2014-11-05T14:04:50-06:00 2014-06-30 580692043 Mauldin & Jenkins LLC P O Box 1877 Macon GA 312021877 990 2013-07-01 208034409 Magnolia Manor of Columbus 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 20816689 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. 14 14 530 245 0 0 0 0 17863235 19450343 1727 175974 214377 1182569 18079339 20808886 0 0 0 0 8789648 8575241 0 0 0 9843196 10208667 18632844 18783908 -553505 2024978 21985299 27381861 28544510 31351312 -6559211 -3969451 X 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 15023461 19450343 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. 15023461 1 0 0 0 0 0 0 0 0 0 1 0 0 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 57 0 530 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 Chuck Reeves Vice Chairman 0.00 X X 0 0 0 Edie Vinson Trustee 0.00 X 0 0 0 John Stephens Trustee 0.00 X 0 0 0 Dr Connie Blanchard Trustee 0.00 X 0 0 0 Jean Wheeler Trustee 0.00 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 10.00 30.00 X 0 226923 9963 Diane Wade SVP Marketing 10.00 30.00 X 0 108604 7526 Jerry Vick SVP Finance 10.00 30.00 X 0 168477 8795 Hill Fort SVP Operations 10.00 30.00 X 0 182231 9070 Angela Rose Administrator 40.00 X 123000 0 7885 123000 686235 43239 1 0 1 0 Aegis Therapies PO Box 8103 Fort Smith AR 72902 Therapy services 1241117 Magnolia Manor Pharmacy PO Box 988 Hawkinsville GA 31036 Pharmaceuticals and consultations 453050 Global Personal Services 1127 Brown Ave Columbus GA 31906 Nursing Contract Labor 286254 All Pro Materials & Services PO Box 1045 Fortson GA 31808 Materials and various repairs 184388 ATC Healthcare Services Inc 25393 Network Place Chicago IL 60673 Nursing Contract Labor 173413 5 Medicare/Medicaid Payments 623000 16197262 16197262 Routine Room/Board 623000 3253081 3253081 19450343 56577 56577 127200 7803 119397 119397 119397 Gain on bond refinance 900099 967559 967559 Share of Pharmacy venture income 900099 146841 146841 Beauty Shop Revenue 900099 31979 31979 36190 36190 1182569 20808886 19450343 0 1358543 6952322 6247069 705253 39025 32520 6505 1020733 954994 65739 563161 507864 55297 42435 42435 28729 28729 52342 52342 2028 2028 967618 967618 19175 6029 13146 771532 771532 629613 629613 355053 355053 Contracted Services 2774082 2774082 Supplies 1422787 1422787 Georgia Provider Fee 1398219 1398219 Management Fees 824496 824496 920558 709353 211205 18783908 15023461 3760447 0 213466 110836 1403489 2061601 6222484 13987 12818 63573 27552 20640466 1821575 19426018 18818891 197748 230589 8906 555202 21985299 27381861 2448301 1494350 1833 1250 14136198 20219512 7607420 5874864 8112094 28544510 31351312 X -6559211 -3969451 -6559211 -3969451 21985299 27381861 X 2024978 564782 X X 0 1 X 1 0 X 18926848 19838078 18034588 17863235 19450343 94113092 18926848 19838078 18034588 17863235 19450343 94113092 0 0 0 94113092 293 2555 2306 1727 56577 63458 293 2555 2306 1727 56577 63458 207487 252666 175671 214377 215010 1065211 19134628 20093299 18212565 18079339 19721930 95241761 0.98810 0.98960 0.00070 0.00010 X Schedule A, Part II, Line 12, Explanation of Other Income: Pharmacy services - 2009 Amount: $ 155,980. 2010 Amount: $ 167,212. 2011 Amount: $ 100,269. 2012 Amount: $ 139,369. 2013 Amount: $ 146,841. Employee cafeteria sales - 2009 Amount: $ 24,863. 2010 Amount: $ 31,436. 2011 Amount: $ 25,479. 2012 Amount: $ 26,139. 2013 Amount: $ 30,090. Beauty shop revenue - 2009 Amount: $ 20,232. 2010 Amount: $ 30,738. 2011 Amount: $ 33,539. 2012 Amount: $ 29,275. 2013 Amount: $ 31,979. Miscellaneous - 2009 Amount: $ 9,992. 2010 Amount: $ 23,280. 2011 Amount: $ 10,944. 2012 Amount: $ 1,101. 2013 Amount: $ 2,905. NATT revenue - 2009 Amount: $ -5,400. 2012 Amount: $ 14,170. Vending machine commissions - 2009 Amount: $ 1,820. 2011 Amount: $ 5,440. 2012 Amount: $ 4,323. 2013 Amount: $ 3,195. 1792197 1792197 16832937 1318470 15514467 2015332 503105 1512227 18818891 Due to/from related parties 8112094 8112094 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 Management functions are performed by Magnolia Manor, Inc., a related Section 501(c)(3) organization. Magnolia Manor, Inc. is related through common management and governing board. 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 XI, line 9: Transfer from related company - forgiveness of debt 564,782. 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. 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