2023-08-15T20:52:45-05:00 2022-09-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2021-10-01 042297845 SOUTH SHORE MEDICAL CENTER INC SOUT 7818785200 143 LONGWATER DRIVE NORWELL MA 02061 ALLEN SMITH PRESIDENT & CEO 7816248000 2023-08-15 1 ALLEN SMITH XXX-XX-XXXX SHAWNA M JANSONS P01222873 3174648600 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ALLEN SMITH MD 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 81808668 0 X WWW.SOUTHSHOREHEALTH.ORG X 2004 MA SOUTH SHORE MEDICAL CENTER CARES FOR PATIENTS COMPASSIONATELY AND EFFECTIVELY, WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS. WE BUILD A BETTER FUTURE FOR THE COMMUNITIES WE SERVE THROUGH TEACHING, LEADERSHIP IN HEALTH CARE INNOVATION AND PHILANTHROPY. 18 14 809 14 0 0 5939950 0 74531177 80625406 1067430 0 1505182 1172835 83043739 81798241 0 0 0 0 65365768 67515262 0 0 0 21628531 21018759 86994299 88534021 -3950560 -6735780 68415013 57053453 56098088 51472308 12316925 5581145 X SOUTH SHORE MEDICAL CENTER DELIVERS EFFECTIVE AND COMPASSIONATE PATIENT CARE WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS. WE BUILD A BETTER FUTURE FOR THE COMMUNITIES WE SERVE THROUGH TEACHING AND LEADERSHIP IN HEALTHCARE INNOVATION. YOUR HEALTH, OUR PASSION, ONE COMMUNITY. 0 0 76314725 81787293 SOUTH SHORE MEDICAL CENTER PROVIDED MEDICAL, PREVENTATIVE AND OTHER CLINICAL SERVICES TO ITS PATIENTS. THE ORGANIZATION WORKS TO IMPROVE THE QUALITY OF HEALTH CARE SERVICES PROVIDED TO PATIENTS IN SOUTHEASTERN MASSACHUSETTS THROUGH CLINICAL INTEGRATION AND THE IMPLEMENTATION OF A UNIFIED ELECTRONIC MEDICAL RECORDS SYSTEM. SOUTH SHORE MEDICAL CENTER PARTICIPATED IN EDUCATIONAL AND TRAINING PROGRAMS FOR MEDICAL STUDENTS AND MEDICAL RESIDENTS AND FOR OTHER HEALTHCARE PROFESSIONALS INCLUDING PHYSICIAN ASSISTANTS AND NURSES. 76314725 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 36 0 1 809 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 14 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X ALLEN SMITH MD 7816248000 55 FOGG RD SOUTH WEYMOUTH MA 01290 ALLEN SMITH MD PRESIDENT/CEO BEGINNING 1/1/21 0.50 44.00 X X 0 1051339 182578 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0.50 43.00 X 0 806027 37909 JUSTIN CAMPBELL DIRECTOR 0.50 4.00 X 0 185099 0 MICHAEL AYERS MD CHAIR PROVIDER COU. THRU 12/31/21 0.50 44.00 X 0 147976 5949 KENNETH KIRKLAND CHAIR THROUGH 12/31/21 0.50 4.00 X X 0 0 0 PAMELA O'LEARY VC THRU 12/31/21 CHAIR AS OF 1/1/22 0.50 4.00 X X 0 0 0 THOMAS MCCARTHY DIRECTOR, VICE CHAIR AS OF 1/1/22 0.50 4.00 X X 0 0 0 ALAN MCKIM DIRECTOR AS OF 1/1/21 0.50 4.00 X 0 0 0 BRADLEY SAMPSON DIRECTOR AS OF 1/1/22 0.50 4.00 X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 0.50 4.00 X 0 0 0 ELLEN ESSENFELD DIRECTOR AS OF 1/1/21 0.50 4.00 X 0 0 0 HELEN GARVEY DIRECTOR 0.50 4.00 X 0 0 0 LINDA THOMPSON MPH DRPH RN FAAN DIRECTOR 0.50 4.00 X 0 0 0 LISA WALSH DIRECTOR 0.50 4.00 X 0 0 0 MICHAEL SHEEHAN DIRECTOR AS OF 1/1/21 0.50 4.00 X 0 0 0 PAUL WANTANABE PHD DIRECTOR 0.50 4.00 X 0 0 0 PAULA L BECKER DIRECTOR 0.50 4.00 X 0 0 0 ROBERT PINEAU DIRECTOR THROUGH 12/31/21 0.50 4.00 X 0 0 0 STEPHEN COCO TREASURER & CFO THROUGH 11/12/21 0.50 44.00 X 0 918235 25066 JOSEPH R DRISCOLL ESQ SECRETARY 0.50 44.00 X 0 460273 32578 MARY SHAUGHNESSY TREAS. & CFO 11/13/21 THRU 6/13/22 0.50 44.00 X 0 45925 0 KRISTINE HANSCOM CPA MST CGMA TREASURER & CFO AS OF 6/14/22 0.50 44.00 X 0 0 0 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 40.00 1.00 X 490913 0 32578 MICHAEL KAPLAN VP OF FINANCE THROUGH 3/31/22 40.00 0.00 X 279470 0 8638 SERGIO FEFER MD PHYSICIAN 40.00 0.00 X 741286 0 32578 YOUNG KIM MD PHYSICIAN 40.00 0.00 X 649909 0 25429 STEVEN STARR MD PHYSICIAN 40.00 0.00 X 607387 0 26621 KEITH TRACY MD PHYSICIAN 40.00 0.00 X 570210 0 32578 MATTHEW HJORT MD PHYSICIAN 40.00 0.00 X 491944 0 32578 PAMELA WHELTON TREASURER THRU 8/22/17 0.00 0.00 X 0 388647 302 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0.50 44.00 X 0 326869 3806 3831119 4330390 479188 111 1 1 0 SOUTH SUBURBAN GASTROENTEROLOGY PC 1085 MAIN STREET SOUTH WEYMOUTH MA 02190 PHYSICIAN SERVICES 1570119 FOXROCK LONGWATER II REALTY LLC C/O BRUNO 57 OBERY ST STE 4 PLYMOUTH MA 02360 MANAGEMENT COMPANY 684049 BOSTON UNIVERSITY DERMATOLOGY 609 ALBANY STREET ROOM J-100 BOSTON MA 02118 PHYSICIAN SERVICES 536711 BEALE'S LLC PO BOX 143 ACCORD MA 02018 CLEANING SERVICES 411448 HANCOCK FLAG REALTY LLC C/O FOXROCK PROPERTIES PO BOX 69 QUINCY MA 02169 MANAGEMENT COMPANY 161031 9 NET PATIENT SVCS. REV. 621110 77829556 77829556 PREMIUM REVENUE 621110 2795850 2795850 80625406 21375 10427 10948 10948 10948 MACRA MEDICARE PAYMENT 900099 370802 370802 CCS PROVIDER ENGAGEMEN 900099 277054 277054 SMC UROLOGY 900099 235813 235813 278218 278218 1161887 81798241 81787293 0 10948 829803 520936 308867 54874865 49509829 5365036 2081399 1869394 212005 6477274 5820646 656628 3251921 2920691 331230 20000 20000 2003855 937066 1066789 29401 29401 1302744 498649 804095 325331 325331 6759845 5062673 1697172 93 93 676863 676619 244 1229334 717039 512295 1486824 1229934 256890 DRUGS & MED. SUPPLIES 6077054 6077054 DUES 301303 301303 EQUIP. MAINT. CONTRACT 194875 189216 5659 REPAIRS 181745 181745 429492 284979 144513 88534021 76314725 12219296 0 7944792 3209933 3507690 4098821 605961 412190 2285035 1344420 14260260 8944446 6317726 5315814 6725099 5656155 34471848 0 6556862 37016120 68415013 57053453 9545495 8613656 970417 4011 45582176 42854641 56098088 51472308 X 12316925 5581145 12316925 5581145 68415013 57053453 -6735780 0 X 0 1 X 1 0 X 7511397 5939950 0 13451347 67782663 74831005 67914644 76000277 81787293 368315882 67782663 74831005 75426041 81940227 81787293 381767229 0 0 0 381767229 250170 242985 593905 1108805 21375 2217240 10 10 250170 242995 593905 1108805 21375 2217250 68032833 75074000 76019946 83049032 81808668 383984479 0.99420 0.99350 0.00580 0.00650 X 271208 16583 254625 5504450 2770619 2733831 8484602 6157244 2327358 5315814 A/R - OTHER 4205426 SECURITY DEPOSITS 92840 DUE FROM THIRD PARTIES 1862985 ROU ASSETS 30854869 37016120 DUE TO AFFILIATES 3528909 DUE TO THIRD PARTY 442929 PHYSICIAN BENEFITS PAYABLE 5656155 ROU LEASE LIABILITY 33226648 42854641 X 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. 1 0 0 0 0 0 0 1 0 ALLEN SMITH MD PRESIDENT/CEO BEGINNING 1/1/21 0 847107 0 198688 0 5544 0 158700 0 23878 0 1233917 0 0 STEPHEN COCO TREASURER & CFO THROUGH 11/12/21 0 520192 0 375000 0 23043 0 8700 0 16366 0 943301 0 0 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0 619719 0 112914 0 73394 0 8700 0 29209 0 843936 0 0 SERGIO FEFER MD PHYSICIAN 684354 0 55000 0 1932 0 8700 0 23878 0 773864 0 0 0 YOUNG KIM MD PHYSICIAN 621297 0 25000 0 3612 0 8700 0 16729 0 675338 0 0 0 STEVEN STARR MD PHYSICIAN 576843 0 25000 0 5544 0 8700 0 17921 0 634008 0 0 0 KEITH TRACY MD PHYSICIAN 543278 0 25000 0 1932 0 8700 0 23878 0 602788 0 0 0 MATTHEW HJORT MD PHYSICIAN 272692 0 218010 0 1242 0 8700 0 23878 0 524522 0 0 0 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 436950 0 52031 0 1932 0 8700 0 23878 0 523491 0 0 0 JOSEPH R DRISCOLL ESQ SECRETARY 0 397252 0 45287 0 17734 0 8700 0 23878 0 492851 0 0 PAMELA WHELTON TREASURER THRU 8/22/17 0 34000 0 0 0 354647 0 302 0 0 0 388949 0 354647 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0 126869 0 200000 0 0 0 3806 0 0 0 330675 0 0 MICHAEL KAPLAN VP OF FINANCE THROUGH 3/31/22 239901 0 26916 0 12653 0 7512 0 1126 0 288108 0 0 0 JUSTIN CAMPBELL DIRECTOR 0 185099 0 0 0 0 0 0 0 0 0 185099 0 0 MICHAEL AYERS MD CHAIR PROVIDER COU. THRU 12/31/21 0 114196 0 15000 0 18780 0 3249 0 2700 0 153925 0 0 PART I, LINE 3 THE PRESIDENT OF AMBULATORY CARE RECEIVES COMPENSATION FOR SERVICES PERFORMED FOR A RELATED ORGANIZATION. THE COMPENSATION COMMITTEE OF SOUTH SHORE HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE PRESIDENT'S COMPENSATION. THE COMPENSATION COMMITTEE MEETS PERIODICALLY AND ENGAGES AN INDEPENDENT EXTERNAL COMPENSATION CONSULTING FIRM TO ESTABLISH THE COMPENSATION OF KEY SYSTEM EMPLOYEES. THE CONSULTING FIRM DEVELOPS AND PRESENTS ALL MATERIALS INCLUDING MARKET TRENDS, COMPENSATION STUDIES AND SURVEYS, AND ADHERES TO BEST PRACTICE GUIDELINES. THE FINAL RECOMMENDATION FOR COMPENSATION CHANGES IS PRESENTED AND APPROVED BY THE ENTIRE INDEPENDENT COMMUNITY OF THE BOARD OF DIRECTORS. PART I, LINE 4A PAMELA WHELTON RECEIVED A SEVERANCE PAYMENT DURING THE YEAR FOR $354,647 PART I, LINE 7 THE NON-FIXED PAYMENTS PROVIDED CONSIST OF STIPENDS. 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 DUE TO THE OVERLAPPING BOARD STRUCTURE OF SOUTH SHORE HEALTH SYSTEM AND ITS RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 COASTAL MEDICAL ASSOCIATES, INC. D/B/A SOUTH SHORE PHYSICIAN AMBULATORY ENTERPRISE IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A OFFICERS AND DIRECTORS ARE ELECTED ANNUALLY BY A BOARD VOTE OF THE SOLE MEMBER. 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/TREASURER. 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 THEN 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 15B THE PRESIDENT OF AMBULATORY CARE, IS CONSIDERED A SOUTH SHORE HEALTH SYSTEM EXECUTIVE; ALL EXECUTIVE COMPENSATION DECISIONS ARE MADE BY THE SSHS PRESIDENT/CEO, USING THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTOR'S APPROVED PHILOSOPHY AND PAY APPROACH FOR THE EXECUTIVE TEAM. THE COMPENSATION COMMITTEE IS INDEPENDENT AND CONSISTS SOLELY OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH REGARDS TO COMPENSATION MATTERS. ANNUAL COMPENSATION DECISIONS FOR COASTAL (SSPAE) PHYSICIANS AND ADVANCED PRACTICE CLINICIAN EMPLOYEES ARE ALSO MADE BY SSHS AND ARE BASED ON A COMBINATION OF ADVICE AND RESEARCH PROVIDED BY OUTSIDE CONSULTANTS, REVIEW OF COMPARABLE INDUSTRY DATA AND MARKET CONDITIONS. FORM 990, PART VI, SECTION C, LINE 19 SOUTH SHORE MEDICAL CENTER 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. SOUTH SHORE HOSPITAL INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 042769210 HOSPITAL MA 501(C)(3) 3 SOUTH SHORE HEALTH SYSTEM INC 0 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 PROPERTY INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 050398822 DEVELOPS AND MANAGES REAL PROPERTY FOR SOUTH SHORE HOSPITAL MA 501(C)(3) 12A, I SOUTH SHORE HEALTH SYSTEM INC 0 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 0 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 0 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 0 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 CONNECTED CARE OF SOUTHEASTERN MASSACHUSETTS INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 823503666 OPERATES AN ACCOUNTABLE CARE ORGANIZATION MA 501(C)(3) 10 SOUTH SHORE HEALTH SYSTEM INC 0 SOUTH SHORE HEALTH INTEGRATED DELIVERY NETWORK INC 55 FOGG RD SOUTH WEYMOUTH MA 02190 852785921 TO DEVELOP & MAINTAIN A NETWORK OF PROVIDERS FOR DELIVERY OF HEALTHCARE SER MA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0