2019-07-18T11:26:59-07:00 2018-09-30 990 2017-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 Fogg Road South Weymouth MA 02190 Stephen Coco SVP, CFO & Treasurer 7816248422 2019-08-15 72.22.189.130 2017 2019-02-21 02:37:17Z Stephen M Coco 55 Fogg Road South Weymouth MA 02190 624348927 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. 15 11 5497 413 851473 0 8797169 7452160 581903445 596179079 11198111 5840842 7770381 13059058 609669106 622531139 54163 121400 0 0 396480194 400599656 0 0 2708891 197660704 207673155 594195061 608394211 15474045 14136928 673557545 666831990 384883805 362270073 288673740 304561917 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. 0 0 448160154 110900 596020475 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 393 acute care beds (composed of 288 medical/surgical, 24 intensive care/coronary care, 53 Level III maternal/newborn, 18 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, pediatric, 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, 2018, the Hospital had 29,719 discharges and approximately 203,702 outpatient days. (Continued on Schedule O) 0 0 0 448160154 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 1 1 0 0 0 1 399 2 1 5497 1 1 1 0 0 0 0 1 1 0 0 0 0 X 15 11 1 0 1 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 DC FL MA NH NJ NY X Stephen M Coco 7816248422 55 Fogg Road South Weymouth MA 02190 Gene E Green MD President/CEO 40 5.5 X X 994038 0 45017 Kenneth Kirkland Chair 1 3.5 X X 0 0 0 Brian Concannon Vice Chair 1 3.5 X X 0 0 0 Kimberly Dever MD Director, Chief OB/GYN 40 5.5 X 666780 14292 66841 Christopher Oddleifson Director 1 3.5 X 0 0 0 John Maguire Director through 5/31/18 1 3.5 X 0 0 0 Laura Avakian Director through 12/31/17 0 1 X 0 0 0 Paula L Becker Director 1 3.5 X 0 0 0 James McDonough Director through 4/30/18 1 3.5 X 0 0 0 Robert Pineau Director 1 3.5 X 0 0 0 Paul Watanabe Director 1 3.5 X 0 0 0 Thomas McCarthy Director 1 3.5 X 0 0 0 Pamela O'Leary Director 1 3.5 X 0 0 0 Lisa Walsh Director 1 3.5 X 0 0 0 Linda Thompson Director 1 3.5 X 0 0 0 Edward Nalband MD Director 1 3.5 X 0 372728 25828 Helen Garvey Director 1 3.5 X 0 0 0 Luke O'Connell MD Chair Provider Council 20 6.5 X 230201 0 21223 Stephen Coco Treasurer 40 7.5 X 429951 0 26992 Joseph R Driscoll Esq General Counsel/Clerk 40 6.5 X 345074 0 66174 Peg Holda Clerk through 11/10/17 40 4 X 433799 0 452930 Pamela Whelton SSH COO, Treasurer through 8/22/17 40 0 X 720512 0 13097 Timothy Lynch MD SSH CMO 40 2 X 568401 0 66636 Timothy Quigley SSH CNO 40 0 X 472260 0 66223 Rose DiPietro President Home & Comm Care through 6/30/18 40 0 X 480587 0 64849 Frederick Millham MD Chief of Surgery 40 0 X 744505 0 37875 Matthew Weiss MD Physician 40 0 X 728291 0 53801 Jason Tracy MD Physician 40 0 X 617273 0 56276 Shay Hershkovitz MD Physician 40 0 X 511961 0 21788 John Stevenson MD Physician/CMO through 5/16/17 0 40 X 847609 75809 29992 Richard Aubut SSHS CEO through 11/2/15 0 0 X 295973 0 0 Joseph Cahill Executive Vice President through 7/15/16 0 0 X 636231 0 24580 E Delroy Dixon SVP, Chief Information Officer through 7/15/16 0 0 X 216544 0 9340 Robert Wheeler SVP Human Resources through 3/10/16 0 0 X 317629 0 7436 10257619 462829 1156898 834 1 1 0 Impact Advisors LLC 931 W 75th Street Suite 137-304 Naperville IL 60565 Consulting 8588534 Brigham & Women's Physician Organization PO Box 3684 Boston MA 022413684 Physician Services 3489366 Staffassist Workforce 62373 Collections Center Drive Chicago IL 60693 Temporary Help 1779408 Specialized Receivables PO Box 12414 Newark NJ 071013514 Billing/Collection 1541602 Audit Billing Center Inc 29 Winter Street Pembroke MA 02359 Billing/Collection 1041350 62 0 0 803857 0 278923 6369380 1401533 7452160 Net Patient Service Revenue 622000 575486386 575486386 0 0 Ambulatory Cancer Center 621000 16913408 16913408 0 0 Medicare Bundled Services 622000 2141015 2141015 0 0 Clinician Services 622000 444152 197320 246832 0 Rental Income from Affiliates 531390 231250 231250 0 0 962868 962868 0 0 596179079 1991278 0 11 1991267 0 0 0 0 0 0 0 0 1233179 0 1125012 0 108167 0 108167 0 0 108167 3902287 3000 0 55723 3902287 -52723 3849564 0 0 3849564 634810 803857 634810 0 0 0 22755 2243 20512 0 20512 0 Settlements & Credits 900099 5597641 0 0 5597641 Food Service Sales 722212 4098365 0 0 4098365 Shields Imaging Income 621000 1465581 0 0 1465581 1768792 88228 584118 1096446 12930379 622531139 596020475 851473 18207031 110900 110900 10500 10500 3274914 2469281 805633 3553264 3553264 317563909 237215736 78716387 1631786 14909918 11016557 3893361 37412276 27642974 9336891 432411 23885375 17648293 6237082 520913 520913 2305839 2305839 281325 281325 219358 219358 22350415 8423089 13833249 94077 900591 899595 996 79149035 76808941 2306238 33856 10331353 10331353 8832946 6183062 2649884 887570 754596 122239 10735 706161 348275 355368 2518 9423247 6596273 2826974 27424701 19197291 8227410 3012622 2095757 916865 Physician Services 13776460 13776460 0 0 Uncompensated Care 5614915 5614915 0 0 Equpipment Maintenance Contracts 7218423 3160928 4057495 0 Leases 3850225 3236990 542713 70522 10867056 5849336 4585730 431990 608394211 448160154 157525166 2708891 29173223 13444483 11698059 19886889 8119666 7078588 71069426 69417287 225000 175000 7116304 8721601 6655096 6868288 587105435 321840956 256809009 265264479 249615928 235985462 3632019 4903895 29443815 35086018 673557545 666831990 77185784 73898164 2340604 4280927 213611966 205475399 91745451 78615583 384883805 362270073 X 270238635 283606442 17031947 19250707 1403158 1704768 288673740 304561917 673557545 666831990 X 14136928 9257372 0 0 0 -7506123 X 0 1 X 0 0 X 0 1 0 0 0 0 1 19900 0 1 199458 219358 0 Schedule C, Part II-B, Line 1 Line 1g: Salary paid to South Shore Health System employee and registered lobbyist for work on legislative and regulatory matters that impact the delivery, access and cost of health care in Massachusetts. Line 1i: Amount represents a percentage of the Hospital's annual apportionment of MHA/AHA dues attributable to lobbying expenses. For the year ended September 30, 2018, it was determined that 90.14% of dues was 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-funded 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. 18435105 5059331 141509 0 2101725 578745 20955475 12798116 7826451 242623 0 2010991 421094 18435105 10612198 4890558 189932 0 2386792 507780 12798116 10698272 3096501 -51363 0 2753182 378030 10612198 12105141 3593941 209640 0 4841905 368545 10698272 0 0.08 0.92 1 0 0 5483563 5483563 0 256653384 131277268 125376116 0 16116895 7454157 8662738 0 280925631 171667772 109257859 0 27925962 11441759 16484203 265264479 Life Insurance 15826065 Pension Asset 8386051 Insurance Recoveries 4734044 Misc Other Revenue 3915923 Due from Affiliates 2116384 Series G Swap 96035 Rent Receivable 11516 35086018 0 Due to 3rd Party 40346330 Cap Leases 12186201 Malpractice Payable 7615765 Executive Benefits Payable 5932166 Loss on Swaps 5356027 Accrued Workers Comp & Separation 4581878 Community Health Initatives 1969280 Retirement 358217 FIN 47 Liability 264941 Security Deposits 4778 78615583 X 620197402 0 0 0 3372871 3372871 616824531 0 5706608 5706608 622531139 609888237 0 0 0 1494026 1494026 608394211 0 0 0 608394211 Schedule D, Part V, Line 4 The Hospital maintains its endowment funds to further its charitable purposes and those of its affiliates. In prior years, endowment funds have been used to maintain and expand the Hospital's infrastructure, purchase state-of-the-art medical equipment and provide health and wellness services to the community. Schedule D, 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. Schedule D, Part XI, Line 2d Net assets released from restrictions; $3,372,871. Schedule D, Part XI, Line 4b Contributions; $7,200,634, Cost of goods sold - shops; -$366,771, Rental expense; -$1,125,012, Gaming expenses; -$2,243. Schedule D, Part XII, Line 2d Cost of goods sold - shops; $366,771, Rental expense; $1,125,012, Gaming expenses; $2,243. Moonlight & Miracles 524144 153245 370899 0 0 163431 135448 30886 41134 Golf Classic 232809 155528 77281 0 0 43700 17723 0 15858 7 681714 495084 186630 0 0 25767 58159 20552 82152 1438667 803857 634810 0 0 232898 211330 51438 139144 634810 0 0 0 0 0 0 0 0 0 0 0 22755 690 0 0 1553 1 1 22755 690 0 0 1553 2243 20512 MA 0 In accordance with Massachusetts state law, South Shore Hospital obtains permits from each town where it holds raffles. 0 1 0 0.33 0.67 Chris O'Connor SVP External Affairs 30 Reservoir Park Drive Rockland MA 02370 0 Christopher O'Connor 0 See Part IV X 0 0 Schedule G, Part III, Line 16 Schedule G, Part III, Line 16 - Christopher O'Connor is the SVP, External Affairs of South Shore Health System Foundation, a department of South Shore Hospital. The SSHS Foundation oversees all gaming and fundraising activities. 1 1 1 X 1 X 1 1 1 0 1 1 3317548 41135 3276413 0.0054 58249730 43219950 15029780 0.0247 3086310 0 3086310 0.0051 0 0 64653588 43261085 21392503 0.0352 911945 0 911945 0.0015 628417 0 628417 0.001 74638639 50436068 24202571 0.0398 155189 120305 34884 0.0001 247500 247500 0.0004 0 0 76581690 50556373 26025317 0.0428 0 0 141235278 93817458 47417820 0.0780 696455 0 696455 0.0011 140015 0 140015 0.0002 18272 0 18272 0 652603 15164 637439 0.001 468649 0 468649 0.0008 0 0 1975994 15164 1960830 0.0031 1 14849392 0 165703024 180965432 -15262408 X 1 1 1 1 South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 southshorehealth.org License #2107 X X X X See Part V, Section D. All non-hospital facilities are included in the Hospital's license. South Shore Hospital Inc 1 0 0 1 X X X X X X X X 15 1 0 1 1 X https://www.southshorehealth.org/media/84/download?disposition=inline X 1 17 1 https://www.southshorehealth.org/media/108/download?disposition=inline 0 0 1 X 200 300 X X X X X X X 1 1 X X X X 1 X https://www.southshorehealth.org/media/783/download?disposition=inline X https://www.southshorehealth.org/media/783/download?disposition=inline X https://www.southshorehealth.org/media/781/download?disposition=inline X X X X X X X 1 X 0 X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-South Shore Hospital Inc The Hospital developed its current Community Health Needs Assessment by holding a workgroup with representatives from the 34 communities it serves. The nineteen 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: Bay State Community Services, CHNA 20 (Blue Hills Community Health Alliance), Dana-Farber/Brigham and Women's Cancer Center, GateHouse Media New England, Hingham Health Department, James M. Hurley Senior and Veterans Center, Manet Community Health Center, Marshfield Public School District, Office of Congressman Bill Keating, Quincy Asian Resources, Quincy Health Department, Scituate Council on Aging, South Shore Elder Services, South Shore YMCA, Weymouth Health Department, 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. Schedule H, Part V, Section B, Line 6b-South Shore Hospital Inc 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). Schedule H, Part V, Section B, Line 7a-South Shore Hospital Inc South Shore Hospital's CHNA report can be found at https://www.southshorehealth.org/media/84/download?disposition=inline. Schedule H, Part V, Section B, Line 11-South Shore Hospital Inc South Shore Hospital identified seventeen health and social issues through its ongoing data collection and the CHNA workgroup findings. Access to health services, behavioral health (including mental health and substance abuse) and cardiovascular care were identified as priority areas. The Hospital continues to address the need for access to health services by providing translation and courtesy shuttle services, and assisting any individual in our service area in obtaining health insurance. SSH plans to work with community leaders and CHNAs to develop programs to address ongoing obstacles contributing to lack of access to care. Behavioral health issues are significant in our service area with demand for mental health services exceeding the supply of providers. Substance abuse, frequently a co-morbid behavioral health condition, increases emergency room visits. Education around the topics of behavioral health and substance abuse was identified as critical in addressing these issues. SSH plans on expanding initiatives to address behavioral health problems by utilizing internal clinicians, supporting local police and fire departments to mitigate substance abuse and partnering with our communities and local groups to increase educational programs. SSH plans to reduce cardiovascular disease by educating people in the communities it serves about the importance of physical activity. We host free programs dedicated to the prevention and treatment of heart disease, stroke and peripheral vascular conditions. SSH will continue to offer rehabilitation services and is partnering with the South Shore YMCA to offer a cardiac rehabilitation maintenance exercise program for individuals with stable heart disease. The Hospital initiated and supported the South Shore Moves! Wellness Challenge to promote wellness and physical activity. Although oral health was identified as a health need during the assessment process, it will not be addressed due to a lack of clinical expertise at South Shore Hospital. The assessment identified dementia as a community health concern but, outside of programs aimed at vulnerable populations, SSH does not plan to offer specific programs at this time. Violence/safety is another area identified that the Hospital cannot fully address as it is beyond our scope as a healthcare provider. Schedule H, Part V, Section B, Line 13h-South Shore Hospital Inc Other factors used to determine amounts charged to patients are eligibility in Medicare/Medicaid programs or through the Commonwealth's Health Connector. Schedule H, Part V, Section B, Line 16a-South Shore Hospital Inc South Shore Hospital's FAP and FAP application form can be found at https://www.southshorehealth.org/media/783/download?disposition=inline. Schedule H, Part V, Section B, Line 16c-South Shore Hospital Inc The Hospital's FAP plain language summary can be found at https://www.southshorehealth.org/media/781/download?disposition=inline. Schedule H, Part V, Section B, Line 16j-South Shore Hospital Inc 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. Schedule H, Part V, Section B, Line 20e-South Shore Hospital Inc 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. 7 Ambulatory Cancer Center 101 Columbian Street South Weymouth MA 02190 Breast care and multispecialty care center Center for Orthopedics Spine and Sports Medicine 2 Pond Park Road Hingham MA 02043 Orthopedic rehabilitation and outpatient surgical satellite clinic Center for Wound Healing 90 Libbey Industrial Parkway South Weymouth MA 02190 Wound care and hyperbaric medicine Cohasset Radiology 233 Chief Justice Cushing Highway Lower Level Cohasset MA 02025 Imaging services Outpatient Services 780 Main Street South Weymouth MA 02190 Outpatient surgery center Center for Physical Wellness 51 Performance Drive 3rd Floor Weymouth MA 02189 Offers exercise, rehabilitation and physical conditioning programs Pre-surgery Evaluation 797 Main Street 1st Floor South Weymouth MA 02190 Pre-surgical testing and evaluation clinic Schedule H, 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 in not included in any amounts reported in the table. Schedule H, Part I, Line 7, Column f The Hospital does not include bad debt in its Statement of Functional Expenses, Form 990, Part IX; not applicable. Schedule H, Part II 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. Schedule H, Part III, Section A, 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 uncollectable amounts and the percentage is applied to aged accounts receivable. Schedule H, Part III, Section A, 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. Schedule H, Part III, Section B, 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. One in 8 people in our area lives 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. Schedule H, Part III, Section C, 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. Schedule H, Part VI, Line 2 The Hospital's most recent Community Health Needs Assessment was completed in March 2016. 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 from the Department of Public Health's Massachusetts Community Health Information Profile (Mass CHIP) as well as information collected by the Massachusetts Hospital Association, Massachusetts Health Data Consortium, Federal Centers for Disease Control, the Kaiser Family Foundation and Sg2, a national health care information company. Schedule H, 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. Schedule H, Part VI, Line 4 South Shore Hospital serves an area south of Boston with a population of approximately 725,000. The majority of patients identify themselves as Caucasian (94%), followed by Black/African American (1.8%), Other (1.8%) and Asian (.9%). After English, the next most common languages that patients reported speaking as a primary language are Portuguese, Spanish, Vietnamese, Arabic and Chinese. Schedule H, 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://www.southshorehealth.org/about-us/community-benefits. Schedule H, Part VI, Line 6 South Shore Hospital is part of an affiliated health care system. Under the control of its parent organization, South Shore Health System (SSHS), affiliates South Shore Hospital, South Shore Property, South Shore Health Express and Coastal Medical Associates (including its subsidiary, South Shore Medical Center) coordinate the provision of health care services to the residents of Southeastern Massachusetts. Schedule H, Part VI, Line 7 South Shore Hospital filed its Community Benefits Report in Massachusetts. 1 United Way Of Greater Plymouth County 934 W Chestnut Street Brockton MA 02301 042103940 501(c)(3) 165000 Community Healthcare Support Bay State Community Services 1120 Hancock Street Quincy MA 02169 042468492 501(c)(3) 82500 Community Healthcare Support Quincy Asian Resources Inc 1509 Hancock Street Suite 209 Quincy MA 02169 010556446 501(c)(3) 18000 Community Healthcare Support Physicians Health Services Inc 860 Winter Street Waltham MA 024511414 042911441 501(c)(3) 15000 Support Provider Wellness Norwell Visiting Nurse Assoc Inc 120 Longwater Drive Norwell MA 02061 042104797 501(c)(3) 10000 Community Healthcare Support United Stroke Alliance 2000 W Pioneer Pkwy Suite 16 Peoria IL 61615 640954851 501(c)(3) 10000 Community Healthcare Support 6 0 Friends scholarships for students pursuing health care degrees 9 10500 0 Cash See Part IV Schedule I, 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 II, Line 1 United Way and Bay State Community Services grants are obligations from a prior year's community healthcare initiative. 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 an BSN degree 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. Nine scholarships totaling $10,500 were awarded in fiscal 2018. The Friends is a department of South Shore Hospital; funds and oversight of Friends scholarships comes from the Hospital. X 1 1 1 1 0 0 0 0 0 1 0 Gene E Green MD President/CEO 825831 0 166275 0 1932 0 25493 0 19524 0 1039055 0 119925 0 Stephen Coco Treasurer 364101 0 50819 0 15031 0 8100 0 18892 0 456943 0 42645 0 Joseph R Driscoll Esq General Counsel/Clerk 313383 0 29944 0 1747 0 46710 0 19464 0 411248 0 40866 0 Kimberly Dever MD Director, Chief OB/GYN 560417 0 80560 0 25803 14292 42185 0 24656 0 733621 14292 43177 0 Edward Nalband MD Director 0 366883 0 950 0 4895 0 8100 0 17728 0 398556 0 0 Luke O'Connell MD Chair Provider Council 216849 0 5542 0 7810 0 2847 0 18376 0 251424 0 0 0 Peg Holda Clerk through 11/10/17 313625 0 80769 0 39405 0 436650 0 16280 0 886729 0 35225 0 Pamela Whelton SSH COO, Treasurer through 8/22/17 566786 0 146975 0 6751 0 8533 0 4564 0 733609 0 84395 0 Timothy Lynch MD SSH CMO 554780 0 8077 0 5544 0 41760 0 24876 0 635037 0 45500 0 Timothy Quigley SSH CNO 363358 0 73429 0 35473 0 46699 0 19524 0 538483 0 43222 0 Rose DiPietro President Home & Comm Care through 6/30/18 377313 0 90392 0 12882 0 55797 0 9052 0 545436 0 54692 0 Frederick Millham MD Chief of Surgery 706366 0 34527 0 3612 0 36251 0 1624 0 782380 0 37194 0 Matthew Weiss MD Physician 513791 0 177348 0 37152 0 34421 0 19380 0 782092 0 49183 0 Jason Tracy MD Physician 534612 0 47733 0 34928 0 36972 0 19304 0 673549 0 35641 0 Shay Hershkovitz MD Physician 487731 0 23606 0 624 0 8100 0 13688 0 533749 0 0 0 John Stevenson MD Physician/CMO through 5/16/17 716892 68087 119498 0 11219 7722 8100 0 17328 4564 873037 80373 74816 0 Richard Aubut SSHS CEO through 11/2/15 0 0 0 0 295973 0 0 0 0 0 295973 0 33221 0 Joseph Cahill Executive Vice President through 7/15/16 0 0 0 0 636231 0 0 0 24580 0 660811 0 87236 0 E Delroy Dixon SVP, Chief Information Officer through 7/15/16 0 0 0 0 216544 0 0 0 9340 0 225884 0 218879 0 Robert Wheeler SVP Human Resources through 3/10/16 0 0 0 0 317629 0 0 0 7436 0 325065 0 319488 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments are reported as income because the Hospital grosses up imputed income from split dollar policies and premiums for long-term disability coverage. Richard Aubut received a gross-up payment of $13,042 in tax year 2017 related to imputed income. Schedule J, Part I, Line 3 For FY18 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. Schedule J, Part I, Line 4 Schedule J, Part I, Line 4 - For the year that ended December 31, 2017 the following individuals received salary continuation payments; E. Delroy Dixon, former CIO received $216,544, Robert Wheeler, former SVP, Human Resources received $317,629, Joseph Cahill, former President/COO received $529,871 and Peg Holda, Clerk, $35,609. South Shore Hospital has established split dollar arrangements for the individuals listed below. The premiums paid into these policies by South Shore are deemed to be loaned to these individuals and these individuals are therefore subject to income tax on the imputed interest associated with the loans. Richard Aubut is provided with an annual gross up to cover the income taxes due with respect to the imputed interest amounts. Amounts related to these arrangements are reported in Schedule J, Part II. Richard Aubut, Joseph Cahill, Margaret Holda, Timothy Quigley, John Stevenson, Pamela Whelton, Kimberly Dever, Stephen Coco, Joseph Driscoll, Matthew Weiss, Jason Tracy and E. Delroy Dixon are participants. Schedule J, Part I, Line 7 The CEO and other key employees have the ability to earn bonuses based upon certain metrics that the Board of Directors approve. In addition, certain physician may earn incentive payments based upon quality and other metrics. A Massachusetts Development Finance Agency 043431814 000000000 2012-09-14 78330000 See Part VI for complete description 0 0 0 B Massachusetts Development Finance Agency 043431814 57584XNN7 2016-05-10 155229109 See Part VI for complete description 0 0 0 A 18038333 0 78330000 0 0 0 739129 0 0 0 77590871 0 1 0 1 1 B 0 0 156259456 1977997 0 0 0 0 0 116138053 35226666 4894737 1 0 0 1 A 0 0 1 1 0 0.022 0 0.022 0 0 1 B 0 0 1 1 0 0 0 0 0 0 1 A 0 0 1 0 1 1 Deutsche Bank 20.0 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 Schedule K, Part I, Column f-09/14/2012 78,330,000 Massachusetts Development Finance Agency Series 2012 refunded bonds issued 02/28/08. Schedule K, Part I, Column f-05/10/2016 155,229,109 Massachusetts Development Finance Agency Series H was used to construct a new critical care unit and will renovate the existing critical care unit; Series I was used to construct a new critical care unit, and will renovate the existing critical care unit and be used for other miscellaneous capital projects. The financing also upgraded the Hospital's electronic health record system and will be used 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 4-05/10/2016 155,229,109 Massachusetts Development Finance Agency Amounts reported here consist entirely of bona fide debt service fund deposits. Gene E Green President/CEO Bridge Loan X 225000 175000 0 1 1 Richard Aubut CEO/President through 11/2/15 Split dollar life insurance policy X 6681533 6681533 0 1 1 Joseph Cahill President through 7/15/16 Split dollar life insurance policy X 3156583 3156583 0 1 1 Stephen Coco SVP, CFO & Treasurer Split dollar life insurance policy X 155512 155512 0 1 1 Peg Holda Clerk/VP Marketing Split dollar life insurance policy X 35350 35350 0 1 1 Joseph Driscoll Clerk/General Counsel Split dollar life insurance policy X 188257 188257 0 1 1 Timothy Quigley VP Nursing/CNO Split dollar life insurance policy X 203220 203220 0 1 1 Kimberly Dever Chief of OB/GYN, Director Split dollar life insurance policy X 312180 312180 0 1 1 John Stevenson Physician, Former VP/CMO Split dollar life insurance policy X 711294 711294 0 1 1 Pamela Whelton EVP/COO Split dollar life insurance policy X 304327 304327 0 1 1 Matthew Weiss Physician/Former Director Split dollar life insurance policy X 190588 190588 0 1 1 12113844 Substantial Contributor Vendor 218744 Independent Contractor 0 Substantial Contributor Vendor 2606866 Independent Contractor 0 Substantial Contributor Vendor 697940 Independent Contractor 0 Substantial Contributor Vendor 454545 Independent Contractor 0 Substantial Contributor Vendor 154336 Independent Contractor 0 Substantial Contributor Vendor 4841314 Independent Contractor 0 Substantial Contributor Vendor 771953 Independent Contractor 0 Substantial Contributor Vendor 1369807 Independent Contractor 0 Substantial Contributor Vendor 202488 Independent Contractor 0 Substantial Contributor Vendor 416154 Independent Contractor 0 Substantial Contributor Vendor 541240 Independent Contractor 0 Substantial Contributor Vendor 156000 Independent Contractor 0 Substantial Contributor Vendor 10811243 Independent Contractor 0 Substantial Contributor Vendor 380444 Independent Contractor 0 Substantial Contributor Vendor 1379827 Independent Contractor 0 Substantial Contributor Vendor 628336 Independent Contractor 0 X 5635 Donor Valuation X 18 1393558 See Part II X 5 1890 Donor Valuation X Floral Arrangements 1 400 Donor Valuation X Event Supplies 1 50 Donor Valuation/Receipts 12 0 1 0 Schedule M, Part I, Line 9 Eighteen donations of publicly traded securities were received in FY18. Valuations for stock transactions are sales price less commission. Schedule M, Part I, Line 19 Five donations of food were made for various fundraising events. Donor valuation was used. Schedule M, Part I, Lines 25-28 One donation of floral centerpieces for use during a fundraising event was received. Donor valuation was used for this item. One donation of venue decor for an event was received. Valuation was based on receipts. Form 990, Part III, Line 4a The Hospital's emergency center is open 24 hours a day, every day of the year, and had 97,630 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 173,854 home visits to patients in FY18. Form 990, Part VI, Section A, Line 2 Kenneth Kirkland and Thomas McCarthy have a business relationship. In addition, many of the persons listed in Part VII have a "business" relationship" with one another by virtue of sitting on boards of entities related to South Shore Hospital. Form 990, Part VI, Section A, Line 4 The corporation amended its bylaws to change its board composition, numbers and qualifications to that of its sole member. 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 Treasurer. Form 990 is presented for review to the governing body as a whole at the next regularly scheduled meeting prior to the filing deadline. 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, as well as all other members of the executive team. The consultant presents relevant data to the Committee for review and approval 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 Pension-related adjustments; $14,492,877, Transfer to affiliates; -$21,999,000. 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 N/A 0 South Shore Property Inc 55 Fogg Road South Weymouth MA 02190 050398822 Develops and manages real property for South Shore Hospital and its affiliates MA 501(c)(3) 12a South Shore Health System Inc 0 Coastal Medical Associates Inc dba South Shore Physician Ambulatory Enterprise 55 Fogg Road South Weymouth MA 02190 043170333 Provides specialized medical care MA 501(c)(3) 3 South Shore Health System Inc 0 MetroSouth Obstetrics & Gynecology Inc 55 Fogg Road South Weymouth MA 02190 330998957 Specialized medical care MA 501(c)(3) 3 South Shore Hospital Inc 1 Atlantic Women's Health Inc 55 Fogg Road South Weymouth MA 02190 200156651 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 0 Friends of South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 042582248 Raises monies in support of South Shore Hospital and builds goodwill in the community MA 501(c)(3) 12a South Shore Hospital Inc 1 South Shore Medical Center Inc 143 Longwater Drive Norwell MA 02061 042297845 Primary and specialized medical care MA 501(c)(3) 10 Coastal Medical Associates Inc 0 Connected Care of Southeastern Massachusetts 55 Fogg Road South Weymouth MA 02190 823503666 Operate an accountable care organization MA 501(c)(3) 10 South Shore Health System Inc 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 1 1