2015-11-16T14:08:34-06:00 2015-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2014-07-01 580911706 MAGNOLIA MANOR INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 Mark Todd President 2299249352 2015-11-13 1 Linda Corty P00221297 4784648000 2015-11-13 X 2014 2016-03-07 17:11:31Z Mark Todd 2001 SOUTH LEE STREET AMERICUS GA 31709 33677081 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 1064909 682271 24842514 26047830 1327830 808272 1179102 2464134 28414355 30002507 0 0 0 0 12583691 13290544 0 0 314641 13513239 13653977 26096930 26944521 2317425 3057986 55702649 60251499 24889023 24530055 30813626 35721444 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 18650064 27976459 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. 18650064 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 1 1 0 0 1 90 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 Eloise Paschal Secretary 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 Board member 1.00 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 240500 0 11545 Scott Adkins SVP Finance 16.00 24.00 X 146140 0 7974 Hill Fort SVP Operations 16.00 24.00 X 189039 0 10516 Diane Wade SVP Marketing 16.00 24.00 X 109418 0 8877 James Griffith SVP Information Systems 16.00 24.00 X 101692 0 8620 Susie Fussell Facility Administrator 40.00 X 122394 0 9183 Jerry Vick Former SVP Finance 16.00 24.00 X 111063 0 5589 1020246 0 62304 7 1 1 0 Southern Rehabilitation Professional In PO Box 1066 Americus GA 31709 Therapy services 532537 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultation 352354 Parkers Heating & Air PO Box 476 Americus GA 31709 Air conditioning services/repairs 237223 Simply Elegant Landscaping 1517 S Lee St Apt C Americus GA 31709 Lawn maintenance and landscaping 180672 Metz Culinary Management Two Woodward Dr Dallas PA 18612 Dietary management services 154844 5 682271 682271 Routine Room/Board 623000 16832257 16832257 Medicare/Medicaid Payments 623000 9054204 9054204 Service Coordinator 623000 134098 134098 Cablevision 623000 12721 12721 Housekeeping Revenue 623000 12670 12670 1880 1880 26047830 435153 435153 4029876 3656757 373119 373119 373119 48645 17817 30828 30828 Management fee revenue 900099 1658628 1658628 Food Sale Revenue 623000 371502 371502 Durable Medical equipment 623000 133521 133521 269655 136480 133175 2433306 30002507 27976459 0 1343777 950973 203220 725173 22580 9361731 7229099 2022745 109887 222170 128776 91172 2222 1963484 1544541 402948 15995 792186 583073 199111 10002 178839 178839 79680 79680 850597 781939 68658 193922 175246 18676 271832 268916 2916 2881869 2867056 14813 156387 11700 128938 15749 1124 1124 31105 29505 1600 1556914 329045 1227869 525947 8146 517801 Contracted Services 2999946 2199858 800088 Supplies 1800360 1654044 99789 46527 Raw Food 1405667 1405667 Repairs & Maintenance 337327 246031 91296 382461 210303 170729 1429 26944521 18650064 7979816 314641 389580 892611 2855768 19106193 5150 3325 7527970 4203975 53612 51378 421801 251005 57250587 38441633 19764902 18808954 14658097 14576202 282761 296469 9743008 2061387 55702649 60251499 2441278 2588482 132078 106561 21139175 20784175 1129744 1004089 46748 46748 24889023 24530055 X 26726346 31416049 1220418 1434673 2866862 2870722 30813626 35721444 55702649 60251499 X 3057986 -291621 2141453 X X 0 1 X 1 1 1 X 1121185 1566557 950422 1064909 682271 5385344 22616924 22230184 22043170 24842514 25974568 117707360 23738109 23796741 22993592 25907423 26656839 123092704 480000 405000 355000 545000 28588 1813588 0 480000 405000 355000 545000 28588 1813588 121279116 371750 427658 373180 319959 435153 1927700 371750 427658 373180 319959 435153 1927700 2126027 2229045 2163114 2514109 2621312 11653607 26235886 26453444 25529886 28741491 29713304 136674011 0.88740 0.88300 0.01410 0.01440 X Schedule A, Part III, Line 12, Explanation of Other Income: Management service fees - 2010 Amount: $ 1,170,945. 2011 Amount: $ 1,204,965. 2012 Amount: $ 1,371,864. 2013 Amount: $ 1,483,680. 2014 Amount: $ 1,627,621. Service Coordinator - 2011 Amount: $ 119,169. 2013 Amount: $ 93,403. 2014 Amount: $ 76,430. Employee cafeteria - 2010 Amount: $ 377,167. 2011 Amount: $ 389,057. 2012 Amount: $ 387,503. 2013 Amount: $ 396,141. 2014 Amount: $ 371,502. Beauty shop - 2010 Amount: $ 143,571. 2011 Amount: $ 138,551. 2012 Amount: $ 130,782. 2013 Amount: $ 121,023. 2014 Amount: $ 108,317. Miscellaneous - 2010 Amount: $ 80,982. 2011 Amount: $ 80,664. 2013 Amount: $ 91,108. 2014 Amount: $ 87,687. Laundry revenue - 2010 Amount: $ 31,375. 2011 Amount: $ 26,699. 2012 Amount: $ 31,224. 2013 Amount: $ 31,787. 2014 Amount: $ 26,215. Vending machine commissions - 2010 Amount: $ 548. 2011 Amount: $ 607. Cable TV charges - 2011 Amount: $ 12,613. 2014 Amount: $ 12,721. Nurse Aide Training payments - 2010 Amount: $ 10,932. 2011 Amount: $ 14,536. 2012 Amount: $ 21,233. 2014 Amount: $ 31,513. Guest apartment fees - 2010 Amount: $ 26,799. 2011 Amount: $ 15. Housekeeping revenue - 2013 Amount: $ 11,556. 2014 Amount: $ 12,670. Resident activities - 2011 Amount: $ 9,650. 2013 Amount: $ 4,121. 2014 Amount: $ 1,922. Rebates and refunds - 2011 Amount: $ 14,841. 2013 Amount: $ 24,610. 2014 Amount: $ 20,362. Share of Joint venture income - 2010 Amount: $ 116,103. 2011 Amount: $ 63,328. 2012 Amount: $ 88,022. 2013 Amount: $ 92,741. 2014 Amount: $ 85,973. Durable Medical equipment - 2010 Amount: $ 167,605. 2011 Amount: $ 154,350. 2012 Amount: $ 132,486. 2013 Amount: $ 139,391. 2014 Amount: $ 133,521. Room Rentals - 2013 Amount: $ 24,548. 2014 Amount: $ 24,858. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13316404 3860 312988 327522 50232 13255498 12381680 3677 1363802 383623 49132 13316404 11637783 3596 1071652 285646 45705 12381680 11910141 3610 47595 275621 47942 11637783 10761618 1475621 278065 49033 11910141 0.78340 0.21660 0.00000 0 0 1181052 1181052 44823787 29020530 15803257 10965815 9421103 1544712 279933 279933 18808954 Annuity Payable 46748 46748 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 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. As of June 30, 2015, tax years that remain subject to examination by taxing authorities begin with 2011. Tax returns for 2011, 2012, 2013 and 2014 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 0 0 0 0 0 0 0 0 0 Mark R Todd President/CEO 240500 0 0 0 0 0 4810 0 6735 0 252045 0 0 0 Scott Adkins SVP Finance 146140 0 0 0 0 0 2923 0 5051 0 154114 0 0 0 Hill Fort SVP Operations 189039 0 0 0 0 0 3781 0 6735 0 199555 0 0 0 Jerry Vick Former SVP Finance 111063 0 0 0 0 0 2221 0 3368 0 116652 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 XI, line 9: Intercompany forgiveness of debt 2,141,453. 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. 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