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 208034409 Magnolia Manor of Columbus Inc MAGN 2299249352 2001 South Lee Street Americus GA 31709 Mark Todd President 2299249352 2015-11-13 1 Linda Corty P00221297 4784648000 2015-11-12 X 2014 2016-04-25 22:37:26Z Mark Todd 2001 South Lee Street Americus GA 31709 22027193 0 X www.magnoliamanor.com X 2007 GA The Corporation is organized to provide long-term care and personal care services to the sick and elderly in a spiritual setting through the operation of 376 long-term care beds and 44 personal care beds on a single campus located in Columbus, Georgia. 13 13 520 245 0 0 0 0 19450343 21720404 175974 69563 1182569 237226 20808886 22027193 0 0 0 0 8575241 9328720 0 0 0 10208667 10864408 18783908 20193128 2024978 1834065 27374279 22226288 31343730 23756924 -3969451 -1530636 The Corporation is organized to provide long-term care and personal care services to the sick and elderly in a spiritual setting through the operation of 376 long-term care beds and 44 personal care beds on a single campus located in Columbus, Georgia. 0 0 18018314 21094178 Provided long-term care and personal care services in a spiritual setting. The Corporation has two nursing facilities with a combined 376 beds, along with a 44-bed personal care facility. The Corporation provided approximately 100,000 days of service during the year. 18018314 1 0 0 0 0 0 0 0 0 0 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 0 0 0 1 58 0 520 1 0 0 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 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 Eloise Paschal Secretary 0.00 X X 0 0 0 Chuck Reeves Vice 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 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 Will Peterson Trustee 0.00 X 0 0 0 Cindy Higdon Trustee 0.00 X 0 0 0 Mark Todd President/CEO 10.00 30.00 X 0 240500 11545 Diane Wade SVP Marketing 10.00 30.00 X 0 109418 8877 Scott Adkins SVP Finance 10.00 30.00 X 0 146140 7974 Hill Fort SVP Operations 10.00 30.00 X 0 189039 10516 James Griffith SVP Information Systems 10.00 30.00 X 0 101692 8620 Angela Rose Administrator 40.00 X 126398 0 9263 Jerry Vick Former SVP Finance 10.00 30.00 X 0 111063 5589 126398 897852 62384 1 1 1 0 Aegis Therapies PO Box 8103 Fort Smith AR 72902 Therapy services 860512 Global Personal Services 1127 Brown Ave Columbus GA 31906 Nursing Contract Labor 454025 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultations 450199 All Pro Materials & Services PO Box 1045 Fortson GA 31808 Materials and various repairs 274008 4 Medicare/Medicaid Payments 623000 17426217 17426217 Routine Room/Board 623000 4294187 4294187 21720404 69563 69563 Share of Pharmacy venture income 900099 135703 135703 Food Sale Revenue 623000 38085 38085 Nurse Aide Training 623000 29142 29142 34296 34296 237226 22027193 21957630 0 69563 7327035 6602215 724820 164050 145340 18710 1262714 1191486 71228 574921 518998 55923 42972 42972 24637 24637 65959 65959 417 417 931130 931130 20955 5410 15545 882538 882538 632525 632525 371101 371101 Contracted Services 2564173 2564173 Georgia Provider Fee 1432194 1432194 Supplies 1374023 1374023 Management Fees 916260 916260 1605524 1367181 238343 20193128 18018314 2174814 0 110836 169354 1403489 1472158 6222484 1492785 12818 8357 27552 55161 20712023 2454098 18818891 18257925 230589 252292 -7582 -16219 555202 534475 27374279 22226288 1494350 1360294 1250 417 14128616 14128616 7607420 7329087 8112094 938510 31343730 23756924 X -3969451 -1530636 -3969451 -1530636 27374279 22226288 X 1834065 604750 X X 0 1 X 1 0 X 19838078 18034588 17863235 19450343 21094178 96280422 19838078 18034588 17863235 19450343 21094178 96280422 0 0 0 96280422 2555 2306 1727 56577 69563 132728 2555 2306 1727 56577 69563 132728 252666 175671 214377 215010 237647 1095371 20093299 18212565 18079339 19721930 21401388 97508521 0.98740 0.98810 0.00140 0.00070 X Schedule A, Part III, Line 12, Explanation of Other Income: Pharmacy services - 2010 Amount: $ 167,212. 2011 Amount: $ 100,269. 2012 Amount: $ 139,369. 2013 Amount: $ 146,841. 2014 Amount: $ 136,124. Employee cafeteria sales - 2010 Amount: $ 31,436. 2011 Amount: $ 25,479. 2012 Amount: $ 26,139. 2013 Amount: $ 30,090. 2014 Amount: $ 38,085. Beauty shop revenue - 2010 Amount: $ 30,738. 2011 Amount: $ 33,539. 2012 Amount: $ 29,275. 2013 Amount: $ 31,979. 2014 Amount: $ 28,794. Miscellaneous - 2010 Amount: $ 23,280. 2011 Amount: $ 10,944. 2012 Amount: $ 1,101. 2013 Amount: $ 2,905. 2014 Amount: $ 2,478. NATT revenue - 2012 Amount: $ 14,170. 2014 Amount: $ 29,142. Vending machine commissions - 2011 Amount: $ 5,440. 2012 Amount: $ 4,323. 2013 Amount: $ 3,195. 2014 Amount: $ 3,024. 1792197 1792197 16838223 1785187 15053036 2081603 668911 1412692 18257925 Due to/from related parties 938510 938510 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. 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 Todd President/CEO 0 240500 0 0 0 0 0 4810 0 6735 0 252045 0 0 Scott Adkins SVP Finance 0 146140 0 0 0 0 0 2923 0 5051 0 154114 0 0 Hill Fort SVP Operations 0 189039 0 0 0 0 0 3781 0 6735 0 199555 0 0 Jerry Vick Former SVP Finance 0 111063 0 0 0 0 0 2221 0 3368 0 116652 0 0 A Americus and Sumter County Hospital Authority 586000058 030695DL1 2013-08-15 35385246 Refinance existing debt 0 0 0 A 14567044 1472158 570386 187209 13829295 2013 1 0 1 1 A 0 0 0 1 0 0 0 0 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 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. 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 and conflict of interest policy available to the public upon request at the Organization's Corporate office in Americus, Georgia. The Organization does not receive separate audited financial statements. Form 990, Part XI, line 9: Transfer from related company - forgiveness of debt 604,750. Form 990, Part XII, Line 2c Review of financial statements - There was no change in the process for the review of the audited financial statements 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 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 Magnolia Manor of Macon Inc 2001 South Lee Street Americus GA 31709 261311379 Operation of a retirement 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 440 Industrial Boulevard Hawkinsville GA 31036 261918757 Provides pharmacy related products and services to Magnolia Manor residents GA Magnolia Manor Inc Related 136124 343748 0 0 0.47500 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 Magnolia Manor Inc M 916260 Amount charged