COOPERATIVE HEALTHCARE SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COOPERATIVE HEALTHCARE SERVICES INC (EIN 01-0594994)
Tax period
2011-05-01 to 2012-04-30
Filed
2012-12-14
IRS object ID
201243499349300414
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-12-14T08:31:08-08:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010594994EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COOPERATIVE HEALTHCARE SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOOPNameControl
Phone9124667049Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12415 PARKWOOD DRAddressLine1
CityBRUNSWICKCity
StateGAState
ZIP Code31520ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMichael DScherneckName
TitlePresidentTitle
Date Signed2012-12-14DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael D ScherneckNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1341 Oak Grove Island DrAddressLine1
CityBrunswickCity
StateGAState
ZIP Code31520ZIPCode
FieldValueIRS element (for citing)
Gross Receipts29032589GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionCooperative Healthcare Services, Inc., will serve as a supporting organization to further enable Southeast Georgia Health System to provide safe, quality, accessible and cost-effictive care to meet the health needs of the people and communities it serves.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers6TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year1004ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21864058ProgramServiceRevenuePriorYear
Program Service Revenue CY27971028ProgramServiceRevenueCY
Investment Income Prior Year520InvestmentIncomePriorYear
Investment Income Current Year3437InvestmentIncomeCurrentYear
Other Revenue Prior Year590159OtherRevenuePriorYear
Other Revenue Current Year1057120OtherRevenueCurrentYear
Total Revenue Prior Year22454737TotalRevenuePriorYear
Total Revenue Current Year29032589TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year25574524SalariesEtcPriorYear
Salaries Etc Current Year38125173SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10102092OtherExpensePriorYear
Other Expenses Current Year13638746OtherExpensesCurrentYear
Total Expenses Prior Year35676616TotalExpensesPriorYear
Total Expenses Current Year51763919TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-13221879RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-22731330RevenuesLessExpensesCY
Total Assets BOY16573286TotalAssetsBOY
Total Assets EOY19908457TotalAssetsEOY
Total Liabilities BOY5055109TotalLiabilitiesBOY
Total Liabilities EOY7890638TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11518177NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12017819NetAssetsOrFundBalancesEOY
Mission DescriptionCooperative Healthcare Services, Inc., will serve as a supporting organization to further enable Southeast Georgia Health System to provide safe, quality, accessible and cost-effictive care to meet the health needs of the people and communities it serves.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense49067730Expense
Revenue29029152Revenue
DescriptionCooperative Healthcare Services, Inc. is an organization based in Southeast Georgia which provides Physician and Immediate Care services on an outpatient basis. For the twelve month fiscal period beginning 05/01/2011 and ended 04/30/2012, the Physician and Immediate Care Centers served 250,327 patients on an outpatient basis in Glynn, Camden, McIntosh and Brantley Counties. Our financial statements for this time period include over $9,302,756 in free care - includes charity care and bad debts.Description
Total Program Service Expense49067730TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvesttrueReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109647NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Employment Tax Returns FiledfalseEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMichael DScherneckExecVPCFONamePerson
Telephone Number9124667049TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12415 PARKWOOD DRAddressLine1
CityBRUNSWICKCity
StateGAState
ZIP Code31520ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerKey EmployeeKeyEmployee
Mike Hodges
Board Member0.00000
J Melvin Deese MD
Bdmbr/Physcn40.000859966108470X
Mitchell Jones MD
Board Member2.00000X
Laura Cross-McKinley
Board Member2.00000X
Carla Lee
Chairperson2.00000XX
WH Bill Gross
Board Member/I2.00000X
Ronald Adams
Board Member/I2.00000X
Carlton DeVooght
Asst. Secretary40.00021937256462X
Michael D Scherneck
ExecVP,CFO40.00034022250897X
Patrick D Ebri
VP Human Resources40.00018818052468X
Gary R Colberg FACHE
President & CEO40.000710031106567X
FieldValueIRS element (for citing)
Total Reportable Comp Frm Rltd Orgs2317771TotalReportableCompFrmRltdOrgs
Total Other Compensation374864TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Golden Isles Medical Transcription
393 EH CourtBrunswickGA31520Transcription Svcs170078
Glynn Physicians PC
3400 Parkwood DrBrunswickGA31520Medical Prof Svcs706340
Coker Consulting LLC
1000 Mansell Exchange West Ste 310AlpharettaGA30022Consultation Service370781
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
All Other Contributions1004AllOtherContributions
Total Contributions1004TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient Svc RevenueDescription
Business Code621400BusinessCode
Total Revenue Column27971028TotalRevenueColumn
Related Or Exempt Function Income27971028RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue27971028TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3437TotalRevenueColumn
Exclusion$3,437ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real5317Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real5317Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column5317TotalRevenueColumn
Related Or Exempt Function Income5317RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Vending Machine Income9000992697$2,697
Other Revenue10256111025611
Medical Record Fees90009923495$23,495
FieldValueIRS element (for citing)
Total Other Revenue1051803TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column29032589TotalRevenueColumn
Related Or Exempt Function Income29001956RelatedOrExemptFunctionIncome
Exclusion$29,629ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total32114529Total
Program Services30680702ProgramServices
Management And General1433827ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total889692Total
Program Services850012ProgramServices
Management And General39680ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3661860Total
Program Services3498541ProgramServices
Management And General163319ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1459092Total
Program Services1394016ProgramServices
Management And General65076ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3964871Total
Program Services3306873ProgramServices
Management And General657998ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total29806Total
Program Services29806ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7455840Total
Program Services7202389ProgramServices
Management And General253451ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total427535Total
Program Services367514ProgramServices
Management And General60021ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total218622Total
Program Services195805ProgramServices
Management And General22817ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total72801Total
Program Services72801ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total485234Total
Program Services485234ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total306921Total
Program Services306921ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
Recruitment Expense631582631582
Property Taxes4523045230
Cash Over and Short304304

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total51763919Total
Program Services49067730ProgramServices
Management And General2696189ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY217685BOY
EOY273390EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7966514BOY
EOY9110698EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY214315BOY
EOY214315EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY527263BOY
EOY34737EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis5475083LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2732209LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2428411BOY
EOY2742874EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY536577BOY
EOY2037183EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4682521BOY
EOY5495260EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY16573286BOY
EOY19908457EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3692168BOY
EOY6570808EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1362941BOY
EOY1319830EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5055109BOY
EOY7890638EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11518177BOY
EOY12017819EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11518177BOY
EOY12017819EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16573286BOY
EOY19908457EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-22731330ReconcilationRevenueExpenses
Reconcilation Other Changes23230972ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Glynn-Brunswick Mem Hospital AuthBusinessNameLine1
FieldValueIRS element (for citing)
EIN586000498EIN
Type Of Organization3TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis350000OtherCostOrOtherBasis
Book Value350000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1364339OtherCostOrOtherBasis
Depreciation527219Depreciation
Book Value837120BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis438780OtherCostOrOtherBasis
Depreciation634327Depreciation
Book Value-195547BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3253777OtherCostOrOtherBasis
Depreciation1557668Depreciation
Book Value1696109BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis68187OtherCostOrOtherBasis
Depreciation12995Depreciation
Book Value55192BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2742874TotalOfBookValueLandBuildings
Total Of Book Value Program Related2037183TotalOfBookValueProgramRelated

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Net Intercompany5474169
025-1000-0182 Travel Advance3563
025-1000-0180 Other Accts Rec8028
005-1000-0180 Accts Rec Dr. Gordon9500
FieldValueIRS element (for citing)
Total Book Value Other Assets5495260TotalBookValueOtherAssets
Total Revenue29032589TotalRevenue
Total Expenses51763919TotalExpenses
Excess Or Deficit For Year-22731330ExcessOrDeficitForYear
Other$23,230,972OtherAmount
Total Adjustments23230972TotalAdjustments
Excess Or Deficit Per FS499642ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt29032589TotRevenueEtcAuditedFinclStmt
Revenue Subtotal29032589RevenueSubtotal
Total Revenue Per Form99029032589TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt51763919TotExpensesEtcAuditedFinclStmt
Expenses Subtotal51763919ExpensesSubtotal
Total Expenses Per Form99051763919TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XPart X : FIN48 FootnoteOn May 1, 2009, Southeast Georgia Health System adopted the uncertain tax positions provisions of FASB ASC Topic 740 ("ASC 740"), Income Taxes, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the combined financial statements. Under ASC 740-10-25, Southeast Georgia Health System may recognize 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. The tax benefits recognized in the combined financial statements from such a position are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC 740 also provides guidance on de-recognition, classification, interest and penalties on income taxes, and accounting in interim periods. The System has determined that it does not have any material unrecognized tax benefits or obligations as of April 30, 2012 and 2011, respectively. Fiscal years ending on and after April 30, 2009 remain subject to examination by federal and state tax authorities.
Part XI, Line 8Part XI, Line 8: Other Changes in Net Assets or Fund BalancesRecapitalize Investment in CHSI $23231000 Glynco Minority Interest $49250 Glynco LLC Distr $ -49278

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgstrueCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Patrick D Ebri
15658918685129061897833490240648
Michael D Scherneck
286148397481432626981239163911195000
J Melvin Deese MD
66367119064756485870049770968436
Gary R Colberg FACHE
3984501282941832875709649471816598
Carlton DeVooght
1897312042292192201534447275834

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Sch J, Part I, Line 7Part I, Line 7: Non-Fixed payments not listed aboveCertain 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.
Sch J, Part I, Line 6bPart I, Line 6b: Explanation of organization compensation contingent on net earnings from related or

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Explanation of Salaries PaidPart IX,Line 7 reflects salaries and wages paid by Glynn Brunswick Memorial Hospital Authority (58-6000498) on behalf of Cooperative Healthcare Services Inc., therefore, no amounts have been entered in Part 5 line 2a with regard to the number of employees reported on form W-3. However, 346 employees were included in the number of employees reported by Glynn Brunswick Memorial Hospital Authority 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 VI, Line 19: Other Organization Documents Publicly AvailableExcept through the normal I.R.S/ Form 990 inspection process, Cooperative Healthcare Services, Inc. has not established a standard process for making its governing documents, conflict of interest policy and financial statements available to the public.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesAll salaries paid by Cooperative Healthcare Services, Inc. are paid under a documented arrangement with The Glynn-Brunswick Memorial Hospital Authority d/b/a Southeast Georgia Health System, whereby those individuals are considered employees of Southeast Georgia Health System, and are in turn leased to Cooperative Healthcare Services, Inc. The number of employees dedicated to Cooperative Healthcare Services, Inc. that were reported in the federal employment tax returns of the Southeast Georgia Health System was 346. As employees of Southeast Georgia Health System, the compensation amounts paid to the individual serving in the capacity as Chief Executive Officer, Executive Director and/or other top management officials and officers are determined based on comparative survey/market data compiled by an independent consulting firm specializing in executive and employee compensation matters. The findings and recommendation of the consultant are reviewed with the Compensation Committee and/or the Executive Compensation Committee of Southeast Georgia Health System which in turn makes recommendations to the full Authority (i.e., Board) of Southeast Georgia Health System which ultimately approves those compensation amounts.Form 990, Part VI, Line 15b
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsCooperative Healthcare Services, Inc. has adopted the conflict-of-interest, whistleblower, and document retention and destruction policies of The Glynn-Brunswick Memorial Hospital Authority d/b/a Southeast Georgia Health System, the sole corporate 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, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessA draft electronic copy of Form 990 was provided to the members of the Board of Directors of Cooperative Healthcare Services, Inc., prior to being filed with the Internal Revenue Service. Management reviewed Form 990 with the Hospital Authority at a subsequent meeting and addressed all questions and recommendations that the Board of Directors raised.Form 990, Part VI, Line 11
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe Glynn-Brunswick Memorial Hospital Authority is the sole corporate member of Cooperative Healthcare Services, Inc.Form 990, Part VI, Line 6

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
SE Georgia Health System Foundation
2415 Parkwood DrBrunswickGA31520582125644Charitable FoundationGA501(c)(3)11Glynn-Brunswick Memorial Hosp Authoritytrue
Kings Bay Community Hospital Inc dba
SE GA Health Sys-CamdenSt MarysGA31558581911751Inpatient and Outpatient Healthcare ServicesGA501(c)(3)3Glynn-Brunswick Memorial Hosp Authoritytrue
Glynn Brunswick Mem Hosp DBA Southeast
Health System-Brunswick CampusPrkwd BrunswickGA31520586000498Inpatient and Outpatient Healthcare ServicesGA501(c)(3)3falseN/A

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Glynco LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14021 W Kilgore AveAddressLine1
CityMuncieCity
StateINState
ZIP Code47304ZIPCode
FieldValueIRS element (for citing)
EIN593762931EIN
Primary ActivityProperty RentalPrimaryActivity
Legal Domicile StateINLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Share Of Total Income49504ShareOfTotalIncome
Share Of EOY Assets97453ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.55000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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