2020-05-07T10:00:16-05:00 2019-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-07-01 201220860 MAGNOLIA MANOR OF MARION COUNTY INC MAGN 2299249352 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK TODD PRESIDENT 2299249352 2020-05-07 1 AMY BIBBY P00445891 8282542254 2020-04-27 99.47.28.203 2020-05-07 09:46:43 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-09-23 17:36:50Z MARK TODD 2001 SOUTH LEE STREET AMERICUS GA 31709 6629167 0 X WWW.MAGNOLIAMANOR.COM X 2004 GA THE CORPORATION IS ORGANIZED TO PROVIDE LONG-TERM CARE TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF A 70-BED SKILLED NURSING FACILITY LOCATED IN BUENA VISTA, GEORGIA. 12 12 81 100 0 0 0 0 5851700 6523137 9196 16306 85735 89724 5946631 6629167 0 0 0 0 2463038 2769704 0 0 0 1693137 1925305 4156175 4695009 1790456 1934158 8090386 8033963 3303902 2995412 4786484 5038551 THE CORPORATION IS ORGANIZED TO PROVIDE LONG-TERM CARE TO THE SICK AND ELDERLY IN A SPIRITUAL SETTING THROUGH THE OPERATION OF A 70-BED SKILLED NURSING FACILITY LOCATED IN BUENA VISTA, GEORGIA. 0 0 4124498 0 6526047 PROVIDED LONG-TERM CARE FOR THE SICK AND ELDERLY IN A SPIRITUAL SETTING IN A 70-BED SKILLED NURSING FACILITY. THE ORGANIZATION PROVIDED 21,414 PATIENT DAYS OF SERVICE DURING THE YEAR. 4124498 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 15 0 1 81 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1 GA X SCOTT ADKINS 2299315907 2001 SOUTH LEE STREET AMERICUS GA 31709 MARK JOHNSON CHAIRMAN 1.00 5.00 X X 0 0 0 CHUCK REEVES VICE CHAIRMAN 1.00 5.00 X X 0 0 0 JEAN WHEELER SECRETARY 1.00 5.00 X X 0 0 0 HAL WEATHERS TRUSTEE 1.00 5.00 X 0 0 0 EDIE VINSON TRUSTEE 1.00 5.00 X 0 0 0 WILL PETERSON TRUSTEE 1.00 5.00 X 0 0 0 ANN HARRIS TRUSTEE 1.00 5.00 X 0 0 0 SCHLEY GATEWOOD JR TRUSTEE 1.00 5.00 X 0 0 0 RUSS CARREKER TRUSTEE 1.00 5.00 X 0 0 0 JAMES BUCHANAN JR TRUSTEE 1.00 5.00 X 0 0 0 CHARLES SHEFFIELD TRUSTEE 1.00 5.00 X 0 0 0 ED COLLIER TRUSTEE 1.00 5.00 X 0 0 0 MARK TODD PRESIDENT/CEO 4.00 56.00 X 0 303782 16280 SCOTT ADKINS SVP FINANCE 4.00 56.00 X 0 181316 26753 0 485098 43033 0 0 1 0 CHRIS R SHERIDAN & CO PO BOX 4441 MACON GA 31208 CONSTRUCTION SERVICES 1195863 BARNES GIBSON PARTNERS ARCHITECTS LLC 1365 WARREN WILLIAMS RD COLUMBUS GA 31901 ARCHITECTURE SERVICES 114610 2 MEDICARE/MEDICAID PAYM 623000 5934863 5934863 ROUTINE ROOM/BOARD 623000 588274 588274 6523137 16306 16306 SHARE OF AFFILATE INVE 900099 82521 82521 MISCELLANEOUS INCOME 900099 4293 4293 CAFETERIA SALES 623000 2910 2910 89724 6629167 6526047 0 103120 2242751 2120209 122542 48208 43999 4209 320054 306798 13256 158691 149454 9237 249768 249768 13228 13228 184221 148989 35232 6397 6397 107282 57507 49775 2123 2123 219417 219417 23013 14613 8400 157217 157217 177618 177618 64587 17476 47111 MEDICAID PROVIDER FEE 348477 348477 RAW FOOD 166489 166489 SUPPLIES 69853 60620 9233 DRUGS 68521 68521 67094 67094 4695009 4124498 570511 0 66844 39676 2009065 2025417 178899 228783 5337 4345 252 252 4630054 506122 4274660 4123932 124847 117367 1430482 1494191 8090386 8033963 303902 264856 3000000 2730556 3303902 2995412 X 4786484 5038551 4786484 5038551 8090386 8033963 X 1934158 -1682091 X X 0 1 X 1 0 X 4897392 4794123 5660763 5855700 6526047 27734025 4897392 4794123 5660763 5855700 6526047 27734025 0 0 0 27734025 1106 1265 1883 9130 16306 29690 1106 1265 1883 9130 16306 29690 28183 31967 78007 90931 86814 315902 4926681 4827355 5740653 5955761 6629167 28079617 0.98770 0.98880 0.00110 0.00070 X 3646760 218881 3427879 612446 256521 355925 370848 30720 340128 4123932 OTHER RECEIVABLES 1000 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 39513 DUE FROM RELATED ORGANIZATIONS 1453124 SECURITY DEPOSITS 554 1494191 X 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 FORM 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 CORPORATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ALL TAX POSITIONS TAKEN, AND THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2019 AND 2018. 0 0 0 0 0 0 0 0 0 MARK TODD PRESIDENT/CEO 0 303782 0 0 0 0 0 8558 0 7722 0 320062 0 29462 SCOTT ADKINS SVP FINANCE 0 181316 0 0 0 0 0 5756 0 20997 0 208069 0 8699 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS ELECTRONICALLY PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C REVIEWED AT QUARTERLY COMPLIANCE COMMITTEE MEETINGS AND ANNUALLY AT BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 15A THE CEO IS PAID ENTIRELY FROM A RELATED TAX-EXEMPT 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 IT FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST AT THE MAGNOLIA MANOR, INC. CORPORATE OFFICE IN AMERICUS, GEORGIA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE MAGNOLIA MANOR, INC. CORPORATE OFFICE IN AMERICUS, GEORGIA. FORM 990, PART XI, LINE 9: CHANGE IN DUE TO/FROM INTERCOMPANY ACCOUNTS -1,682,091. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MAGNOLIA MANOR INC 2001 S LEE STREET AMERICUS GA 31709 580911706 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF ST SIMONS INC 2255 FREDENCA RD ST SIMMONS ISLAND GA 31522 201364957 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON SUPPORTIVE HOUSING INC 190 PIERCE AVE MACON GA 31204 311651955 ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF COLUMBUS INC 2010 WARM SPRINGS RD COLUMBUS GA 31904 208034409 ELDERLY AFFORDABLE LONG-TERM CARE AND ASSISTED LIVING GA 501(C)(3) LINE 10 0 MAGNOLIA MANOR OF MACON INC 190 PIERCE AVE MACON GA 31204 261311379 ASSISTED LIVING GA 501(C)(3) LINE 10 0 GEORGIA PHARMACY VENTURES LLC 440 INDUSTRIAL BOULEVARD HAWKINSVILLE GA 31036 261918757 PROVISION OF PHARMACY-RELATED PRODUCTS AND SERVICES GA MAGNOLIA MANOR INC RELATED 0 0 0.07320 MMI ASSURANCE LTD 2001 S LEE STREET AMERICUS GA 31709 981082342 CAPTIVE INSURANCE COMPANY CJ N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1