2014-11-17T09:19:39-06:00 2014-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2013-07-01 580911706 MAGNOLIA MANOR INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 Mark Todd President 2299249352 2014-11-11 1 Rick Alibozek P00108158 4784648000 2014-11-10 X 2013 2015-11-30 17:44:51Z Mark Todd 2001 SOUTH LEE STREET AMERICUS GA 31709 33857922 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 . 14 14 608 450 0 0 950422 1064909 22043170 24842514 890083 1327830 2244137 1179102 26127812 28414355 0 0 0 0 12940969 12583691 0 0 337309 12840238 13513239 25781207 26096930 346605 2317425 51896694 55702649 24060795 24889023 27835899 30813626 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 19799429 26603257 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. 19799429 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 1 105 0 1 608 1 0 1 CJ 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1 GA X The Organization 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 Connie Blanchard Board member 1.00 X 0 0 0 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 John Stephens 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 Kip Smith 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 Shane Green 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 226923 0 9963 Jerry Vick SVP Finance 16.00 24.00 X 168477 0 8795 Hill Fort SVP Operations 16.00 24.00 X 182231 0 9070 Diane Wade SVP Marketing 16.00 24.00 X 108604 0 7526 Susie Fussell Facility Administrator 40.00 X 123059 0 7886 809294 0 43240 5 0 1 0 Southern Rehabilitation Professional In PO Box 1066 Americus GA 31709 Therapy services 630155 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultation 267409 Dixon Hughes Goodman LLP PO BOX 602828 Charlotte NC 28260 Accounting 250629 Simply Elegant Landscaping 1517 S Lee St Apt C Americus GA 31709 Lawn maintenance and landscaping 184039 D2 Architecture LLC 2001 N Lamar St Suite 450 Dallas TX 75202 Architecture design 162315 5 1064909 1064909 Routine Room/Board 623000 15731050 15731050 Medicare/Medicaid Payments 623000 8992552 8992552 Service Coordinator 623000 93403 93403 Cablevision 623000 12753 12753 Housekeeping Revenue 623000 11556 11556 1200 1200 24842514 319959 319959 6451438 5443567 1007871 1007871 1007871 Management fee revenue 900099 1483679 1483679 Food Sale Revenue 623000 396141 396141 Durable Medical equipment 623000 139391 139391 -840109 137673 -977782 1179102 28414355 26603257 0 746189 721589 192685 507495 21409 9363395 7500890 1705010 157495 138894 65108 72631 1155 1576063 1237624 323240 15199 783750 586033 185678 12039 108112 108112 78694 78694 800394 744824 55570 196737 186535 10202 253940 251649 2291 3122940 3115461 7479 156034 8867 124290 22877 21295 21295 41093 39493 1600 1542525 1462309 80216 549378 7796 541582 Contracted Services 1930065 1930065 Supplies 1632597 1632597 Raw Food 1426717 1426717 Contracted Services 707190 707190 945528 593784 312672 39072 26096930 19799429 5960192 337309 371558 389580 6443453 2855768 13298 5150 3391595 7527970 51683 53612 107461 421801 56667811 36902909 20782391 19764902 13211883 14658097 262020 282761 7261352 9743008 51896694 55702649 2541186 2441278 72486 132078 19607629 21139175 1792746 1129744 46748 46748 24060795 24889023 X 23941066 26726346 1031648 1220418 2863185 2866862 27835899 30813626 51896694 55702649 X 2317425 629858 30444 X X 0 1 X 1 1 1 X 1509300 1121185 1566557 950422 1064909 6212373 22076648 22616924 22230184 22043170 24842514 113809440 23585948 23738109 23796741 22993592 25907423 120021813 951813 480000 405000 355000 545000 2736813 0 951813 480000 405000 355000 545000 2736813 117285000 414379 371750 427658 373180 319959 1906926 414379 371750 427658 373180 319959 1906926 1864767 2126027 2229045 2163114 2514109 10897062 25865094 26235886 26453444 25529886 28741491 132825801 0.88300 0.88160 0.01440 0.01560 X Schedule A, Part III, Line 12, Explanation of Other Income: Management service fees - 2009 Amount: $ 990,248. 2010 Amount: $ 1,170,945. 2011 Amount: $ 1,204,965. 2012 Amount: $ 1,371,864. 2013 Amount: $ 1,483,680. Service Coordinator - 2009 Amount: $ 98,631. 2011 Amount: $ 119,169. 2013 Amount: $ 93,403. Employee cafeteria - 2009 Amount: $ 370,249. 2010 Amount: $ 377,167. 2011 Amount: $ 389,057. 2012 Amount: $ 387,503. 2013 Amount: $ 396,141. Beauty shop - 2009 Amount: $ 145,921. 2010 Amount: $ 143,571. 2011 Amount: $ 138,551. 2012 Amount: $ 130,782. 2013 Amount: $ 121,023. Miscellaneous - 2010 Amount: $ 80,982. 2011 Amount: $ 80,664. 2013 Amount: $ 91,108. Laundry revenue - 2009 Amount: $ 30,201. 2010 Amount: $ 31,375. 2011 Amount: $ 26,699. 2012 Amount: $ 31,224. 2013 Amount: $ 31,787. Wellness Center revenue - 2009 Amount: $ 69,186. Vending machine commissions - 2009 Amount: $ 1,965. 2010 Amount: $ 548. 2011 Amount: $ 607. Cable TV charges - 2009 Amount: $ 13,862. 2011 Amount: $ 12,613. Telephone revenue - 2009 Amount: $ 3. Nurse Aide Training payments - 2010 Amount: $ 10,932. 2011 Amount: $ 14,536. 2012 Amount: $ 21,233. 2013 Amount: $ 0. Guest apartment fees - 2009 Amount: $ 32,170. 2010 Amount: $ 26,799. 2011 Amount: $ 15. Housekeeping revenue - 2009 Amount: $ 13,817. 2013 Amount: $ 11,556. Resident activities - 2011 Amount: $ 9,650. 2013 Amount: $ 4,121. Rebates and refunds - 2011 Amount: $ 14,841. 2013 Amount: $ 24,610. Share of Joint venture income - 2009 Amount: $ 98,514. 2010 Amount: $ 116,103. 2011 Amount: $ 63,328. 2012 Amount: $ 88,022. 2013 Amount: $ 92,741. Durable Medical equipment - 2010 Amount: $ 167,605. 2011 Amount: $ 154,350. 2012 Amount: $ 132,486. 2013 Amount: $ 139,391. Room Rentals - 2013 Amount: $ 24,548. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12381680 3677 1363802 383623 49132 13316404 11637783 3596 1071652 285646 45705 12381680 11910141 3610 47595 275621 47942 11637783 10761618 1475621 278065 49033 11910141 10160681 4860 929723 287880 45766 10761618 0.78470 0.21530 0 0 1181052 1181052 44745219 27747545 16997674 10445759 9155364 1290395 295781 295781 19764902 Deferred loan costs 1074277 Intercompany receivable 8321224 Cash - Repair & Replacement 347507 9743008 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 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. X 0 0 0 0 0 0 0 0 0 Mark R Todd President/CEO 226923 0 0 0 0 0 4538 0 5425 0 236886 0 0 0 Jerry Vick SVP Finance 168477 0 0 0 0 0 3370 0 5425 0 177272 0 0 0 Hill Fort SVP Operations 182231 0 0 0 0 0 3645 0 5425 0 191301 0 0 0 A Americus and Sumter County Hospital Authority 586000058 030695DL1 2013-08-15 35385246 Refinance existing debt 0 0 0 A 385000 35385246 1084384 707705 454754 33593157 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 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 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 30,444. 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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