2024-08-15T16:16:03-05:00 2023-09-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2022-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 STEPHEN JENNEY SVP & CFO 7816248000 2024-08-15 1 0 SHAWNA M JANSONS P01222873 3174648600 2022 2024-08-08 14:25:15Z STEPHEN JENNEY 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 835669944 0 X WWW.SOUTHSHOREHEALTH.ORG X 1982 MA SOUTH SHORE HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY INCLUDING SURGICAL, MEDICAL AND OTHER TREATMENT OF THE SICK AND INJURED. 17 12 5953 195 2504509 0 5634281 16987711 740903562 792143584 25009920 7298248 11233445 12062504 782781208 828492047 8500 26500 0 0 553566594 502269786 0 0 2348416 275615799 320058532 829190893 822354818 -46409685 6137229 662180992 655989824 337394047 307645448 324786945 348344376 X SOUTH SHORE HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY INCLUDING SURGICAL, MEDICAL AND OTHER TREATMENT OF THE SICK AND INJURED. SOUTH SHORE HEALTH SYSTEM HAS AN OVERARCHING MISSION FOR EVERY ENTITY THAT IS PART OF THEIR HEALTH SYSTEM. THAT MISSION IS AS FOLLOWS: YOUR HEALTH. OUR PASSION. ONE COMMUNITY. 0 0 732341910 26500 808839576 HEALTH CARE PROGRAMS, GENERAL/OTHER: SOUTH SHORE HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE, REGIONAL HOSPITAL LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE 374 ACUTE CARE BEDS (COMPOSED OF 287 MEDICAL/SURGICAL, 24 INTENSIVE CARE/CORONARY CARE, 51 LEVEL III MATERNAL/NEWBORN, 12 PEDIATRIC/YOUNG ADULT AND 10 NEONATAL), AND 67 BASSINETS (COMPOSED OF 20 LEVEL II SPECIAL CARE NURSERY BASSINETS AND 47 NEWBORN BASSINETS). THE HOSPITAL OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO MEET DIVERSE COMMUNITY NEEDS, INCLUDING EMERGENCY CARE, ACUTE CARE (INCLUDING MEDICAL, SURGICAL, OBSTETRICAL/GYNECOLOGICAL, PEDIATRICS, CARDIAC AND CANCER CARE), OUTPATIENT SERVICES (INCLUDING IMAGING, SURGICAL, REHABILITATION, WOUND AND SPECIALIZED ORTHOPEDIC CARE), HOME HEALTH SERVICES AND COMMUNITY SERVICES. THE HOSPITAL PROVIDES FREE CARE TO THOSE WHO ARE UNABLE TO PAY, SPONSORS FREE CANCER SCREENINGS, OTHER HEALTH SCREENINGS, VARIOUS SUPPORT GROUPS AND EDUCATIONAL PROGRAMS, INCLUDING PUBLIC HEALTH EDUCATION, WELLNESS PROGRAMS AND THE TRAINING OF HEALTH PROFESSIONALS SUCH AS PHYSICIANS, NURSES AND TECHNICIANS. DURING THE YEAR ENDED SEPTEMBER 30, 2023, THE HOSPITAL HAD 33,159 DISCHARGES AND APPROXIMATELY 336,387 OUTPATIENT VISITS. THE HOSPITAL'S EMERGENCY CENTER IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR, AND HAD 115,372 VISITS DURING THE YEAR. THE HOSPITAL'S HOME CARE DIVISION HELPS PEOPLE MAINTAIN INDEPENDENCE AT HOME. THE VISITING NURSES COORDINATE THE APPROPRIATE SPECIALISTS, SERVICES AND COMMUNITY RESOURCES FOR EACH PATIENT. OUR HOME CARE DIVISION PROVIDED OVER 126,986 HOME VISITS TO PATIENTS IN FY23. 732341910 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 1 1 0 0 0 1 345 0 1 5953 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 17 12 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CO DC FL GA IL MA MI NC NH NJ NY OH PA TN WI X STEPHEN JENNEY 7816248000 55 FOGG RD SOUTH WEYMOUTH MA 01290 ALLEN SMITH MD PRESIDENT & CEO 40.00 4.50 X X 944596 0 183703 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 40.00 3.50 X 760671 0 39182 JUSTIN CAMPBELL DIRECTOR/CHAIR OF PROVIDER COUNCIL 1.00 3.50 X 181000 0 0 BRADFORD SAMPSON MEDICAL STAFF PRESIDENT AS OF 2/1/22 1.00 3.50 X 82000 0 0 MICHAEL AYERS MD DIRECTOR/MEDICAL STAFF PRES 2/1/21 THRU 1/31/22 1.00 4.50 X 73333 0 0 PAMELA O'LEARY CHAIR 1.00 3.50 X X 0 0 0 THOMAS MCCARTHY VICE CHAIR 1.00 3.50 X X 0 0 0 ALAN MCKIM DIRECTOR 1.00 3.50 X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 1.00 3.50 X 0 0 0 ELLEN ESSENFELD DIRECTOR 1.00 3.50 X 0 0 0 HELEN GARVEY DIRECTOR 1.00 3.50 X 0 0 0 LINDA THOMPSON MPH DRPH RN FAAN DIRECTOR 1.00 3.50 X 0 0 0 LISA WALSH DIRECTOR 1.00 3.50 X 0 0 0 MICHAEL SHEEHAN DIRECTOR 1.00 3.50 X 0 0 0 PAMELA WHELTON DIRECTOR AS OF 1/1/22 1.00 3.50 X 0 0 0 PAUL WANTANABE PHD DIRECTOR 1.00 3.50 X 0 0 0 PAULA L BECKER DIRECTOR 1.00 3.50 X 0 0 0 WILLIAM JOHNSTON CHIEF OPERATING OFFICER 40.00 0.00 X 667043 0 141703 JOSEPH R DRISCOLL ESQ SECRETARY 40.00 4.50 X 433280 0 33703 KRISTINE HANSCOM CPA MST CGMA TREAS. & CFO 6/14/22 THRU 5/31/23 40.00 4.50 X 329597 0 18439 STEPHEN JENNEY INT. CFO & TREAS. AS OF 6/1/23 40.00 4.50 X 0 0 0 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 40.00 1.00 X 733619 0 33703 TIMOTHY QUIGLEY SVP SPECIAL PROJECTS 40.00 0.00 X 425077 0 33854 FREDERICK MILLHAM MD CHAIR, SURGERY 40.00 0.00 X 942402 0 27901 DILIP NATARAJ MD CHAIR, CRITICAL CARE 40.00 0.00 X 770828 0 20017 HOWARD CHANG MD CHIEF, PSYCHIATRY 40.00 0.00 X 703081 0 27135 JASON TRACY MD CHAIR, EMERGENCY SERVICES 40.00 0.00 X 634256 0 29205 ERIK SHANK MD CHAIR, ANESTHESIA 40.00 0.00 X 588678 0 31241 MARY SHAUGHNESSY FORMER TREAS. & CFO THRU 6/13/22 0.00 0.00 X 499538 0 0 TIMOTHY R LYNCH MD CHIEF MED. OFFICER THROUGH 7/22/22 0.00 0.00 X 734952 0 406944 9503951 0 1026730 1213 1 1 0 HEALTHCARE WORKFORCE LOGISTICS LLC PO BOX 860573 MINNEAPOLIS MN 554860573 PHYSICIAN SERVICES 12222315 BRIGHAM WOMEN'S PHYSICIAN ORG PO BOX 3684 BOSTON MA 022413684 PHYSICIAN SERVICES 5422176 MEDICUS HOSPITALIST SERVICES LLC 22 ROULSTON RD WINDHAM NH 03087 PHYSICIAN SERVICES 4175489 AW PERRY INC 20 WINTHROP SQUARE SUITE 500 BOSTON MA 02110 MANAGEMENT COMPANY 2762514 DELL MARKETING LP C/O DELL USA LP PO BOX 643561 PITTSBURGH PA 02360 IT SERVICES 2343015 65 626000 13645769 2715942 181383 16987711 NET PATIENT SVC REV 622000 760941643 760941643 AMBULATORY CANCER CTR 621000 28426535 28426535 MIH PROGRAM 622000 884515 884515 RENTAL INCOME FROM AFF 621000 351250 351250 BCBS SUPPLEMENTAL 622000 250006 250006 1289635 621963 667672 792143584 3344503 3344503 876122 0 876122 876122 876122 3912634 6437760 0 6396649 3912634 41111 3953745 3953745 466589 626000 466589 0 2995 525 2470 2470 558597 314134 244463 244463 FOOD SERVICE SALES 722212 4818334 2007073 2811261 SHIELDS IMAGING 621000 2089970 2089970 IDN INTERCO REVENUE 900099 1327573 1327573 2703572 293985 1836837 572750 10939449 828492047 795104543 2504509 13895284 5000 5000 21500 21500 5784248 2809362 2974886 414660645 377549373 35210071 1901201 80947276 73140378 7342706 464192 877617 792926 79603 5088 1114815 1114815 68389 68389 8182940 3786791 4390499 5650 40319 40319 192564085 182905883 9622041 36161 44335954 38933458 5341590 60906 6411571 4875636 1373964 161971 560306 519871 29379 11056 8042260 5629582 2412678 28464453 19925117 8539336 4933381 3971865 961516 GROSS POOL ASSESSMENT 7359920 7359920 EQUIP MAINT CONTRACT 4553353 4361098 192255 CATERING & FOOD 4286304 4286304 MINOR EQUIPMENT 2078165 2007819 70346 7062317 3746331 3613795 -297809 822354818 732341910 87664492 2348416 14943804 11671589 0 0 5514281 4889074 75282323 92173609 2283760 2348225 0 9031323 14528875 11944065 11835254 9932436 610883062 378872554 244360178 232010508 207659748 221639462 4971699 6064845 71769747 63316011 662180992 655989824 90590388 73448974 1357366 1182263 171354916 162305360 74091377 70708851 337394047 307645448 X 305726451 332214978 19060494 16129398 324786945 348344376 662180992 655989824 X 6137229 17568592 251060 -399450 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 32442 32442 0 PART II-B, LINE 1: LINE 11I: AMOUNT REPRESENTS A PERCENTAGE OF THE HOSPITAL'S ANNUAL APPORTIONMENT OF MHA/AHA DUES ATTRIBUTABLE TO LOBBYING EXPENSES FOR THE YEAR ENDED SEPTEMBER 30, 2023. IT WAS DETEMINED THAT 14.15% OF DUES WERE USED FOR LOBBYING PURPOSES. SOUTH SHORE HOSPITAL ADVOCATES FOR PUBLIC POLICY THAT POSITIVELY IMPACTS THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE. THE HOSPITAL WORKS WITH LOCAL, STATE, AND FEDERAL OFFICIALS TO ADVANCE INITIATIVES THAT WILL ENHANCE PUBLIC SAFETY, IMPROVE ACCESS TO HEALTH SERVICES, ASSURE APPROPRIATE HEALTH CARE REIMBURSEMENTS, AND STIMULATE ECONOMIC DEVELOPMENT. WE PARTNER WITH STATE AND NATIONAL HEALTH CARE ASSOCIATIONS TO DEVELOP AND IMPROVE GOVERNMENT FUNDING PROGRAMS. WE WELCOME ELECTED AND NON-ELECTED OFFICIALS TO VISIT OUR HOSPITAL TO DISCUSS HEALTH CARE POLICY ISSUES AFFECTING OUR REGION, THE COMMONWEALTH, AND THE NATION. 19060494 3664759 275282 6237090 634048 16129397 26309249 4826647 -510538 0 11272863 292001 19060494 29150277 7649387 476222 0 10532663 433974 26309249 31183081 3126282 164025 0 4956693 366418 29150277 20955475 13842437 156623 0 3202899 568555 31183081 0.00000 0.13000 0.87000 0 0 5162377 5162377 283883798 171081995 112801803 14457062 9707488 4749574 289478996 187070225 102408771 17900829 11012846 6887983 232010508 DUE FROM AFFILIATES 9298196 OTHER ACCOUNTS RECEIVABLE 30481425 RIGHT OF USE ASSETS 23218216 SECURITY DEPOSITS 318030 DUE FROM THIRD PARTY 144 63316011 ACCRUED WORKERS COMP & SEPARATION 3060000 CAPITAL LEASES 29802575 DUE TO THIRD PARTY 12609839 EXECUTIVE BENEFITS 7742606 FIN 47 LIABILITY 264941 MALPRACTICE PAYABLE 13226879 OTHER LIABILITIES 1411860 SECURITY DEPOSITS 4778 ROU LEASE LIABILITY 2585373 70708851 X PART V, LINE 4: THE HOSPITAL MAINTAINS ITS ENDOWMENT FUNDS TO FURTHER ITS CHARITABLE PURPOSE AND THE CHARITABLE PURPOSE OF ITS AFFILIATES. THE HOSPITAL HAS USED ITS FUNDS TO PURCHASE MEDICAL EQUIPMENT, FUND PROGRAMS, AND IMPROVE ITS INFRASTRUCTURE. PART X, LINE 2: THE CORPORATION FOLLOWS THE PROVISIONS OF FASB ASC 740, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. IT PRESCRIBES AN UNCERTAINTY THRESHOLD AND MEASUREMENT ATTRIBUTES FOR FINANCIAL STATEMENT DISCLOSURE OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN. MOONLIGHT & MIRACLES GALA 407644 104744 302900 0 0 131874 74546 48335 48145 GOLF TOURNAMENT 334248 235543 98705 0 0 72825 16915 0 8965 4 350697 285713 64984 0 0 6136 5628 500 52720 1092589 626000 466589 210835 97089 48835 109830 466589 0 1 1 1 X 1 X 1 1 1 0 1 1 4039057 23843 4015214 0.00490 82225175 52018605 30206570 0.03670 4606579 4606579 0.00560 90870811 52042448 38828363 0.04720 524720 524720 0.00060 540660 540660 0.00070 79199172 54735443 24463729 0.02970 184354 184354 0.00020 0 80448906 54735443 25713463 0.03120 171319717 106777891 64541826 0.07840 768144 768144 0.00090 105986 105986 0.00010 758379 10537 747842 0.00090 461239 461239 0.00060 2093748 10537 2083211 0.00250 1 18841830 206618446 227787704 -21169258 X 1 1 1 1 SOUTH SHORE HOSPITAL INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 SOUTHSHOREHEALTH.ORG 2107 X X X X X ALL HOSP. FAC. ARE INCLUDED IN SSH'S LICENSE SOUTH SHORE HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS X 1 21 1 HTTPS://WWW.SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X X 1 X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X X X X X X X 1 X 0 X X X X X 1 X 0 0 SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 5: THE HOSPITAL DEVELOPED ITS CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT BY HOLDING A WORKGROUP WITH REPRESENTATIVES FROM THE 31 COMMUNITIES IT SERVES. THE THIRTY-ONE PARTICIPANTS WERE DRAWN FROM A DIVERSE CROSS-SECTION OF INTERESTED PARTIES INVOLVED IN OUR COMMUNITY AND KNOWLEDGEABLE OF OUR LOCAL HEALTH CHALLENGES AND NEEDS. THE WORKGROUP WAS COMPRISED OF INDIVIDUALS FROM THE HEALTH SYSTEM AND HOSPITAL (INCLUDING THE VISITING NURSE ASSOCIATION) AS WELL AS INDIVIDUALS FROM THE FOLLOWING GROUPS/ORGANIZATIONS: ASPIRE, BAY STATE COMMUNITY SERVICES, CHNA 20 (BLUE HILLS COMMUNITY HEALTH ALLIANCE), BEST OF CARE, BOSTON CHINATOWN NEIGHBORHOOD CENTER, DOVE, FATHER BILLS & MAINSPRING, HEALTH IMPERATIVES, INTERFAITH SOCIAL SERVICES, MANET COMMUNITY HEALTH CENTER, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES, PAARI, QUINCY ASIAN RESOURCES, QUINCY COMMUNITY ACTION PROGRAM, QUINCY POLICE, TOWN OF RANDOLPH, SCITUATE FACTS, SOUTH SHORE ELDER SERVICES, SOUTH SHORE MANOR, WELLSPRING, TOWN OF WEYMOUTH, WOLLASTON SENIOR CENTER AND YOUTH HEALTH CONNECTION. IN ADDITION TO THIS WORKGROUP, THE HOSPITAL REGULARLY COLLECTS DATA THROUGH MEETINGS WITH STATE AND LOCAL LEADERS, HEALTH SERVICES PROVIDERS, EMS, POLICE AND FIRE OFFICIALS, BUSINESS LEADERS, AND OTHERS WHO ARE KNOWLEDGEABLE ABOUT SOUTHEASTERN MASSACHUSETTS' HEALTH NEEDS. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 6B: SOUTH SHORE HOSPITAL COLLABORATES WITH THREE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH'S COMMUNITY HEALTH NETWORK AREAS. WE SUPPORT AND FUND COMMUNITY HEALTH INITIATIVES SPONSORED BY THE BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20), SOUTH SHORE COMMUNITY PARTNERS IN PREVENTION (CHNA 23) AND GREATER BROCKTON COMMUNITY HEALTH NETWORK AREA (CHNA 22). SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 11: SOUTH SHORE HOSPITAL IDENTIFIED MANY HEALTH AND SOCIAL ISSUES THROUGH ITS ONGOING DATA COLLECTION AND THE CHNA WORKGROUP FILINGS. THESE ISSUES WERE FRAMED INTO FOUR PRIORITY STRATEGIC DOMAINS; MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC & COMPLEX CONDITIONS AND THEIR RISK FACTORS, AND HEALTH LITERACY & COMMUNICATIONS. TO ADDRESS THE ISSUES FRAMED IN THESE FOUR DOMAINS, SSH PLANS TO DEVELOP OUTREACH, EDUCATION, AND SUPPORT PROGRAMS FOR THOSE AT-RISK, PROVIDE RESOURCES AND PROGRAMS TO ADDRESS SOCIAL ISOLATION, INCREASE ACCESS TO BEHAVIORAL HEALTH AND SUBSTANCE ABUSE PROGRAMS, PROVIDE NARCAN AND ASSOCIATED TRAINING IN COMMUNITY BASED SETTINGS, SUPPORT DRUG TAKE-BACK EFFORTS, ENHANCE CAREGIVER SUPPORT, ENHANCE ACCESS TO THOSE WHO FACE BARRIERS TO HEALTH CARE, ENHANCE ACCESS TO TRANSPORTATION SERVICES, SUPPORT WORKFORCE DEVELOPMENT AND CREATION OF EMPLOYMENT OPPORTUNITIES, INCREASE AVAILABILITY OF TRANSITIONAL HOUSING, IMPROVE CHRONIC CARE MANAGEMENT THROUGH INCREASED SERVICES, ENHANCE INFORMATION SHARING BETWEEN HOSPITALS, LOCAL HEALTH DEPARTMENTS AND LOCAL PROVIDERS, INCREASE HEALTH LITERACY BY DEVELOPING AND DISSEMINATING HEALTH RELATED INFORMATION THAT IS ACCURATE, ACCESSIBLE AND TRANSLATED, AND PROMOTE COMMUNITY COLLABORATION AND COORDINATION. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 13H: OTHER FACTORS USED TO DETERMINE AMOUNTS CHARGED TO PATIENTS ARE ELIGIBILITY IN MEDICARE/MEDICAID PROGRAMS OR THROUGH THE COMMONWEALTH'S HEALTH CONNECTOR. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 16J: THE HOSPITAL'S POLICY IS ATTACHED TO BILLING INVOICES. ADDITIONALLY, THE HOSPITAL SUMMARIZES ITS POLICY THROUGHOUT ITS FACILITIES: IN THE EMERGENCY DEPARTMENT AND WAITING ROOMS, THE ADMISSIONS OFFICE, FINANCIAL COUNSELORS' OFFICE AND THE BUSINESS OFFICE/PATIENT ACCOUNTING LOCATIONS. PATIENTS WITHOUT INSURANCE ARE DIRECTED TO A FINANCIAL COUNSELOR WHO WILL PROVIDE THEM WITH INFORMATION ABOUT OUR FINANCIAL ASSISTANCE POLICY AS WELL AS RESOURCES AVAILABLE TO THEM THROUGH MASSHEALTH OR THE COMMONWEALTH'S HEALTH SAFETY NET. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 20E: INDIVIDUALS REFERRED TO SOUTH SHORE HOSPITAL MAY MEET WITH A FINANCIAL COUNSELOR TO LEARN ABOUT OUR FINANCIAL ASSISTANCE POLICY AS PART OF THE PRE-ADMISSION PROCESS. IF THE HOSPITAL IS UNABLE TO NOTIFY A PATIENT OF ITS FINANCIAL ASSISTANCE POLICY BEFORE OR DURING THE ADMISSION PROCESS, A FINANCIAL COUNSELOR MAY MEET WITH THE PATIENT DURING HIS HOSPITAL STAY. COUNSELORS ASSIST UNINSURED INDIVIDUALS IDENTIFIED DURING THE NOTIFICATION/ELIGIBILITY PROCESS IN APPLYING FOR INSURANCE THROUGH THE COMMONWEALTH OF MASSACHUSETTS'S HEALTH CONNECTOR PORTAL. COUNSELORS WORK WITH UNDERINSURED, MEDICALLY DISABLED INDIVIDUALS TO FIND ADDITIONAL RESOURCES TO HELP PAY THEIR MEDICAL BILLS. 9 1 - AMBULATORY CANCER CENTER 101 COLOMBIAN STREET SOUTH WEYMOUTH MA 02190 BREAST CARE AND MULTISPECIALTY CARE CENTER 2 - CENTER FOR ORTHO SPINE & SPORTS MEDICIN 2 POND PARK ROAD HINGHAM MA 02043 ORTHOPEDIC REHABILITATION AND OUTPATIENT SURGICAL SATELLITE CLINIC 3 - CENTER FOR WOUND HEAL 90 LIBBEY INDUSTRIAL PARKWAY SOUTH WEYMOUTH MA 02190 WOUND CARE AND HYPERBARIC MEDICINE 4 - OUTPATIENT SERVICES 780 MAIN STREET SOUTH WEYMOUTH MA 02190 OUTPATIENT SURGERY CENTER 5 - PRE-SURGERY EVALUATION 2 POND PARK HINGHAM MA 02043 PRE-SURGICAL TESTING AND EVALUATION CLINIC 6 - PAIN MANAGEMENT CLINIC 2 POND PARK ROAD HINGHAM MA 02043 PAIN MANAGEMENT CLINIC 7 - CENTER FOR PHYSICAL WELLNESS 780 MAIN STREET SOUTH WEYMOUTH MA 02190 OUTPATIENT CENTER FOCUSED ON EXERCISE AND PEDIATRIC OCCUPATIONAL THERAPY 8 - SOUTH SHORE UROLOGY 780 MAIN STREET SOUTH WEYMOUTH MA 02190 OUTPATIENT UROLOGY CENTER 9 - GRAYKEN CENTER FOR TREATMENT 797 MAIN STREET SOUTH WEYMOUTH MA 02190 SUBSTANCE ABUSE DISORDER AND BEHAVIORAL HEALTH SERVICES AND INTIATIVES PART I, LINE 7: SOUTH SHORE HOSPITAL USES THE COST TO CHARGE RATIO FOR CALCULATING AMOUNTS IN THE TABLE FOR LINE 7. THE COST TO CHARGE RATIO IS TOTAL PATIENT CARE COSTS DIVIDED BY TOTAL PATIENT CARE CHARGES PER WORKSHEET S-10, LINE 1 OF THE MEDICARE COST REPORT. BAD DEBT IS NOT INCLUDED IN ANY AMOUNTS REPORTED IN THE TABLE. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE UNDERTAKEN TO MEET THE NEEDS OF THE RESIDENTS OF SOUTHEASTERN MASSACHUSETTS. THE HOSPITAL PARTICIPATES IN OUTREACH PROGRAMS AND MEETS WITH MEMBERS OF THE COMMUNITIES IT SERVES TO ASSESS HEALTH CARE NEEDS. TRANSLATION SERVICES AND PROGRAMS SUCH AS THE COURTESY COACH AND MD ACCESS AND REFERRAL LINE HELP REDUCE HEALTH DISPARITIES BY PROVIDING ACCESS TO CARE. SOUTH SHORE HOSPITAL'S EMERGENCY PREPAREDNESS, INFECTION CONTROL, AND CLINICAL AND MEDICAL WORKFORCE DEVELOPMENT PROGRAMS ENSURE THE NEEDS OF THE COMMUNITY ARE MET. THE HOSPITAL PROVIDES SERVICES SUCH AS PASTORAL CARE TO PATIENTS AND THEIR FAMILIES AND PROGRAMS FOR YOUTH IN OUR COMMUNITY. PART III, LINE 2: THE HOSPITAL ANALYZES ACCOUNTS RECEIVABLE BY MAJOR INSURANCE GROUP AND LOOKS AT THE HISTORY OF BAD DEBT BY PAYOR. BAD DEBT IS CALCULATED ON A PERCENTAGE BASIS BASED ON THIS HISTORICAL ANALYSIS OF UNCOLLECTIBLE AMOUNTS AND THE PERCENTAGE IS APPLIED TO AGED ACCOUNTS RECEIVABLE. PART III, LINE 4: UNCOMPENSATED CARE EXPENSE IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS REPRESENTS THE HOSPITAL'S PAYMENTS TO THE STATEWIDE HEALTH SAFETY NET FUND (HSN)-- NET OF RECOVERIES FROM HSN FOR REIMBURSABLE BAD DEBTS. PART III, LINE 8: SOUTH SHORE HOSPITAL PROVIDES A VALUABLE COMMUNITY BENEFIT BY TREATING ALL INDIVIDUALS WITHIN THE HOSPITAL'S SERVICE AREA REGARDLESS OF ABILITY TO PAY. ABOUT 7% OF PEOPLE IN OUR AREA LIVE NEAR OR BELOW THE POVERTY LEVEL. THESE INDIVIDUALS WOULD HAVE TO TRAVEL OUT OF OUR AREA OR POSSIBLY FORGO MEDICAL TREATMENT WITHOUT THE SERVICES THE HOSPITAL PROVIDES. THE HOSPITAL USES THE MEDICARE 2552 REPORT FOR COSTS. THE MEDICARE SHORTFALL INCURRED BY SSH IS VIEWED AS LESSENING THE BURDEN OF GOVERNMENT AND THEREFORE PROVIDES A VALUABLE COMMUNITY BENEFIT. PART III, LINE 9B: THE HOSPITAL DOES NOT BILL THE FOLLOWING CATEGORIES OF PATIENTS (EXCEPT THAT THE HOSPITAL WILL BILL PATIENTS FOR ANY APPLICABLE CO-PAYMENTS OR DEDUCTIBLES REQUIRED BY A PARTICULAR ASSISTANCE PROGRAM): PATIENTS ENROLLED IN MASSHEALTH, PATIENTS RECEIVING GOVERNMENTAL BENEFITS UNDER THE EMERGENCY AID TO THE ELDERLY AND DISABLED CHILDREN PROGRAM AND IN THE HEALTHY START PROGRAM. ALSO, PARTICIPANTS IN THE CHILDREN'S MEDICAL SECURITY PLAN WHOSE FAMILY INCOME IS EQUAL TO OR LESS THAN 300% OF THE FEDERAL POVERTY LIMIT (FPL) ARE EXEMPT FROM COLLECTION ACTION. LOW-INCOME PATIENTS, DETERMINED PURSUANT TO 114.6 CMR 13.04(2), ARE EXEMPT FROM COLLECTION ACTION FOR ANY ELIGIBLE SERVICES, EXCEPT FOR CO-PAYMENTS AND DEDUCTIBLES THAT ARE NOT ELIGIBLE SERVICES UNDER 114.6 CMR 12.03(6)(B). LOW-INCOME PATIENTS DETERMINED PURSUANT TO 114.6 CMR 12.03(3)(B), WITHIN 150.1-300% OF THE FPL ARE EXEMPT FROM COLLECTION ACTION FOR THE PORTION OF THE PROVIDER BILL THAT EXCEEDS THE DEDUCTIBLE AND MAY BE BILLED FOR CO-PAYMENTS AND DEDUCTIBLES AS SET FORTH IN 114.6 CMR 13.04. SSH MAY BILL LOW-INCOME PATIENTS FOR SERVICES OTHER THAN ELIGIBLE SERVICES PROVIDED AT THE REQUEST OF THE PATIENT, AND FOR WHICH THE PATIENT HAS AGREED TO BE RESPONSIBLE, IF PROVIDERS RECEIVE THE PATIENT'S WRITTEN CONSENT TO BE BILLED FOR THE SERVICES. THE HOSPITAL WILL NOT UNDERTAKE COLLECTION ACTION AGAINST AN INDIVIDUAL THAT HAS QUALIFIED FOR MEDICAL HARDSHIP WITH RESPECT TO THE AMOUNT OF THE BILL THAT EXCEEDS THE MEDICAL HARDSHIP CONTRIBUTION. SOUTH SHORE HOSPITAL WILL NOT CONTINUE COLLECTION OR BILLINGS ON A PATIENT WHO IS A MEMBER OF BANKRUPTCY PROCEEDINGS, EXCEPT TO SECURE ITS RIGHTS AS A CREDITOR IN THE APPROPRIATE ORDER. THE HOSPITAL MAY INITIATE BILLING FOR A PATIENT WHO CLAIMS TO BE ELIGIBLE FOR ASSISTANCE PROGRAMS BUT FAILS TO PROVIDE PROOF OF ELIGIBILITY. UPON RECEIPT OF SATISFACTORY PROOF OF ELIGIBILITY, THE HOSPITAL SHALL CEASE ALL COLLECTION ACTIVITIES. THE HOSPITAL, OR ITS AGENTS, WILL NOT CHARGE INTEREST ON AN OVERDUE BALANCE FOR A LOW-INCOME PATIENT OR FOR PATIENTS WHO ARE LOW INCOME BASED ON THE HOSPITAL'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 2: THE HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN OCTOBER 2021. THE CHNA WAS THE CULMINATION OF SSH'S EFFORTS TO UNDERSTAND THE NEEDS OF THE COMMUNITY IT SERVES. IN ADDITION TO THE WORKGROUP FORMED TO ASSESS AND PRIORITIZE HEALTH NEEDS, THE HOSPITAL CONTINUOUSLY ENGAGES SYSTEM CLINICIANS AND LEADERS, COMMUNITY SERVICE PROVIDERS, MEMBERS OF STATE AND LOCAL GOVERNMENTS, EMS PROVIDERS, POLICE AND FIRE OFFICIALS AND OTHER INTERESTED PARTIES IN THE COLLECTION AND REVIEW OF DATA. SSH TRACKS AND STUDIES TRENDS IN OUR PATIENT POPULATION. WE REVIEW COMMUNITY HEALTH DATA PRIMARILY FROM THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH AND THE U.S CENSUS BUREAU. PART VI, LINE 3: SOUTH SHORE HOSPITAL PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE INFORMATION IN PUBLIC AREAS THROUGHOUT THE HOSPITAL. INFORMATION IS PROVIDED TO INDIVIDUALS DURING THE INTAKE PROCESS. THE HOSPITAL POSTS ITS CREDIT AND COLLECTION POLICY, IN PLAIN LANGUAGE SUMMARY AND ITS ENTIRETY, ON ITS WEBSITE AND COPIES ARE ALSO AVAILABLE UPON REQUEST. OUR FINANCIAL ASSISTANCE PLAN EXPLAINS HOW INDIVIDUALS MAY BE ELIGIBLE FOR ASSISTANCE UNDER FEDERAL AND STATE PROGRAMS, AS WELL AS THE HOSPITAL'S REDUCED FEE AND CHARITY CARE POLICIES. IN ADDITION, THE HOSPITAL'S INSURANCE COUNSELORS CAN EXPLAIN VARIOUS OPTIONS AND WILL HELP ANYONE WHO WANTS ASSISTANCE WITH HEALTH INSURANCE ENROLLMENT UNDER THE COMMONWEALTH'S HEALTH CARE REFORM LAW. COUNSELORS ARE AVAILABLE TO ASSIST PATIENTS DURING THE INTAKE PROCESS AND ARE ALSO AVAILABLE TO THE PUBLIC SIX DAYS A WEEK. IN ADDITION TO HELPING PATIENTS UNDERSTAND ELIGIBILITY FOR REDUCED OR FREE CARE, COUNSELORS ARE AVAILABLE TO ASSIST INDIVIDUALS IN OUR SERVICE AREA IN OBTAINING HEALTH INSURANCE, WHETHER THEY ARE PATIENTS OF THE HOSPITAL OR NOT. PART VI, LINE 4: SOUTH SHORE HOSPITAL SERVES AN AREA SOUTH OF BOSTON WITH A POPULATION OF APPROXIMATELY 630,000. THE MAJORITY OF PATIENTS IDENTIFY THEMSELVES AS CAUCASIAN (71.97%), FOLLOWED BY BLACK/AFRICAN AMERICAN (5.30%), ASIAN (2.79%) AND OTHER (15.26%). AFTER ENGLISH, THE NEXT MOST COMMON LANGUAGES THAT PATIENTS REPORTED SPEAKING AS A PRIMARY LANGUAGE ARE PORTUGUESE, SPANISH, ARABIC, VIETNAMESE, AND CANTONESE. PART VI, LINE 5: SOUTH SHORE HOSPITAL IS COMMITTED TO PROVIDING COMMUNITY BUILDING ACTIVITIES THAT PROMOTE THE HEALTH AND WELL-BEING OF ALL THE PEOPLE IN OUR AREA. THE HOSPITAL PROVIDES PASTORAL CARE TO PATIENTS AND THEIR FAMILIES. PEOPLE LIVING WITHIN THE HOSPITAL'S SERVICE AREA MAY RECEIVE HELP IN FINDING AFFORDABLE HEALTH INSURANCE AND ARE ASSISTED IN FINDING MEDICAL CARE THROUGH OUR MD ACCESS AND REFERRAL PROGRAMS. THE HOSPITAL ELIMINATES BARRIERS TO CARE BY PROVIDING A COURTESY COACH TO ANY PATIENT NEEDING TRANSPORTATION TO OR FROM ITS FACILITIES. WE HAVE MADE A COMMITMENT TO PHYSICIAN RECRUITMENT IN SPECIALTIES THAT MEET COMMUNITY NEEDS, NOW AND IN THE FUTURE, AND TO PROVIDING OUR CLINICIANS WITH CONTINUING MEDICAL EDUCATION. SOUTH SHORE HOSPITAL HAS INVESTED IN EMERGENCY PREPAREDNESS TRAINING AND EQUIPMENT TO SERVE THE COMMUNITY IN THE EVENT OF A NATURAL OR MAN-MADE DISASTER. THE HOSPITAL MAKES ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY AND COMMUNITY BENEFITS REPORTS AVAILABLE ON ITS WEBSITE. FOR MORE INFORMATION ABOUT SOUTH SHORE HOSPITAL'S ACTIVE ROLE IN MEETING THE NEEDS OF OUR COMMUNITY, PLEASE VISIT HTTPS://SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS. PART VI, LINE 6: SOUTH SHORE HOSPITAL IS PART OF AN AFFILIATE HEALTH CARE SYSTEM. UNDER THE CONTROL OF ITS PARENT ORGANIZATION, SOUTH SHORE HEALTH SYSTEM (SSHS), AFFILIATES SOUTH SHORE HOSPITAL, SOUTH SHORE PROPERTY, CONNECTED CARE OF SOUTHEASTERN MASSACHUSETTS, SOUTH SHORE HEALTH INTEGRATED DELIVERY NETWORK, INC. AND COASTAL MEDICAL ASSOCIATES (INCLUDING ITS SUBSIDIARIES SOUTH SHORE MEDICAL CENTER AND SOUTH SHORE HEALTH EXPRESS) COORDINATE THE PROVISION OF HEALTH CARE SERVICES TO THE RESIDENTS OF SOUTHEASTERN MASSACHUSETTS. PART VI, LINE 7, REPORTS FILED WITH STATES MA 1 FRIENDS SCHOLARSHIPS FOR STUDENTS PURSUING HEALTH CARE DEGREES 19 21500 0 PART I, LINE 2: SOUTH SHORE HOSPITAL ADMINISTERS GRANTS IN ACCORDANCE WITH GRANTOR DOCUMENTS AND MAINTAINS RECORDS TO SUBSTANTIATE COMPLIANCE. GRANTEES ARE REQUIRED TO PROVIDE EVIDENCE OF MEETING CRITERIA ESTABLISHED FOR VARIOUS ASSISTANCE GRANTS OR SCHOLARSHIPS AWARDED BY SSH. SCHEDULE I, PART III THE FRIENDS OF SOUTH SHORE HEALTH SYSTEM, AN AUXILIARY HOSPITAL ORGANIZATION, OFFERS SEVERAL SCHOLARSHIPS TO STUDENTS INTERESTED IN FURTHERING THEIR EDUCATION IN HEALTH CARE AND HEALTH CARE RELATED FIELDS. INTERESTED, ELIGIBLE APPLICANTS ARE ENCOURAGED TO APPLY FOR THESE SCHOLARSHIPS. THE NURSING SCHOLARSHIP IS FOR A FULL-TIME OR REGULAR PART-TIME EMPLOYEE OF SOUTH SHORE HOSPITAL PRESENTLY ENROLLED AT AN ACCREDITED SCHOOL PURSUING A BSN OR HIGHER. THE MARION C. MARTINSEN SCHOLARSHIP IS FOR A HIGH SCHOOL SENIOR OR GRADUATE FROM AN ACCREDITED PUBLIC, PRIVATE, OR PAROCHIAL SCHOOL. THE VOLUNTEERS AND FAMILIES SCHOLARSHIP IS FOR AN ACTIVE VOLUNTEER, CHILD OR GRANDCHILD OF AN ACTIVE SOUTH SHORE HOSPITAL OR HOME CARE DIVISION VOLUNTEER. THE HEALTH-RELATED FIELD SCHOLARSHIP IS FOR A FULL-TIME OR REGULAR PART-TIME EMPLOYEE PRESENTLY ENROLLED AT AN ACCREDITED SCHOOL PURSUING AN ASSOCIATE DEGREE, A BACHELOR'S DEGREE, OR FOR TECHNICAL ACCREDITATION IN A HEALTH-RELATED FIELD. THE TERRY RIES NURSING EDUCATION AND DEVELOPMENT SCHOLARSHIP IS FOR FULL-TIME OR REGULAR PART-TIME EMPLOYEES WHO HAVE BEEN EMPLOYED FOR AT LEAST A YEAR AND ACCEPTED INTO AN ACCREDITED PROGRAM TO BEGIN OR ADVANCE THEIR NURSING CAREER. NINETEEN SCHOLARSHIPS TOTALING $21,500 WERE AWARDED IN FISCAL 2023. THE FRIENDS IS A DEPARTMENT OF SOUTH SHORE HOSPITAL; FUNDS AND OVERSIGHT OF FRIENDS SCHOLARSHIPS COMES FROM THE HOSPITAL. X 1 1 1 0 0 0 0 0 0 1 0 TIMOTHY R LYNCH MD CHIEF MED. OFFICER THROUGH 7/22/22 468575 0 300 0 266077 0 392239 0 14705 0 1141896 0 0 0 ALLEN SMITH MD PRESIDENT & CEO 872900 0 65025 0 6671 0 159150 0 24553 0 1128299 0 0 0 FREDERICK MILLHAM MD CHAIR, SURGERY 871609 0 33143 0 37650 0 9150 0 18751 0 970303 0 0 0 WILLIAM JOHNSTON CHIEF OPERATING OFFICER 603431 0 60000 0 3612 0 117150 0 24553 0 808746 0 0 0 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 629868 0 73395 0 57408 0 9150 0 30032 0 799853 0 0 0 DILIP NATARAJ MD CHAIR, CRITICAL CARE 622493 0 76460 0 71875 0 9150 0 10867 0 790845 0 0 0 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 627090 0 80666 0 25863 0 9150 0 24553 0 767322 0 0 0 HOWARD CHANG MD CHIEF, PSYCHIATRY 674531 0 0 0 28550 0 9150 0 17985 0 730216 0 0 0 JASON TRACY MD CHAIR, EMERGENCY SERVICES 570571 0 23274 0 40411 0 9150 0 20055 0 663461 0 0 0 ERIK SHANK MD CHAIR, ANESTHESIA 562842 0 22224 0 3612 0 9150 0 22091 0 619919 0 0 0 MARY SHAUGHNESSY FORMER TREAS. & CFO THRU 6/13/22 499538 0 0 0 0 0 0 0 0 0 499538 0 0 0 JOSEPH R DRISCOLL ESQ SECRETARY 413606 0 12351 0 7323 0 9150 0 24553 0 466983 0 0 0 TIMOTHY QUIGLEY SVP SPECIAL PROJECTS 375725 0 11493 0 37859 0 9301 0 24553 0 458931 0 0 0 KRISTINE HANSCOM CPA MST CGMA TREAS. & CFO 6/14/22 THRU 5/31/23 296902 0 30750 0 1945 0 9150 0 9289 0 348036 0 0 0 JUSTIN CAMPBELL DIRECTOR/CHAIR OF PROVIDER COUNCIL 181000 0 0 0 0 0 0 0 0 0 181000 0 0 0 PART I, LINE 1A FREDERICK MILLHAM RECEIVED A $139.93 GROSS-UP PAYMENT. PART I, LINE 3 FOR FY23 COMPENSATION DECISIONS, THE HOSPITAL'S PARENT COMPANY, SOUTH SHORE HEALTH SYSTEM, HAS A COMPENSATION COMMITTEE THAT MAKES COMPENSATION DECISIONS FOR ALL SYSTEM EXECUTIVES. THE COMPENSATION COMMITTEE MEETS PERIODICALLY AND ENGAGES AN INDEPENDENT EXTERNAL COMPENSATION CONSULTING FIRM TO ESTABLISH THE COMPENSATION OF THE SSH PRESIDENT AND OTHER KEY EMPLOYEES. THE CONSULTING FIRM DEVELOPS AND PRESENTS ALL MATERIALS INCLUDING MARKET TRENDS, COMPENSATION STUDIES AND SURVEYS, AND ADHERES TO BEST PRACTICES GUIDELINES. THE FINAL RECOMMENDATION FOR COMPENSATION CHANGES IS PRESENTED AND APPROVED BY THE ENTIRE INDEPENDENT COMMUNITY OF THE SYSTEM'S BOARD OF DIRECTORS. PART I, LINE 4A TIMOTHY R LYNCH RECEIVED A SEVERANCE PAYMENT DURING THE YEAR FOR $259,512. PART I, LINE 7 THE NON-FIXED PAYMENTS PROVIDED CONSIST OF STIPENDS. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 000000000 2021-03-24 49221667 TO REFUND BONDS ISSUED 9/14/2012 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584XNN7 2016-05-09 155229109 SEE PART VI FOR COMPLETE DESCRIPTION 0 0 0 A 10716667 49221667 49221667 1 0 1 1 B 23668889 156274667 2094564 121048000 35226666 2019 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 DEUTSCHE BANK AG 11.300000000000 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART I, COLUMN F, BOND B SERIES H WAS USED TO CONSTRUCT A NEW CRITICAL CARE UNIT AND TO RENOVATE THE EXISTING CRITICAL CARE UNIT; SERIES I WAS USED TO CONSTRUCT A NEW CRITICAL CARE UNIT AND TO RENOVATE THE EXISTING CRITICAL CARE UNIT AND FOR OTHER MISCELLANEOUS CAPITAL PROJECTS. THE FINANCING ALSO UPGRADED THE HOSPITAL'S ELECTRONIC HEALTH RECORD SYSTEM AND TO IMPLEMENT ENTERPRISE RESOURCE PLANNING SOFTWARE AND OTHER SYSTEM-WIDE TECHNOLOGY UPDATES. A PORTION OF SERIES I REFUNDS 7/14/99 AND 12/16/11 ISSUES. SCHEDULE K, PART II, LINE 3, BOND B THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS DUE TO INTEREST INCOME. SCHEDULE K, PART II, LINE 4, BOND B AMOUNTS REPORTED HERE CONSIST OF ENTIRELY BONA FIDE DEBT SERVICE FUND DEPOSITS. SCHEDULE K, PART IV, LINE 2C, BOND B THE DATE OF THE REBATE CALCULATION IS JULY 1, 2020. TIMOTHY QUIGLEY CNO THROUGH 9/30/21, SSH SVP SPECIAL PROJECTS SPLIT DOLLAR LIFE POLICY X 203220 203220 0 1 1 JOHN STEVENSON PHYSICIAN, CMO THROUGH 5/16/17 SPLIT DOLLAR LIFE POLICY X 783980 783980 0 1 1 JOSEPH DRISCOLL GENERAL COUNSEL/CLERK/SECRETARY SPLIT DOLLAR LIFE POLICY X 451255 451255 0 1 1 KIMBERLY DEVER CHIEF OB/GYN, DIRECTOR THOUGH 9/20, VP WOMEN'S HEALTH AND CHAIR OBGYN SPLIT DOLLAR LIFE POLICY X 520300 520300 0 1 1 JASON TRACY MD EMERGENCY DEPARTMENT CHAIR THROUGH SPLIT DOLLAR LIFE POLICY X 389470 389470 0 1 1 2348225 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 3279580 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 37009 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 5659 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 49299103 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 637944 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 113072 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 7954 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 109490 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2816112 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2753197 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2242450 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 67823 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 30729 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 126600 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2492 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 27210237 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 29133 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 6956 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 545788 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 132287 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 6167 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2631936 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 208619 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 740415 INDEPENDENT CONTRACTOR 0 X 588 REPLACEMENTS COST X 5 87763 COST OR SELLING PRICE X 1 10000 COST OR SELLING PRICE X 12 25085 COST OR SELLING PRICE X ADVERTISING 9 58041 COST OR SELLING PRIC X PROFESSIONAL SERVICES 7 8961 COST OR SELLING PRIC X FLOWERS 1 150 COST OR SELLING PRIC 0 1 0 PART I, COLUMN (B): THE INFORMATION PROVIDED ABOVE IS THE NUMBER OF CONTRIBUTIONS RECEIVED. UNLESS OTHERWISE NOTED, DONOR VALUATION WAS USED TO DETERMINE THE AMOUNT OF NONCASH CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 2 PERSONS LISTED IN PART VII HAVE A "BUSINESS RELATIONSHIP" WITH ONE ANOTHER DUE TO THE OVERLAPPING BOARD STRUCTURE OF SOUTH SHORE HEALTH SYSTEM AND ITS RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 SOUTH SHORE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 IS PREPARED INTERNALLY AND REVIEWED BY THE TAX PRACTICE OF ITS INDEPENDENT AUDITORS. THE RETURN IS THEN REVIEWED BY THE CFO. FORM 990 IS UPLOADED TO THE GOVERNING BOARD'S WEB PORTAL FOR ALL BOD MEMBERS TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED FOR CONFLICTS OR POTENTIAL CONFLICTS. BOARD MEMBERS ABSTAIN FROM VOTING ON MATTERS THAT PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 SOUTH SHORE HEALTH SYSTEM (SSHS), PARENT OF SOUTH SHORE HOSPITAL, HAS A COMPENSATION COMMITTEE THAT SETS THE COMPENSATION PHILOSOPHY AND PAY APPROACH FOR THE EXECUTIVE TEAM AND MAKES COMPENSATION DECISIONS FOR THE PRESIDENT/CEO. UTILIZING THE ESTABLISHED PHILOSOPHY AND APPROACH, THE COMMITTEE DELEGATES COMPENSATION DECISIONS FOR THE REST OF THE EXECUTIVE TEAM TO THE PRESIDENT/CEO. THE COMPENSATION COMMITTEE MEETS PERIODICALLY, IS INDEPENDENT AND CONSISTS SOLELY OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH REGARDS TO COMPENSATION MATTERS. SSHS UTILIZES AN INDEPENDENT OUTSIDE CONSULTANT TO DETERMINE EXECUTIVE COMPENSATION FOR THE PRESIDENT/CEO. ALL DATA PRESENTED, AS WELL AS COMPENSATION DELIBERATIONS AND VOTES, IS DOCUMENTED IN THE COMPENSATION COMMITTEE MINUTES. THE BOARD'S REVIEW AND APPROVAL PROCESS TAKES PLACE ANNUALLY FOR IMPLEMENTATION AT THE START OF THE NEW FISCAL YEAR. COMPENSATION DECISIONS FOR ALL OTHER HOSPITAL EMPLOYEES, INCLUDING KEY EMPLOYEES, ARE ALSO MADE ANNUALLY AND ARE BASED ON A REVIEW OF COMPARABLE INDUSTRY DATA, MARKET CONDITIONS AND RESEARCH PROVIDED BY OUTSIDE CONSULTANTS. FORM 990, PART VI, SECTION C, LINE 19 SOUTH SHORE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR INSPECTION AT THE CORPORATION'S OFFICE. COPIES OF THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, CERTAIN GOVERNING DOCUMENTS ARE ALSO AVAILABLE THROUGH THE MASSACHUSETTS SECRETARY OF THE COMMONWEALTH'S CORPORATIONS DIVISION DATABASE. FORM 990, PART XI, LINE 9: OTHER -399,450. ATLANTIC WOMEN'S HEALTH INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 200156651 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HOSPITAL INC 1 COASTAL MEDICAL ASSOCIATES INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 043170333 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HEALTH SYSTEM INC 1 CONNECTED CARE OF SOUTHEASTERN MASSACHUSETTS INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 823503666 OPERATES AN ACOUNTABLE CARE ORGANIZATION MA 501(C)(3) 10 SOUTH SHORE HEALTH SYSTEM INC 1 METROSOUTH OBSTETRICS & GYNECOLOGY INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 330998957 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HOSPITAL INC 1 SOUTH SHORE HEALTH EXPRESS INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 452385865 OPERATES MEDICAL URGENT CARE CENTERS MA 501(C)(3) 10 COASTAL MEDICAL ASSOCIATES INC 1 SOUTH SHORE HEALTH SYSTEM INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 042105926 SUPPORTS THE CHARITABLE MISSION OF SOUTH SHORE HOSPITAL AND ITS AFFILIATES MA 501(C)(3) 12B, II N/A 0 SOUTH SHORE MEDICAL CENTER INC 143 LONGWATER DRIVE NORWELL MA 02061 042297845 SPECIALIZED AND PRIMARY MEDICAL CARE MA 501(C)(3) 10 COASTAL MEDICAL ASSOCIATES INC 1 FRIENDS OF SOUTH SHORE HOSPITAL INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 042582248 RAISES MONIES IN SUPPORT OF SSH AND BUILDS GOODWILL IN THE COMMUNITY MA 501(C)(3) 12A, I SOUTH SHORE HOSPITAL INC 1 SOUTH SHORE PROPERTY INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 050398822 DEVELOPS AND MANAGES REAL ESTATE PROPERTY FOR SOUTH SHORE HOSPITAL MA 501(C)(3) 12A, I SOUTH SHORE HEALTH SYSTEM INC 1 SOUTH SHORE HEALTH INTEGRATED DELIVERY NETWORK INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 852785921 TO DEVELOP & MAINTAIN A NETWORK OF PROVIDERS FOR DELIVERY OF HEALTHCARE SERV MA N/A C 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1