274 1982500 135087 1551566 101188 430934 33899 464833 464833 72540 24560 47980 47980 Management fee revenue 900099 1784628 1784628 Food Sale Revenue 623000 366669 366669 Durable Medical equipment 623000 109428 109428 162177 162177 2422902 29509764 27866419 0 1069087 X 879430 224096 630434 24900 10516208 7635093 2763940 117175 182623 80494 100140 1989 2140671 1671308 450034 19329 859967 607905 241363 10699 118329 118329 81256 81256 3215833 2401623 814210 460166 375416 84750 201577 181326 20251 296523 296523 2858909 2851765 7144 209144 14175 183180 11789 19060 17460 1600 1543728 320894 1222834 523660 523660 Supplies 1942465 1739337 148973 54155 Raw Food 1404100 1404100 Repairs & Maintenance 427915 331664 96251 Bad debt expense 171818 171818 229493 45628 179050 4815 28282875 19517360 8415663 349852 892611 541774 19106193 24212444 3325 4203975 5517953 51378 57607 251005 19150 57814135 39949451 18808954 17864684 14576202 14196801 296469 700860 2061387 1353912 60251499 64465185 2588482 3574635 106561 128036 20784175 20409174 1004089 988378 46748 1821946 24530055 26922169 X 31416049 34009915 1434673 658291 2870722 2874810 35721444 37543016 60251499 64465185 X 1226889 -548437 1143120 X X 0 1 X 1 1 1 X 1566557 950422 1064909 682271 574258 4838417 22230184 22043170 24842514 25974568 27846743 122937179 23796741 22993592 25907423 26656839 28421001 127775596 405000 355000 545000 28588 34394 1367982 0 405000 355000 545000 28588 34394 1367982 126407614 427658 373180 319959 435153 574965 2130915 427658 373180 319959 435153 574965 2130915 2229045 2163114 2514109 2621312 464833 9992413 26453444 25529886 28741491 29713304 29460799 139898924 0.90360 0.88740 0.01520 0.01410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 48000 48000 0 Part II-B, Line 1: The organization entered into a contract with a law firm to perform lobbying on their bhalf. No direct lobbying payments were made to any specific candidate. 13255498 4088 119712 345045 48801 12985452 13316404 3860 312988 327522 50232 13255498 12381680 3677 1363802 383623 49132 13316404 11637783 3596 1071652 285646 45705 12381680 11910141 3610 47595 275621 47942 11637783 0.77860 0.22140 0.00000 0 0 1180221 1180221 45318940 30250988 15067952 11314974 9698463 1616511 17864684 Annuity Payable 46748 Intercompany Payables 1775198 1821946 X Part V, Line 4: Endowment funds are held for the intended use of furthering the Organization's mission. 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 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. As of June 30, 2016, tax years that remain subject to examination by taxing authorities begin with 2011. Tax returns for 2012, 2013, 2014 and 2015 remain open to examination by taxing authorities. Management believes that all positions taken in those returns would be sustained if examined by taxing authorities. X X Quail Hunt 23100 23100 600 5909 1944 5K run/walk 21955 21955 4909 1 27485 27485 726 2682 3255 4535 72540 72540 1326 8591 3255 11388 24560 47980 X 0 0 0 0 0 0 0 0 0 Mark R Todd President/CEO 220531 0 0 0 0 0 3434 0 4536 0 228501 0 0 0 Hillery Fort SVP Operations 166053 0 0 0 0 0 2723 0 5744 0 174520 0 0 0 Diane Harrison SVP Of Human Resources 145513 0 0 0 0 0 0 0 5600 0 151113 0 0 0 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 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Americus and Sumter County Hospital Authority Date the Rebate Computation was Performed: 06/30/2014 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the Organization's President and Senior Vice President for Finance prior to filing. The contents of the Form 990 are made available to the members of the Executive Committee for their review, and management responds to any questions. 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 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 IX, line 11g Dietary Contract Services: Program service expenses 128,054. Management and general expenses 0. Fundraising expenses 0. Total expenses 128,054. Laundry and Housekeeping Contract S : Program service expenses 32,731. Management and general expenses 0. Fundraising expenses 0. Total expenses 32,731. Plant Contract Services : Program service expenses 1,044,911. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,044,911. Resident Care Contract Services : Program service expenses 1,195,927. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,195,927. Administrative Contract Services: Program service expenses 0. Management and general expenses 814,210. Fundraising expenses 0. Total expenses 814,210. Form 990, Part XI, line 9: Intercompany forgiveness of debt 1,143,120. Form 990, Part XII, Line 2c Review of audited financial statements - The process for reviewing the audited financial statements has not changed from the prior period. 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 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 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 9 0 MMI Assurance Ltd 2001 South Lee Street Americus GA 31709 Captive insurance company CJ Magnolia Manor Inc 1 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 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 104746 268316 0 0 0.30000 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 MMI Assurance Ltd R 365910 Premiums paid