2014-11-05T14:05:43-06:00 2014-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2013-07-01 201364957 Magnolia Manor of St Simons Inc MAGN 2299249352 2001 South Lee Street Americus GA 31709 Mark Todd President 2299249352 2014-10-31 1 Rick Alibozek P00108158 4784648000 2014-10-31 X 2013 2015-11-30 17:44:51Z Mark Todd 2001 South Lee Street Americus GA 31709 10490726 0 X www.magnoliamanor.com X 2004 GA The Corporation is organized to provide residential and long-term care services to the sick and elderly in a spirtual setting. The mission is accomplished through the operation of a 125-bed long term care facility and a 94-unit retirement community located on St. Simon's Island, Georgia. 14 14 257 45 0 0 0 0 10799223 10423247 651 916 68790 66563 10868664 10490726 0 0 0 0 4733525 4375751 0 0 0 6511813 6373809 11245338 10749560 -376674 -258834 2048283 1344688 3161995 3229852 -1113712 -1885164 X The Corporation is organized to provide residential and long-term care services to the sick and elderly in a spiritual setting. The mission is accomplished through the operation of a 125-bed long-term care facility and a 94-unit retirement community located on St. Simon's Island, Georgia. 0 0 8878059 10423247 The Corporation provided residential services to the sick and aged through the operation of a 125-bed long term care facililty and a 94-bed retirement community located in St. Simons, Georgia. The Corporation provided approximately 70,000 patient days of service during the year. 8878059 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 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 39 0 257 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 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 Edie Vinson Trustee 0.00 X 0 0 0 Dr Connie Blanchard Trustee 0.00 X 0 0 0 John Stephens 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 Hal Weathers 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 6.00 34.00 X 0 226923 9963 Jerry Vick SVP Finance 6.00 34.00 X 0 168477 8795 Hill Fort SVP Operations 6.00 34.00 X 0 182231 9070 Diane Wade SVP Marketing 6.00 34.00 X 0 108604 7526 Jackie Crisp Administrator 40.00 X 103273 0 7490 103273 686235 42844 1 0 1 0 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72919 Therapy services 860042 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceutical and Consultation 198999 2 Medicare/Medicaid Payments 623000 6220311 6220311 Routine Room/Board 623000 4202936 4202936 10423247 916 916 Share of earning in GPV 900099 46371 46371 Miscellaneous 900099 11233 11233 Food Sale Revenue 623000 4568 4568 4391 4391 66563 10490726 10423247 0 67479 3544256 3183961 360295 28164 21989 6175 503680 466809 36871 299651 270840 28811 21317 21317 25373 25373 78747 78747 2765 2765 2118273 2118273 14199 10333 3866 66358 66358 150374 150374 Contracted Services 1254740 1254740 Supplies 649494 649494 Georgia Provider Fee 604503 604503 Management Fees 466944 466944 920722 835262 85460 10749560 8878059 1871501 0 36795 119647 1419494 683173 8282 11011 147443 133885 825804 501649 373823 324155 62446 72817 2048283 1344688 822827 990374 2339168 2239478 3161995 3229852 X -1113712 -1885164 -1113712 -1885164 2048283 1344688 X -258834 -512618 X X 0 1 X 1 0 X 8742718 9368528 9687096 10799223 10423247 49020812 8742718 9368528 9687096 10799223 10423247 49020812 0 0 0 49020812 204 1286 542 651 916 3599 204 1286 542 651 916 3599 78333 70619 53963 68790 66563 338268 8821255 9440433 9741601 10868664 10490726 49362679 0.99310 0.99270 0.00010 0.00010 X Schedule A, Part II, Line 12, Explanation of Other Income: Resident fees - Vending machine commissions - Rebates refunds - 2010 Amount: $ 2,856. Employee cafeteria sales - 2009 Amount: $ 1,567. 2010 Amount: $ 2,044. 2011 Amount: $ 3,324. 2012 Amount: $ 5,296. 2013 Amount: $ 4,568. Laundry services - Beauty shop revenue - 2009 Amount: $ 5,812. 2010 Amount: $ 5,600. 2011 Amount: $ 7,002. 2012 Amount: $ 5,064. 2013 Amount: $ 4,391. Miscellaneous - 2009 Amount: $ 21,697. 2010 Amount: $ 2,068. 2011 Amount: $ 11,973. 2012 Amount: $ 14,419. 2013 Amount: $ 11,233. Share of joint venture - 2009 Amount: $ 49,257. 2010 Amount: $ 58,051. 2011 Amount: $ 31,664. 2012 Amount: $ 44,011. 2013 Amount: $ 46,371. 445267 295599 149668 380537 206050 174487 324155 Investment in GA Pharmacy 72817 C 72817 Intercompany Payable 2239478 2239478 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. The contents of the Form 990 were presented and explained to the members of the Executive Committee for their review and approval prior to filing. 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, conflict of interest policy and financial statements available to the public upon request at the Organization's Corporate office in Americus, Georgia. Form 990, Part XI, line 9: Transfer to related party - forgiveness of debt -512,618. Form 990, Part XII, Line 2c Review of financial statements - The process for the review of the audited financial statements has not changed 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 Columbus Inc 2001 South Lee Street Americus GA 31709 208034409 Operation of two (2) nursing facilities and a retirement facility 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 Macon Inc 2001 South Lee Street Americus GA 31709 261311379 Operation of an assisted living 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 0 Georgia Pharmacy Ventures LLC 440 Industrial Boulevard Hawkinsville GA 31036 261918757 Provides pharmacy related products and services to Magnolia Manor residents GA Magnolia Manor Inc Related 46371 100028 0 0 0.15000 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1