2024-03-15T15:39:41-05:00 2023-04-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-05-01 010594994 COOPERATIVE HEALTHCARE SERVICES INC COOP 9124667058 2415 PARKWOOD DR BRUNSWICK GA 31520 DAVID D STOB EXEC. CONSULTANT & INTERIM CFO 9124667058 2024-03-15 1 DAVID STOB 999009999 1 AMY BIBBY P00445891 8282542254 2024-03-15 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z BYRON S RAYNES 2415 PARKWOOD DR BRUNSWICK GA 31520 79673246 0 X HTTP://WWW.SGHS.ORG/ABOUT/SGHS-COOPERATIVE-HEALTH X 2002 GA COOPERATIVE HEALTHCARE SERVICES, INC., WILL SERVE AS A SUPPORTING ORGANIZATION TO FURTHER ENABLE SOUTHEAST GEORGIA HEALTH SYSTEM TO PROVIDE SAFE, QUALITY, ACCESSIBLE, AND COST-EFFECTIVE CARE TO MEET THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES IT SERVES. 6 4 573 0 0 0 664828 0 66929588 71042857 17072 6570 8524296 8623819 76135784 79673246 0 0 0 0 94814166 98499991 0 0 0 20845688 18621299 115659854 117121290 -39524070 -37448044 14369691 13928658 30824665 30404495 -16454974 -16475837 COOPERATIVE HEALTHCARE SERVICES, INC., WILL SERVE AS A SUPPORTING ORGANIZATION TO FURTHER ENABLE SOUTHEAST GEORGIA HEALTH SYSTEM TO PROVIDE SAFE, QUALITY, ACCESSIBLE, AND COST-EFFECTIVE CARE TO MEET THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES IT DERVES. 0 0 114015080 79666676 COOPERATIVE HEALTHCARE SERVICES, INC. IS AN ORGANIZATION BASED IN SOUTHEAST GEORGIA WHICH PROVIDES PHYSICIAN AND IMMEDIATE CARE SERVICES ON AN INPATIENT AND OUTPATIENT BASIS. FOR THE TWELVE MONTH FISCAL PERIOD BEGINNING 05/01/2022 AND ENDED 04/30/2023, THE PHYSICIAN AND IMMEDIATE CARE CENTERS SERVED PATIENTS IN GLYNN, CAMDEN, MCINTOSH, AND BRANTLEY COUNTIES. OUR FINANCIAL STATEMENTS FOR THIS TIME PERIOD INCLUDE OVER 8,055,000 IN FREE CARE (CHARITY CARE AND BAD DEBTS). 114015080 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 23 0 1 573 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 GA X X JOHN A MILAZZO III VP CFO 9124667058 2415 PARKWOOD DR BRUNSWICK GA 31520 STEPHEN CHITTY IV MD BOARD MEMBER / PHYSICIAN 40.00 40.00 X 0 704622 41939 MITCHELL T JONES MD CHAIRMAN / BOARD MEMBER 40.00 8.00 X X 0 838955 36654 RON ADAMS BOARD MEMBER 2.00 2.00 X 0 0 0 W H BILL GROSS BOARD MEMBER 2.00 2.00 X 0 0 0 ROOSEVELT HARRIS BOARD MEMBER 2.00 4.00 X 0 0 0 BYRON S RAYNES PRESIDENT & CEO 8.00 46.00 X X 0 757738 157257 TIMOTHY JAMIESON MD PHYSICIAN 1.00 40.00 X 1471807 0 55094 DENNIS CARTER MD PHYSICIAN 1.00 40.00 X 1247031 0 44652 THOMAS SASSER MD PHYSICIAN 1.00 40.00 X 1248005 0 42312 MICHAEL SULLIVAN MD PHYSICIAN 1.00 40.00 X 1034055 0 42312 MATTHEW CERTAIN MD PHYSICIAN 1.00 40.00 X 1000902 0 41939 MICHAEL D SCHERNECK FORMER PRESIDENT & CEO 0.00 0.00 X 0 751201 18300 6001800 3052516 480459 181 1 1 0 GEORGIA NEUROSURGICAL SOLUTIONS LLC 632 DEL PRADO BLVD STE 101 CAPE CORAL FL 33909 MEDICAL PROFESSIONAL SERVICES 476054 CARE ATC 4500 S 129TH E AVE STE 191 TULSA OK 74134 HEALTHCARE SERVICES 314530 CERNER HEALTHCARE SOLUTIONS INC P O BOX 203448 DALLAS TX 75320 HEALTHCARE SERVICES 308544 BAY ANESTHESIA LLC 131 GALLERY WAY BRUNSWICK GA 31525 ANESTHESIA SERVICES 220200 BERRY & ASSOCIATES OF RICHMOND HILL INC 184 CARTER ST RICHMOND HILL GA 31324 MEDICAL PROFESSIONAL SERVICES 201400 6 NET PATIENT SERVICE REVENUE 621400 71042857 71042857 71042857 6570 6570 CHSI ED CALL COVERAGE 621400 7513980 7513980 OTHER REVENUE 621990 1094863 1094863 MEDICAL RECORD FEES 900099 14976 14976 8623819 79673246 79666676 0 6570 X 84216864 83215471 1001393 2719221 2580541 138680 7671526 7280278 391248 3892380 3693869 198511 128804 128804 5850412 4917816 932596 10385351 10076662 308689 227702 223475 4227 264398 262509 1889 379954 379954 437274 437274 RECRUITMENT EXPENSE 748993 748993 PROVIDER FEES/ASSESSMEN 187238 187238 LICENSES & PERMITS 11027 10854 173 CASH OVER/SHORT 146 146 117121290 114015080 3106210 0 -465687 -463206 7905404 8323552 185754 185754 98224 83217 7836498 6300611 1772428 1535887 4873568 4263454 14369691 13928658 30765165 30404495 59500 30824665 30404495 X -16454974 -16475837 -16454974 -16475837 14369691 13928658 X -37448044 37427181 X X 0 1 X 1 0 X X 1 SOUTHEAST GEORGIA HEALTH SYSTEM INC 581911751 3 1 0 114015080 1 0 114015080 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I: ADDITIONAL INFORMATION COOPERATIVE HEALTHCARE SERVICES, INC., PROVIDES A REQUIRED SERVICE THAT THE SUPPORTED ORGANIZATION WOULD OTHERWISE HAVE TO ENGAGE ON ITS OWN. 439681 294413 145268 7338817 5948198 1390619 58000 58000 0 1535887 ROU ASSET LT 2756489 A/R PAYROLL CLEARING -6585 OTHER ACCOUNTS RECEIVABLE 1066456 TRAVEL ADVANCE 15421 ROU ASSET ST 431673 4263454 X 79673246 0 79673246 0 79673246 117166578 45288 45288 117121290 0 117121290 PART X, LINE 2: THE COOPERATIVE HEALTHCARE SERVICES, INC (CHSI) HAS BEEN RECOGNIZED AS A TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR STATE OR FEDERAL INCOME TAXES HAS BEEN PRESENTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. CHSI RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. CHSI HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNKNOWN DIFFERENCE 45,288. 0 1 0 0 0 0 1 1 0 TIMOTHY JAMIESON MD PHYSICIAN 599634 0 853873 0 18300 0 28742 0 26352 0 1526901 0 0 0 DENNIS CARTER MD PHYSICIAN 614892 0 613838 0 18301 0 18300 0 26352 0 1291683 0 0 0 THOMAS SASSER MD PHYSICIAN 605382 0 614813 0 27810 0 18300 0 24012 0 1290317 0 0 0 MICHAEL SULLIVAN MD PHYSICIAN 604382 0 401431 0 28242 0 18300 0 24012 0 1076367 0 0 0 MATTHEW CERTAIN MD PHYSICIAN 582316 0 405892 0 12694 0 18300 0 23639 0 1042841 0 0 0 BYRON S RAYNES PRESIDENT & CEO 0 675636 0 66923 0 15179 0 137089 0 20168 0 914995 0 0 MITCHELL T JONES MD CHAIRMAN / BOARD MEMBER 0 450875 0 368861 0 19219 0 10675 0 25979 0 875609 0 0 MICHAEL D SCHERNECK FORMER PRESIDENT & CEO 0 19632 0 2060 0 729509 0 18300 0 0 0 769501 0 0 STEPHEN CHITTY IV MD BOARD MEMBER / PHYSICIAN 0 372376 0 304436 0 27810 0 18300 0 23639 0 746561 0 0 PART I, LINE 4B SOUTHEAST GEORGIA HEALTH SYSTEM INC. HAS CERTAIN EMPLOYEES THAT PARTICIPATE IN A 457(F) DEFERRED COMPENSATION PLAN WHICH GIVES SGHS AN OPPORTUNITY TO SUPPLEMENT THE RETIREMENT INCOME OF ITS SELECT MANAGEMENT GROUP OR HIGHLY COMPENSATED EMPLOYEES BY CONTRIBUTING TO A PLAN THAT WILL BE PAID TO THE EXECUTIVE AT RETIREMENT. PART I, LINE 6 COMPENSATION CONTINGENT ON NET EARNINGS OF THE ORGANIZATION: CERTAIN MEMBERS OF MANAGEMENT PARTICIPATE IN A MANAGEMENT INCENTIVE PLAN WHICH IS BASED ON A VARIETY OF MANAGERIAL, QUALITY, AND FINANCIAL PERFORMANCE INDICATORS. HOWEVER, COMPENSATION IS PROVIDED UNDER THAT PLAN ONLY IF A CERTAIN NET EARNINGS THRESHOLD IS MET. PART I, LINE 7 CERTAIN PHYSICIANS ARE ENTITLED TO RECEIVE NON-FIXED PAYMENTS BASED ON THE PRODUCTIVITY OF THAT PHYSICIAN BASED UPON WORKED RELATIVE VALUE UNITS (WRVU) WITHOUT REGARD TO THE REVENUES OR NET EARNINGS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE MAY 1, 2015, SOUTHEAST GEORGIA HEALTH SYSTEM, INC. (SGHS, INC.) IS THE SOLE CORPORATE MEMBER OF COOPERATIVE HEALTHCARE SERVICES, INC. (CHSI). FORM 990, PART VI, SECTION A, LINE 7A EFFECTIVE MAY 1, 2015, SOUTHEAST GEORGIA HEALTH SYSTEM, INC. (SGHS, INC.) IS THE SOLE CORPORATE MEMBER OF COOPERATIVE HEALTHCARE SERVICES, INC. (CHSI). SGHS, INC HAS THE POWER TO APPROVE AND APPOINT BOARD MEMBERS OF CHSI. FORM 990, PART VI, SECTION B, LINE 11B AN ELECTRONIC COPY OF FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS OF COOPERATIVE HEALTHCARE SERVICES, INC., PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C COOPERATIVE HEALTHCARE SERVICES, INC., HAS ADOPTED THE CONFLICT-OF-INTEREST, WHISTLEBLOWER, AND DOCUMENT RETENTION AND DESTRUCTION POLICIES OF SOUTHEAST GEORGIA HEALTH SYSTEM, INC., THE SOLE MEMBER OF COOPERATIVE HEALTHCARE SERVICES, INC. UNDER THE CONFLICT-OF-INTEREST POLICY, THE COMPLIANCE DEPARTMENT REQUIRES ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES TO REPORT ANY POTENTIAL CONFLICTS ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 EXCEPT THROUGH THE NORMAL IRS/FORM 990 INSPECTION PROCESS, SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC. HAS NOT ESTABLISHED A STANDARD PROCESS FOR MAKING ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. EXPLANATION OF SALARIES PAID PART IX, LINE 7 REFLECTS SALARIES AND WAGES PAID BY SOUTHEAST GEORGIA HEALTH SYSTEM, INC., (58-1911751), ON BEHALF OF COOPERATIVE HEALTHCARE SERVICES INC., THEREFORE, NO AMOUNTS HAVE BEEN ENTERED IN PART 5 LINA 2A WITH REGARD TO THE NUMBER OF EMPLOYEES REPORTED ON FORM W-3. HOWEVER, 3 EMPLOYEES WERE INCLUDED IN THE NUMBER OF EMPLOYEES REPORTED BY SOUTHEAST GEORGIA HEALTH SYSTEM, INC., FOR THE CALENDAR YEAR ENDING WITHIN THE YEAR COVERED BY THIS RETURN CORRESPONDING TO THE AMOUNT REPORTED ON PART IX, LINE 7. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY 37,427,181. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GLYNN-BRUNSWICK MEM HOSP AUTHORITY 2415 PARKWOOD DR BRUNSWICK GA 31520 586000498 LEASED EMPLOYEES GA 501(C)(3) LINE 3 N/A 0 SOUTHEAST GEORGIA HEALTH SYSTEM INC 2415 PARKWOOD DR BRUNSWICK GA 31520 581911751 INPATIENT AND OUTPATIENT HEALTHCARE SERVICES GA 501(C)(3) LINE 3 N/A 0 SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION 2415 PARKWOOD DR BRUNSWICK GA 31520 582125644 CHARITABLE FOUNDATION GA 501(C)(3) LINE 12A, I SOUTHEAST GEORGIA HEALTH SYSTEM INC 1 COASTAL COMMUNITY HEALTH INC 3563 PHILIPS HWY BLD F STE 608 JACKSONVILLE FL 32207 471322041 REGIONAL AFFILIATION OF 501(C)(3) ORGS FL 501(C)(3) LINE 3 N/A 0 SOUTHEAST GEORGIA CYBERKNIFE CENTER LLC 2500 STARLING ST STE 107 BRUNSWICK GA 31520 273316081 MEDICAL SERVICES GA N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0