2024-03-15T15:39:41-05:00 2023-04-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-05-01 582125644 SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION INC SOUT 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 1923492 0 X HTTP://WWW.SGHS.ORG/ABOUT/SGHS-FOUNDATION X 1985 GA SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC., WILL SERVE AS A SUPPORTING ORGANIZATION TO FURTHER ENABLE SE GA HEALTH SYSTEM TO PROVIDE SAFE, QUALITY, ACCESSIBLE, AND COST-EFFECTIVE CARE TO MEET THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES IT SERVES. 11 9 0 9 0 0 1286814 1090686 0 0 693888 832806 0 0 1980702 1923492 1354879 994665 0 0 295794 298505 0 0 232168 93360 165836 1744033 1459006 236669 464486 9574047 9211835 3448 1663 9570599 9210172 SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC., WILL SERVE AS A SUPPORTING ORGANIZATION TO FURTHER ENABLE SE GA HEALTH SYSTEM TO PROVIDE SAFE, QUALITY, ACCESSIBLE, AND COST-EFFECTIVE CARE TO MEET THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES IT SERVES. 0 0 994665 994665 1923492 THE ORGANIZATION PROVIDED FINANCIAL SUPPORT TO SOUTHEAST GEORGIA HEALTH SYSTEM, INC FOR EQUIPMENT AND OPERATING NEEDS FOR THE 12 MONTH FISCAL PERIOD BEGINNING 05/01/2022 AND ENDED 04/30/2023. 994665 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X X JOHN A MILAZZO III VP CFO 9124667058 2415 PARKWOOD DR BRUNSWICK GA 31520 RUSSELL S MENTZER CHAIRMAN 2.00 0.00 X X 0 0 0 CORNELIUS P HOLLAND III VICE CHAIRMAN 2.00 0.00 X X 0 0 0 CARL B COOLIDGE SECRETARY / TREASURER 2.00 0.00 X X 0 0 0 DONNA B GODBEY BOARD MEMBER 2.00 0.00 X 0 0 0 WILLIAM H GROSS BOARD MEMBER 2.00 0.00 X 0 0 0 LUCIA G GUMAER BOARD MEMBER 2.00 0.00 X 0 0 0 DR THOMAS M SASSER JR BOARD MEMBER 2.00 0.00 X 0 0 0 BRUCE C DIXON BOARD MEMBER 2.00 0.00 X 0 0 0 JO ANN JOUBERT BOARD MEMBER 2.00 0.00 X 0 0 0 RANDALL E MORRIS BOARD MEMBER 2.00 0.00 X 0 0 0 WILLIAM J STEMBLER BOARD MEMBER 2.00 0.00 X 0 0 0 JAMES A BISHOP DIRECTORS EMERITUS 2.00 0.00 X 0 0 0 J DEWEY BENEFIELD JR DIRECTORS EMERITUS 2.00 0.00 X 0 0 0 COL TOM W FULLER USA RET DIRECTORS EMERITUS 2.00 0.00 X 0 0 0 MR SCOTT RAYNES MBA MA PRESIDENT & CEO 2.00 52.00 X 0 757738 157257 MICHAEL D SCHERNECK FORMER PRES & CEO 0.00 0.00 X 0 751201 18300 0 1508939 175557 0 1 1 0 0 457830 632856 1090686 190156 190156 642650 0 642650 642650 642650 1923492 0 0 832806 X 994665 994665 238614 119307 119307 6946 3473 3473 35437 17719 17718 17508 8754 8754 68548 34274 34274 78351 39176 39175 15383 7692 7691 3529 1765 1764 25 13 12 1459006 994665 232173 232168 432792 912784 561745 521698 8565618 7755954 13892 21399 9574047 9211835 3448 1663 3448 1663 X 9570599 9210172 9570599 9210172 9574047 9211835 464486 -824913 0 X X 0 1 X 1 0 X X 1 SOUTHEAST GEORGIA HEALTH SYSTEM INC 581911751 3 1 994665 0 1 994665 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO SOUTH GEORGIA HEALTH SYSTEM 1663 1663 X PART X, LINE 2: THE SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC (THE FOUNDATION) 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. THE FOUNDATION 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. THE FOUNDATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS. 1 SOUTHEAST GEORGIA HEALTH SYSTEM INC 2415 PARKWOOD DR BRUNSWICK GA 31520 581911751 501(C)(3) 994665 0 FUNDS PAID TO SGHS, INC FOR PROGRAMS 1 0 PART I, LINE 2: SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC. MAKES GRANT DISTRIBUTIONS ONLY TO THE SOUTHEAST GEORGIA HEALTH SYSTEM, INC., AND ITS SUPPORTED ORGANIZATIONS, WITH WHICH GOVERNANCE IS SHARED. 0 1 0 0 0 0 1 0 0 MR SCOTT RAYNES MBA MA PRESIDENT & CEO 0 675636 0 66923 0 15179 0 137089 0 20168 0 914995 0 0 MICHAEL D SCHERNECK FORMER PRES & CEO 0 19632 0 2060 0 729509 0 18300 0 0 0 769501 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. UNDER THE TERMS OF THE PLAN THE FOLLOWING AMOUNTS WERE DEFERRED DURING CALENDAR YEAR 2022. SCOTT RAYNES: $118,789 UNDER THE TERMS OF THE PLAN THE FOLLOWING AMOUNTS WERE INCLUDED IN THE FORM W-2 AS TAXABLE INCOME FOR CALENDAR YEAR 2022. MICHAEL SHERNECK: $702,509 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. COMPENSATION PAID FROM RELATED ORGNAIZATIN PART IX, LINE 7 REFLECTS SALARIES AND WAGES PAID BY SOUTHEAST GEORGIA HEALTH SYSTEM, INC., (58-1911751), ON BEHALF OF SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, 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 VI, SECTION A, LINE 6 EFFECTIVE MAY 1, 2015, SOUTHEAST GEORGIA HEALTH SYSTEM, INC. (SGHS, INC.) IS THE SOLE CORPORATE MEMBER OF THE SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC. (FOUNDATION). THE SOLE PURPOSE OF THE FOUNDATION IS TO SERVE AS A SUPPORTING ORGANIZATION TO SOUTHEAST GEORGIA HEALTH SYSTEM, INC., AND ITS SUBSIDIARIES IN FURTHERING THEIR CHARITABLE ACTIVITIES. 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 THE SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC. (FOUNDATION). THE SOLE PURPOSE OF THE FOUNDATION IS TO SERVE AS A SUPPORTING ORGANIZATION TO SOUTHEAST GEORGIA HEALTH SYSTEM, INC., AND ITS SUBSIDIARIES IN FURTHERING THEIR CHARITABLE ACTIVITIES. SGHS, INC HAS THE POWER TO APPOINT AND APPROVE THE BOARD MEMBERS OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B AN ELETRONIC COPY OF FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS OF SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC., PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, INC., HAS ADOPTED THE CONFLICT-OF-INTEREST, WHISTLEBLOWER, AND DOCUMENT RETENTION AND DESTRUCTION POLICIES OF SOUTHEAST GEORGIA HEALTH SYSTEM, 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 SOUTHEAST GEORGIA HEALTH SYSTEM FOUNDATION, 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 XII THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 COOPERATIVE HEALTHCARE SVCS INC 2415 PARKWOOD DR BRUNSWICK GA 31520 010594994 PHYSICIAN AND IMMEDIATE CARE FACILITIES GA 501(C)(3) LINE 12A, I SOUTHEAST GEORGIA HEALTH SYSTEM INC 1 COASTAL COMMUNITY HEALTH INC 3653 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0