2014-11-05T14:05:10-06:00 2014-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2013-07-01 201220860 Magnolia Manor of Marion County Inc MAGN 2299249352 2001 South Lee Street Americus GA 31709 Mark Todd President 2299249352 2014-10-31 1 Rick Alibozek P00108158 4784648000 2014-10-30 X 2013 2015-11-30 17:44:51Z Mark Todd 2001 South Lee Street Americus GA 31709 4681454 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 operation of a 70-bed skilled nursing facility located in Buena Vista, Georgia. 14 14 104 28 0 0 0 0 4806252 4631778 807 845 96351 48831 4903410 4681454 0 0 0 0 1788575 1844774 0 0 0 1585927 1642778 3374502 3487552 1528908 1193902 1818024 3175308 257088 323815 1560936 2851493 X 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 2733479 4657424 Provided long-term care for the sick and elderly in a spiritual setting in a 70-bed skilled nursing facility. The Organization provided 21,477 patient days of service during the year. 2733479 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 9 0 104 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 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 James R Buchanan Jr Trustee 0.00 X 0 0 0 Eloise Paschal Secretary 0.00 X X 0 0 0 Ann Harris Trustee 0.00 X 0 0 0 Mark Johnson Chairman 0.00 X X 0 0 0 John Stephens Trustee 0.00 X 0 0 0 Edie Vinson Trustee 0.00 X 0 0 0 Connie Blanchard Trustee 0.00 X 0 0 0 Hal Weathers Trustee 0.00 X 0 0 0 Jean Wheeler Trustee 0.00 X 0 0 0 Chuck Reeves Vice Chairman 0.00 X X 0 0 0 Kip Smith Trustee 0.00 X 0 0 0 Robert Beckum Trustee 0.00 X 0 0 0 Shane Green Trustee 0.00 X 0 0 0 Cindy Higdon Trustee 0.00 X 0 0 0 Mark Todd President/CEO 4.00 36.00 X 0 226923 9963 Jerry Vick SVP Finance 4.00 36.00 X 0 168477 8795 Hill Fort SVP Operations 4.00 36.00 X 0 182231 9070 Diane Wade SVP Marketing 4.00 36.00 X 0 108604 7526 0 686235 35354 0 0 1 0 0 Medicare/Medicaid Paym 623000 4335673 4335673 Routine Room/Board 623000 296105 296105 4631778 845 845 5113 0 5113 5113 5113 Share of LLC investmen 900099 23185 23185 Miscellaneous 623000 17213 17213 Food Sale Revenue 623000 3320 3320 43718 4681454 4657424 0 24030 1506318 1398758 107560 15402 13258 2144 202950 193962 8988 120104 111760 8344 9517 9517 7602 7602 24642 24642 190 190 299037 299037 7418 6001 1417 28362 28362 61417 61417 Georgia Provider Fee 351114 351114 Contracted Services 283682 283682 Supplies 214079 214079 Management Fees 144024 144024 211694 184580 27114 3487552 2733479 754073 0 49162 130662 625729 1812775 5182 5225 10847 6558 370593 98678 200246 271915 31223 36408 895635 911765 1818024 3175308 257088 323815 257088 323815 X 1560936 2851493 1560936 2851493 1818024 3175308 X 1193902 96655 X X 0 1 X 1 0 X 3813848 4191696 4354128 4806252 4631778 21797702 3813848 4191696 4354128 4806252 4631778 21797702 0 0 0 21797702 61821 67241 57113 62163 5958 254296 61821 67241 57113 62163 5958 254296 30524 32934 22111 34995 43718 164282 3906193 4291871 4433352 4903410 4681454 22216280 0.98120 0.97970 0.01140 0.01440 X Schedule A, Part II, Line 12, Explanation of Other Income: Employee cafeteria sales - 2009 Amount: $ 3,640. 2010 Amount: $ 4,803. 2011 Amount: $ 5,008. 2012 Amount: $ 3,945. 2013 Amount: $ 3,320. Share of income from joint venture - 2009 Amount: $ 24,628. 2010 Amount: $ 26,402. 2011 Amount: $ 15,832. 2012 Amount: $ 22,005. 2013 Amount: $ 23,185. Miscellaneous receipts - 2009 Amount: $ 2,256. 2010 Amount: $ 1,729. 2011 Amount: $ 1,271. 2012 Amount: $ 9,045. 2013 Amount: $ 17,213. 33654 4026 29628 336939 94652 242287 271915 Related party accounts receivable 911765 911765 X 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. 0 0 0 0 0 0 0 0 0 Mark Todd President/CEO 0 226923 0 0 0 0 0 4538 0 5425 0 236886 0 0 Jerry Vick SVP Finance 0 168477 0 0 0 0 0 3370 0 5425 0 177272 0 0 Hill Fort SVP Operations 0 182231 0 0 0 0 0 3645 0 5425 0 191301 0 0 Form 990, Part VI, Section A, line 3 Magnolia Manor, Inc., a related Section 501(c)(3) organization, provided certain management services to the Organization. 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. A copy of the Form 990 was also provided to all members of the Executive Committee of the Board of Trustees for their review and approval. Form 990, Part VI, Section B, line 12c Board members in general and Finance Committee members in particular are aware of potential conflicts and consider these potential conflicts in making decisions. 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 its 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 its 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: Transfers from related parties - forgiveness of debt 96,655. Form 990, Part XII, Line 2c Review of financial statements - The process for the review and oversight of the audit process and audited financial statements 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 9 0 Magnolia Manor of St Simons Inc 2255 Frederica Rd St Simons Island GA 31522 201364957 Elderly affordable long-term care and assisted living GA 501(c)(3) Line 9 0 Magnolia Manor of Macon Supportive Housing Inc 190 Pierce Ave Macon GA 31204 311651955 Assisted Living GA 501(c)(3) Line 9 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 9 0 Magnolia Manor of Macon Inc 190 Pierce Ave Macon GA 31204 261311379 Assisted Living GA 501(c)(3) Line 9 0 MMI Assurance Ltd 2001 S Lee Street Americus GA 31709 981082342 Captive Insurance company CJ Magnolia Manor Inc 1 Georgia Pharmacy Ventures LLC 440 Industrial Boulevard Hawkinsville GA 31036 261918757 Provision of pharmacy-related products and services GA Magnolia Manor Inc Related 23185 50014 0 0 0.07500 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1