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 208034409 Magnolia Manor of Columbus Inc MAGN 2299249352 2001 South Lee Street Americus GA 31709 Mark Todd President 2299249352 2016-11-22 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 21390793 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. 12 12 481 245 0 0 0 0 21720404 20883839 69563 227597 237226 255565 22027193 21367001 0 0 0 0 9328720 10006131 0 0 0 10864408 9952316 20193128 19958447 1834065 1408554 22226288 22705400 23756924 22900760 -1530636 -195360 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 17278824 21139404 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. 17278824 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 49 0 1 481 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 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 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 Secretary 0.00 X 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 220531 7970 Diane Harrison SVP of Human Resources 10.00 30.00 X 0 145513 5600 Scott Adkins SVP Finance 10.00 30.00 X 0 137919 8205 Hillery Fort SVP Operations 10.00 30.00 X 0 166053 8467 Mary Walhert Administrator 40.00 X 102981 0 6017 102981 670016 36259 1 0 1 0 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultations 548035 Magnolia Manor Rehabilitation 1013 Riverburch Parkway Dalton GA 30721 Therapy services 382087 Aegis Therapies PO Box 8103 Fort Smith AR 72902 Therapy services 223834 Global Personal Services 1127 Brown Ave Columbus GA 31906 Nursing Contract Labor 161259 4 Medicare/Medicaid Payments 623000 17712796 17712796 Routine Room/Board 623000 3171043 3171043 20883839 72389 72389 179000 23792 155208 155208 155208 Share of Pharmacy venture income 900099 165846 165846 Food Sale Revenue 623000 35086 35086 Nurse Aide Training 623000 33991 33991 20642 20642 255565 21367001 21139404 0 227597 X 7929340 7210533 718807 45034 40383 4651 1429033 1335603 93430 602724 549267 53457 570 570 42972 42972 2017466 1884716 132750 34389 34389 70030 70030 962 962 911833 911833 15581 6421 9160 882538 882538 640398 640398 369407 369407 Supplies 1626869 1595041 31828 Medicaid Provider fee 1461216 1461216 Management Fees 1008096 1008096 Raw Food 673457 673457 196532 87418 109114 19958447 17278824 2679623 0 169354 104549 1472158 1543563 1492785 1663502 8357 11548 55161 5244 20829819 3094498 18257925 17735321 252292 247139 -16219 534475 1394534 22226288 22705400 1360294 1729786 417 1417 14128616 14128616 7329087 7040941 938510 0 23756924 22900760 X -1530636 -195360 -1530636 -195360 22226288 22705400 X 1408554 -73278 X X 0 1 X 1 0 X 18034588 17863235 19450343 21094178 20883839 97326183 18034588 17863235 19450343 21094178 20883839 97326183 0 0 0 97326183 2306 1727 56577 69563 72389 202562 2306 1727 56577 69563 72389 202562 175671 214377 215010 237647 255565 1098270 18212565 18079339 19721930 21401388 21211793 98627015 0.98680 0.98740 0.00210 0.00140 X 1768405 1768405 16893023 2252597 14640426 2168391 841901 1326490 17735321 Deferred loan costs 486070 Due from related parties 908464 1394534 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. 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 220531 0 0 0 0 0 3434 0 4536 0 228501 0 0 Diane Harrison SVP of Human Resources 0 145513 0 0 0 0 0 0 0 5600 0 151113 0 0 Hillery Fort SVP Operations 0 166053 0 0 0 0 0 2723 0 5744 0 174520 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 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 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 IX, line 11g Dietary Contract Services : Program service expenses 387,818. Management and general expenses 0. Fundraising expenses 0. Total expenses 387,818. Plant Contract Services : Program service expenses 303,837. Management and general expenses 0. Fundraising expenses 0. Total expenses 303,837. Laundry and Housekeeping Contract Services: Program service expenses 175,473. Management and general expenses 0. Fundraising expenses 0. Total expenses 175,473. Resident Care Contract Services : Program service expenses 1,017,588. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,017,588. Administrative Contract Services: Program service expenses 0. Management and general expenses 132,750. Fundraising expenses 0. Total expenses 132,750. Form 990, Part XI, line 9: Transfer from related company - forgiveness of debt -73,278. 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 165846 424833 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 1008096 Amount charged