2016-07-22T09:51:09-07:00 2015-09-30 990 2014-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 Fogg Road South Weymouth MA 02190 Pamela Whelton EVP/CFO & Treasurer 7816248626 2016-08-15 2014 2016-09-27 15:27:22Z Pamela Whelton 55 Fogg Road South Weymouth MA 02190 567412275 0 X www.southshorehospital.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. 11 8 4551 608 591030 0 4545055 6220513 482819308 524603998 1630072 27644939 8090227 7184659 497084662 565654109 13000 8000 0 0 313401965 321685460 0 0 2490421 165589221 193043099 479004186 514736559 18080476 50917550 501846203 520501227 280597613 294151338 221248590 226349889 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 369740996 8000 525358872 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 378 acute care beds (composed of 265 medical/surgical, 32 intensive care/coronary care, 53 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 officers 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 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, 2015, the Hospital had 27,255 discharges and 200,048 outpatient days. The Hospital's emergency center is open 24 hours a day, every day of the year, and had 94,667 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 185,812 home visits to patients in fiscal 2015. 0 0 0 369740996 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 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 1 399 0 1 4551 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 8 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X Pamela Whelton EVP CFO Treasurer 7816248626 55 Fogg Road South Weymouth MA 02190 John Walsh MD Director, President Medical Staff 40 2 X 380389 0 27593 Brian Hotarek Immediate Past Chair 1 1 X 0 0 0 Sherry Penney Director 1 0 X 0 0 0 Kenneth Kirkland Chairman of the Board 1 1 X X 0 0 0 Lisa Walsh Director 1 0 X 0 0 0 John Maguire Director 1 0 X 0 0 0 Chris Oddleifson Vice Chairman 1 0 X X 0 0 0 David C Howse Director 1 0 X 0 0 0 Thomas McCarthy Director 1 0 X 0 0 0 Richard Aubut CEO 40 9 X X 1243158 0 102152 Matthew Weiss MD SSPAE Director 1 42 X 28333 482834 90299 Joseph Cahill SSH President & COO 40 8 X 691204 0 92099 Margaret Holda Clerk 40 4 X 325039 0 70755 Michael Cullen SVP, CFO & Treasurer thru 1/8/15 40 10 X 565821 0 35968 Pamela Whelton EVP, CFO & Treasurer 40 11 X 440291 0 95131 Rose Dipietro VP Clinical, Home Care, and Support Services 40 1 X 369975 0 82436 Timothy Quigley VP Nursing Services and CNO 45 0 X 419421 0 73208 John Stevenson MD Vice President 45 0 X 551101 0 108293 Richard Mirel MD Chair, Dpt Medicine 45 0 X 559237 0 29350 Kimberly Dever MD Chief, OB and GYN 45 0 X 559969 8249 78911 Jason Tracy MD Chief Emergency Medicine 45 2 X 574561 0 72757 Frederick Millham MD Chief of Surgery beg 2/18/14 40 0 X 538890 0 50027 E Delroy Dixon SVP, Chief Information Officer 40 0 X 374706 0 81316 Frederick Ayers MD Chief, Surgery thru 2/18/14 45 0 X 126613 0 3127 7748708 491083 1093422 576 1 1 0 Brigham Women's Hospital PO Box 3684 Boston MA 022413684 Physician Services 2190434 Aramark Corporation 12483 Collections Center Drive Chicago IL 60693 Facilities Maintenance 1361877 South Shore Anesthesia Associates Inc 163 Libbey Pkwy Weymouth MA 02189 Physician Services 1216412 Core Medical Group 2 Keewaydin Drive Salem NH 03079 Temporary Help 1145765 Foley & Lardner LLP 111 Huntington Aveenue 26th Floor Boston MA 02199 Legal 1142000 74 0 0 578635 0 98446 5543432 2658049 6220513 Net Patient Service Revenue 622000 509910813 509910813 0 0 Ambulatory Cancer Center 621000 13004127 13004127 0 0 Meaningful Use 622000 840468 840468 0 0 Rental Income - Affiliates 531390 231250 231250 0 0 Clinical Trial Revenue 621999 180767 180767 0 0 436573 436573 0 0 524603998 2996328 0 0 2996328 0 0 0 0 0 0 0 0 1261790 0 1183484 0 78306 0 78306 0 0 78306 24399245 436762 0 187396 24399245 249366 24648611 0 0 24648611 387286 578635 387286 0 0 0 0 Food Service Sales 722212 3779826 0 0 3779826 Shields Imaging Income 621000 1452090 0 0 1452090 Miscellaneous Income 900099 686704 686704 0 0 1187733 68170 591030 528533 7106353 565654109 525358872 591030 33483694 8000 8000 2187302 1402870 784432 3414727 3414727 248078847 170696224 75585234 1797389 15370455 10427437 4943018 34577047 23480194 11096853 18057082 12250066 5807016 478441 478441 1017596 1017596 305790 305790 44648 44648 21948295 10941265 10748698 258332 768224 755773 12451 69630601 66548360 3032227 50014 5969821 5969821 8463274 5924292 2538982 1086872 821578 251338 13956 383537 58382 321717 3438 6702056 4691439 2010617 20670702 14469491 6201211 2534031 1566990 967041 Physician Services 29369092 29369092 0 0 Equipment Maintenance Contracts 5886578 2930419 2956159 0 Leases 5481095 5403113 77982 0 Gross Pool Assessment 3642080 3642080 0 0 8660366 5109704 3195821 354841 514736559 369740996 142505142 2490421 34501082 66085321 3146664 2842753 67465500 64458302 5365489 6095503 3380179 3335202 419229086 256571150 169691277 162657936 184741895 184856614 7048445 7871600 26505672 22297996 501846203 520501227 58539550 62004632 1217378 1530773 117619708 111978029 103220977 118637904 280597613 294151338 X 210550318 215737691 9357614 9254040 1340658 1358158 221248590 226349889 501846203 520501227 X 50917550 -28004680 0 0 0 -17811571 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 3260 0 1 44648 47908 0 Schedule C, Part II-B, Line 1 Item g: Amount represents the portion of salary and related business expenses for the employee who engages in lobbying activities on behalf of South Shore Hospital. Item i: Amount represents a percentage of the Hospital's annual apportionment of MHA/AHA dues attributable to lobbying expenses. For the year ended September 30, 2015, it was determined that 20.83% 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. 10698272 3096501 -51363 0 2753182 378030 10612198 12105141 3593941 209640 0 4841905 368545 10698272 16660514 -549950 213862 0 3837515 381770 12105141 14377293 9263114 291483 0 6836541 434835 16660514 15699262 4387199 9081 0 5718249 0 14377293 0 0.13 0.87 1 0 0 5009617 5009617 0 205907949 106252676 99655273 0 15231922 4899071 10332851 0 172764388 137956682 34807706 0 20315210 7462721 12852489 162657936 0 Due to Third Party Payors 38416645 Accrued Pension 36775087 Capital Leases 13557807 Loss on Swaps 11958769 Malpractice Payable 6677093 Accrued Workers Comp 6172963 Executive & Physician Benefits Payable 2328932 Other Long Term Liabilities 795890 Due to Affiliates 743886 Community Health Initiatives 550000 Post Retirement Benefits 391113 FIN 47 Liability 264941 Security Deposits 4778 118637904 X 562007697 0 0 0 2153519 2153519 559854178 0 5799931 5799931 565654109 516277575 0 0 0 1541016 1541016 514736559 0 0 0 514736559 Schedule D, Part V, Line 4 The Hospital maintains its endowment funds to further its charitable purposes and those of its affiliates. In the past, endowment funds have been used to expand and maintain 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 Hospital 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; $2,153,519. Schedule D, Part XI, Line 4b Contributions net of grants reported in Other Revenue; $6,122,067, loss on interest rate swaps, -$1,592,285, Investment income; $2,811,165, cost of goods sold-shops; -$357,532, rental expense; $-1,183,484. Schedule D, Part XII, Line 2d Cost of goods sold-shops; $357,532, rental expense; $1,183,484. Moonlight & Miracles 274186 107928 166258 0 0 39675 79743 14238 32602 Walk for Hospice 183692 139257 44435 0 151 2430 2394 0 39460 7 508043 331450 176593 0 0 56193 48496 14559 57345 965921 578635 387286 0 151 98298 130633 28797 129407 387286 0 1 1 1 X 1 X 1 1 1 0 1 1 2147551 0 2147551 0.0042 56498359 46509463 9988896 0.0194 3093026 0 3093026 0.006 0 0 61738936 46509463 15229473 0.0296 946984 6080 940904 0.0018 714468 0 714468 0.0014 86505853 74782921 11772932 0.0229 259890 180766 79124 0.0002 0 0 88427195 74969767 13507428 0.0263 0 0 150166131 121479230 28736901 0.0559 877035 0 877035 0.0017 128790 0 128790 0.0003 64640 0 64640 0.0001 448946 13850 435096 0.0008 524497 0 524497 0.001 0 0 2043908 13850 2030058 0.0039 1 12246072 0 149729300 157527509 -7798209 X 1 1 1 1 South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 southshorehospital.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 12 1 0 1 1 X http://www.southshorehospital.org/ X 1 15 1 http://www.southshorehospital.org/workfiles/About/FY2016_Community_Benefits_Plan.pdf 0 0 1 X 200 400 X X X X X 1 1 X X X X 1 X http://www.southshorehospital.org/workfiles/Patients_and_Visitors/Credit_and_Collection_Policy.pdf 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 relies on input from individuals and organizations within the community to develop its Needs Assessment. The Hospital is an active supporter of, and participant in, three Community Health Network Area (CHNAs)--Blue Hills Community Health Alliance (CHNA 20), the Greater Brockton Community Health Network Area (CHNA 22) and the South Shore Community Partners in Prevention (CHNA 23). The CHNAs collected information by meeting with groups and individuals and also conducting surveys. The Hospital utilized data gathered by the CHNAs in its Needs Assessment. Our Patient and Family Advisory Council brings together patients and their families, South Shore Hospital administrators and healthcare professionals to develop new services and programs and improve the overall patient experience. The group meets monthly and issues an annual report of their findings and accomplishments. The Hospital also relies on the expertise of various physicians, nurses and other clinical and non-clinical professionals within our facility. Hospital colleague advisers, in groups and as individuals, have been instrumental in the development of the Needs Assessment. Finally, the Hospital gets input from community advisors. Local school, government, law enforcement and safety officials, social service and health and welfare agencies make up this group. While many of these agencies participate in the CHNAs, Hospital personnel also meet with representatives of various groups/agencies individually to seek their input in formulating the Needs Assessment. Schedule H, Part V, Section B, Line 6b-South Shore Hospital Inc South Shore Hospital collaborates with three of the 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 11-South Shore Hospital Inc Fifteen community health and social issues were identified during the assessment process. While the Hospital offers programs that focus on adolescent mental health, specifically youth suicide prevention, it does not directly address mental health issues affecting adults and the community at large due to the scope of the problem and limited resources. Violence/safety was another area identified that the Hospital cannot fully address as it is beyond our scope as a health care provider. Lack of sleep is an identified area of need that the Hospital can address in a limited way via its sleep clinic. Oral health in the community will not be addressed due to the a lack of expertise and supporting clinical programs at the Hospital. The Hospital has identified dementia as a community health issue. Although the Hospital has various wellness in vulnerable population programs focusing on seniors, it does not plan to offer specific programs related to dementia at this time. Schedule H, Part V, Section B, Line 13h-South Shore Hospital Inc Other factors used to determine amounts charged to patients is eligibility in Medicare/Medicaid programs or through the Commonwealth's Health Connector. Schedule H, Part V, Section B, Line 16i-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. Pre-surgery Evaluation 797 Main Street 1st Floor South Weymouth MA 02190 Pre-surgical testing and evaluation clinic. Outpatient Services 780 Main Street South Weymouth MA 02190 Outpatient surgery center. Center for Physical Wellness 51 Performance Drive 3rd Floor Weymouth MA 02189 Exercise, rehabilitation and physical conditioning programs are offered at this facility. 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 is 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. 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. 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 uncollectible 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 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 burdens of the government and therefore providing 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-pays 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 400% of the 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 201-400% 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. SSH 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 September 2013. South Shore Hospital utilizes information from many sources to determine the needs of individuals in the communities it serves. The Hospital reviews and analyzes health trends in our patient population. The Hospital also reviews data from the Town of Weymouth, Massachusetts Community Health Information Profile, American Hospital Association, Massachusetts Hospital Association, Massachusetts Health Data Consortium, Federal Centers for Disease Control, Trust for America's Health, Kaiser Family Foundation, Truven Health Analytics and Health Communities Institute. South Shore Hospital is involved with three Community Health Networks (CHNAs), serving 34 communities south of Boston, to address public health priorities. CHNAs were formed in 1992 by the Massachusetts Department of Public Health to encourage public, non-profit and private sectors to work together to build healthier communities. South Shore Hospital is working with these CHNAs to conduct community health assessments. Data collected helps determine unmet needs in the region. Our Community Health Needs Assessment can be found at: http://www.southshorehospital.org/community-health-assessments. 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 its entirety, on its website and copies are also available upon request. This document 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 700,000. 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 and Arabic. Schedule H, Part VI, Line 5 South Shore Hospital is committed to providing community building activities that promote the health and wellbeing 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 Community Benefits Report and current Community Benefits Plan available through mailings and on its website. For more information about South Shore Hospital's active role in meeting the needs of our community please visit http://www.southshorehospital.org/communitybenefits. 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, Health Provider Services Organization of the South Shore and Coastal Medical Associates coordinate the provision of health care services to the residents of Southeastern Massachusetts. Schedule H, Part VI, Line 7 South Shore Hospital files its Community Benefits Report in Massachusetts. 1 Friends Scholarships for students pursuing heath care degrees. 8 8000 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 the Hospital. Schedule I, Part III The Friends of South Shore Hospital, an auxiliary Hospital organization, offers several scholarships to students pursuing health care degrees. 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 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. Eight $1,000 scholarships were awarded in fiscal 2015. The Friends is a department of South Shore Hospital; funds and oversight of Friends scholarships comes from the Hospital. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 Richard Aubut CEO 802364 0 58587 0 382208 0 84445 0 17706 0 1345310 0 58587 0 Michael Cullen SVP, CFO & Treasurer thru 1/8/15 454935 0 5376 0 105510 0 18262 0 17706 0 601789 0 5376 0 Joseph Cahill SSH President & COO 511451 0 47053 0 132700 0 68727 0 23372 0 783303 0 47053 0 Pamela Whelton EVP, CFO & Treasurer 396947 0 39024 0 4321 0 76369 0 18762 0 535423 0 39024 0 Margaret Holda Clerk 276147 0 30852 0 18041 0 53048 0 17706 0 395794 0 30852 0 Rose Dipietro VP Clinical, Home Care, and Support Services 324660 0 42187 0 3127 0 73584 0 8853 0 452411 0 42187 0 Timothy Quigley VP Nursing Services and CNO 326014 0 75694 0 17713 0 54914 0 18293 0 492628 0 0 0 John Stevenson MD Vice President 483947 0 63990 0 3163 0 84922 0 23372 0 659394 0 0 0 John Walsh MD Director, President Medical Staff 304589 0 75000 0 800 0 10608 0 16985 0 407982 0 0 0 Richard Mirel MD Chair, Dpt Medicine 496789 0 32731 0 29717 0 26223 0 3127 0 588587 0 0 0 Matthew Weiss MD SSPAE Director 0 432918 0 49080 28333 837 0 66927 0 23372 28333 573134 0 0 Kimberly Dever MD Chief, OB and GYN 558454 0 0 0 1515 8249 55538 0 23371 0 638878 8249 0 0 Jason Tracy MD Chief Emergency Medicine 510839 0 43005 0 20718 0 54463 0 18293 0 647318 0 43005 0 Frederick Ayers MD Chief, Surgery thru 2/18/14 81146 0 13649 0 31817 0 0 0 3128 0 129740 0 13649 0 Frederick Millham MD Chief of Surgery beg 2/18/14 504302 0 31532 0 3056 0 48967 0 1060 0 588917 0 0 0 E Delroy Dixon SVP, Chief Information Officer 308873 0 44303 0 21530 0 57945 0 23371 0 456022 0 44303 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 ($130,983), Joseph Cahill ($40,688) and Michael Cullen ($31,725) received gross-up payments in tax year 2014. Schedule J, Part I, Line 3 The Hospital's parent company, South Shore Health System, formerly known as South Shore Health & Educational Corporation, 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 CEO 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 7 The Chief of Surgery received a one-time signing bonus. Emergency department physicians are eligible to receive two types of incentives. Quarterly incentives are based on the number of patients treated above budgeted quotas. Pay for performance incentives are awarded annually to physicians who exceed certain quality metrics. A Massachusetts Development Finance Agency 043431814 2011-12-16 20000000 See Part VI for complete description 0 0 0 B Massachusetts Development Finance Agency 043431814 2012-09-14 78330000 See Part VI for complete description 0 0 0 A 1607143 0 20023794 0 0 0 49000 0 0 19974794 0 0 2012 0 0 1 1 B 10030833 0 78330000 0 0 0 739129 0 0 0 77590871 0 1 0 1 1 A 0 0 1 1 0 0 0 0 0 0 0 B 0 0 1 1 0 0.022 0 0.022 0 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 1 Deutsche Bank 20.0 0 0 0 0 0 A 0 B 0 Schedule K, Part I, Column f-12/16/2011 20,000,000 Massachusetts Development Finance Agency The Series 2011 bond issue financed construction of a two-story addition to the Emerson wing of the Hospital. The expansion created 60 new private inpatient rooms and related clinical space. Series 2011 also financed all equipment purchases for the addition. 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 II, Line 3-12/16/2011 20,000,000 Massachusetts Development Finance Agency Differences between the issue price (Part I) and total proceeds (Part II, line 3) are due to interest income. Richard Aubut CEO Split dollar insurance policy X 6325367 6325367 0 1 1 Joseph Cahill President Split dollar insurance policy X 2466947 2466947 0 1 1 Michael Cullen SVP, CFO until 1/15 Split dollar insurance policy X 1552108 1552108 0 1 1 Frederick Ayers MD Former Chief of Surgery Split dollar insurance policy X 842240 842240 0 1 1 Paul Taylor Former Clerk and VP Split dollar life insurance policy X 1324853 1324853 0 1 1 Margaret Holda Clerk and VP Split dollar insurance policy X 216519 216519 0 1 1 Timothy Quigley VP Nursing Split dollar insurance policy X 330670 330670 0 1 1 John Stevenson MD VP Split dollar insurance policy X 558782 558782 0 1 1 Pamela Whelton SVP and CFO Split dollar insurance policy X 269668 269668 0 1 1 Kimberly Dever MD Chief of OB/GYN Split dollar insurance policy X 156090 156090 0 1 1 Jason Tracy Chief of Emergency Medicine Split dollar insurance policy X 155788 155788 0 1 1 Matthew Weiss SSPAE Director Split dollar insurance policy X 47647 47647 0 1 1 14246679 Schedule B Line 1 Vendor 282969 Independent Contractor 0 Schedule B Line 2 Vendor 2422480 Independent Contractor 0 Schedule B Line 53 Vendor 294172 Independent Contractor 0 Schedule B Line 87 Vendor 33148272 Independent Contractor 0 Schedule B Line 132 Vendor 829330 Independent Contractor 0 Schedule B Line 181 Vendor 705626 Independent Contractor 0 Schedule B Line 183 Vendor 360434 Independent Contractor 0 Schedule B Line 197 Vendor 514086 Independent Contractor 0 Schedule B Line 200 Vendor 209360 Independent Contractor 0 X 7652 donor valuation X 6 111383 See Part II X 1 2500000 appraisal X 4 4904 donor valuation X 1 34110 See Part II 0 0 1 1 Schedule M, Part I, Line 9 Six donations of publicly traded securities were received. Valuations for stock transactions are sales price less commission. Schedule M, Part I, Line 17 One parcel of undeveloped land was donated. Valuation was based on an appraisal provided by a independent, professional real estate appraiser. Schedule M, Part I, Line 19 Four food donations were made for various fundraising events. Donor valuation was used. Schedule M, Part I, Line 20 Thirty webcams were installed in each of the isolettes in NICU and special care units. The vendor made a donation by giving the Hospital a 41% reduction in the total price for the entire system. Schedule M, Part I, Line 32b The Hospital liquidates contributions of publicly traded securities through a third party brokerage firm. Whenever possible, the brokerage firm sells stock on the next business day after receipt. The Hospital has engaged the services of a Realtor to sell the donated land. Form 990, Part VI, Section A, Line 2 Kenneth Kirkland and Thomas McCarthy have a business relationship. John Walsh and Lisa Walsh have a family 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 6 South Shore Health System, formerly known as South Shore Health and Educational Corporation, the parent, is the sole member of the corporation. 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, Deloitte Tax LLP. The return is then reviewed by the CFO and CEO. The complete Form 990 is presented for review to the governing body as a whole at the next regularly scheduled meeting prior to the filing deadline. The Board Chair and Vice Chair will review and comment to executive leadership regarding Form 990 prior to the filing deadline. Form 990, Part VI, Section B, Line 12c Employees and 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), formerly South Shore Health & Educational Corporation, an affiliate, has a Compensation Committee that determines South Shore Hospital executive compensation. SSHS utilized an outside consultant to determine executive compensation for Richard Aubut (CEO), Michael Cullen (SSH CFO thru 01/08/15) and Joseph Cahill (SSH President/COO). The consultant presents relevant data to the board for review and approval for these individuals. All data presented, as well as compensation deliberations and votes, is documented in the board 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 Health System 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; -$17,811,571. Form 990, Part XII, Line 2b The Hospital's financial statements are presented on both a consolidated and separate basis. The audit of South Shore Health System and its subsidiaries is conducted by the independent accountant Deloitte & Touche LLP. The governing body of South Shore Health System, formerly South Shore Health & Educational Corporation, acting as an audit committee of the whole, assumes responsibility for oversight of the audit of its (parent and affiliate) financial statements and selection of an independent auditor. In fiscal 2015, the audit of South Shore Hospital, Inc. was issued separately and consolidated by Deloitte & Touche LLP into the annual audit of South Shore Health and Educational Corporation and Subsidiaries. The financial statements are prepared in accordance with GAAP. South Shore Health System Inc formerly South Shore Health & Educational Corporation 55 Fogg Road South Weymouth MA 02190 042105926 Supports the charitable mission of South Shore Hospital and its affiliates MA 501(c)(3) 11c, Type III 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) 11a, Type I South Shore Health System Inc 0 Coastal Medical Associates Inc dba South Shore Physician Ambulatory Enterprise 55 Fogg Road South Weymouth MA 02190 043170333 Primary and 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 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 1 Health Provider Services Organization of the South Shore Inc 55 Fogg Road South Weymouth MA 02190 452385865 Supports the charitable mission of SSH&E and affiliates MA 501(c)(3) 11c, Type III South Shore Health System 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) 11a, Type I South Shore Hospital 1 South Shore Medical Center Inc 143 Longwater Drive Norwell MA 02061 042297845 Primary and specialized medical care MA 501(c)(3) 9 Coastal Medical Associates 0 South Shore Physician-Hospital Organization Inc 55 Fogg Road South Weymouth MA 02190 043248480 Negotiates contracts on behalf of SSH member physicians MA N/A C 1680662 3177008 0.5 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 0 0