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 452385865 SOUTH SHORE HEALTH EXPRESS INC SOUT 7816248000 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 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 16688127 0 X N/A X 2011 MA SOUTH SHORE HEALTH EXPRESS PROVIDES COMPREHENSIVE, URGENT MEDICAL CARE TO THE RESIDENTS OF SOUTHEASTERN MASSACHUSETTS THROUGH MEDICAL FACILITIES IN SEVEN COMMUNITIES. ALSO, SOUTH SHORE HEALTH EXPRESS SUPPORTS AND FURTHERS THE MISSION OF THE SOUTH SHORE HEALTH SYSTEM, INCLUDING THAT OF ITS AFFILIATES, WHICH IS TO PROMOTE THE GENERAL HEALTH AND WELL-BEING OF THE RESIDENTS OF SOUTHEASTERN MASSACHUSETTS. 18 14 182 14 0 0 396182 0 12996327 16399984 1333 0 425211 288143 13819053 16688127 0 0 0 0 6073041 7274590 0 0 0 8299021 9344078 14372062 16618668 -553009 69459 31558831 29491209 33995329 31858248 -2436498 -2367039 THE ORGANIZATION SUPPORTS AND FURTHERS THE MISSION OF THE SOUTH SHORE HEALTH SYSTEM, INC. HEALTH CARE SYSTEM, INCLUDING THAT OF ITS AFFILIATE CORPORATION, SOUTH SHORE HOSPITAL, INC. 0 0 7985397 16688127 SOUTH SHORE HEALTH EXPRESS PROVIDED URGENT CARE MEDICAL SERVICES TO THE RESIDENTS OF SOUTHEASTERN MASSACHUSETTS THROUGH RETAIL LOCATIONS IN SEVEN COMMUNITIES. ALSO, SOUTH SHORE HEALTH EXPRESS SUPPORTED AND FURTHERED THE MISSION OF THE SOUTH SHORE HEALTH SYSTEM, INCLUDING THAT OF AFFILIATE, SOUTH SHORE HOSPITAL, INC. 7985397 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 20 0 1 182 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 1 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 COUN. 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 BEG 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 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 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 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 JAMES MENSCHING MD PHYSICIAN 40.00 0.00 X 280498 0 87573 MARK DURFEE MD PHYSICIAN 40.00 0.00 X 249842 0 84864 BARRY FISHER MD PHYSICIAN 40.00 0.00 X 256772 0 24596 ANTOINETTE ENG MD PHYSICIAN 40.00 0.00 X 258493 0 21407 KATHERINE COMIS VP OF OPERATIONS 40.00 0.00 X 227715 0 19500 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0.50 44.00 X 0 326869 3806 1273320 3941743 525826 14 1 1 0 QUEST DIAGNOSTICS LLC PO BOX 844226 BOSTON MA 022844226 LAB SERVICES 158810 TRT KINGSTON II LLC PO BOX 809144 CHICAGO IL 606809144 MANAGEMENT COMPANY 146173 LATE NIGHT LLC ONE VAN DE GRAFF DRIVE SUITE 402 BURLINGTON MA 01803 MANAGEMENT COMPANY 116657 REAL RADIOLOGY LLC 17310 WRIGHT STREET SUITE 103 OMAHA NE 68130 RADIOLOGY SERVICES 112472 4 NET PATIENT SVCS. REV 621110 16399984 16399984 16399984 OCCUPATIONAL HLTH. SVC 621999 283276 283276 MEDICAL RECORDS INCOME 621999 3626 3626 PURCHASE DISCOUNTS 999999 733 733 508 508 288143 16688127 16688127 0 0 6017676 5323981 693695 112631 99092 13539 718026 518905 199121 426257 377471 48786 8400 8400 1127956 284469 843487 19577 19577 187233 69639 117594 110431 110431 720853 623898 96955 179 179 27395 27395 945901 945901 2935303 539884 2395419 83119 66200 16919 MEDICAL SUPPLIES 3088815 3088815 REPAIRS 27995 27995 WASTE DISPOSAL 17301 17301 HAZARDOUS WASTE DISP. 13490 13490 30130 12978 17152 16618668 7985397 8633271 0 5473779 3370280 2313276 1534581 381934 332926 223998 136002 2767965 1713141 1649001 1054824 20833 34627 21478448 17771944 17562 5256025 31558831 29491209 2684707 1157348 31310622 30700900 33995329 31858248 X -2436498 -2367039 -2436498 -2367039 31558831 29491209 69459 0 X 0 1 X 1 0 X X 2 SOUTH SHORE HEALTH SYSTEM INC 042105926 3 1 0 0 SOUTH SHORE HOSPITAL INC 042769210 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART IV, SECTION D, LINE 3: SOUTH SHORE HEALTH EXPRESS SUPPORTED BOTH SOUTH SHORE HOSPITAL, INC. AND SOUTH SHORE HEALTH SYSTEM, INC. IN JANUARY 2018, THE BOARD COMPOSITION FOR THE HEALTH SYSTEM AND ALL RELATED ORGANIZATIONS WERE ALIGNED. THIS GAVE THE SUPPORTED ORGANIZATIONS SIGNIFICANT SAY IN THE STRATEGIC DIRECTION OF THE CORPORATION. INCOME TO HEALTH EXPRESS DIRECTLY SUPPORTED SOUTH SHORE HOSPITAL IN THE DEVELOPMENT AND IMPLEMENTATION OF HEALTH EXPRESS'S INITIATIVES. SCHEDULE A, PART IV, SECTION E, LINE 2A: SOUTH SHORE HEALTH EXPRESS (HXP) OPERATED TO EXCLUSIVELY SUPPORT AND FURTHER THE MISSION OF SOUTH SHORE HEALTH SYSTEM, INC. (SSHS) AND SOUTH SHORE HOSPITAL, INC. (SSH). SSHS IS THE PARENT OF SEVERAL CORPORATIONS, INCLUDING SSH AND HXP. HXP DID NOT PROVIDE MONETARY SUPPORT TO SSHS, BUT INDIRECTLY SUPPORTED SSHS THROUGH ITS SUPPORT OF SOUTH SHORE HOSPITAL. 100% OF HXP'S ACTIVITIES DIRECTLY FURTHERED THE EXEMPT PURPOSES OF SOUTH SHORE HOSPITAL BY PROVIDING URGENT MEDICAL CARE SERVICES FOR ALL INDIVIDUALS IN THE HOSPITAL'S SERVICE AREA. SCHEDULE A, PART IV, SECTION E, LINE 2B: WERE IT NOT FOR HXP, SOUTH SHORE HOSPITAL, A SUPPORTED ORGANIZATION, WOULD ENGAGE IN THE ACTIVITIES HXP UNDERTAKES-PROVIDE URGENT MEDICAL CARE FOR THOSE INDIVIDUALS LIVING IN SOUTHEASTERN MASSACHUSETTS. 175354 20458 154896 2020370 1237943 782427 572241 454740 117501 1054824 SECURITY DEPOSITS 17562 DUE FROM AFFILIATES 3103973 ROU ASSETS 2134490 5256025 LOANS PAYABLE 28482112 ROU LEASE LIABILITY 2184161 EXECUTIVE BENEFITS 34627 30700900 X PART X, LINE 2: THE CORPORATION FOLLOWS THE PROVISION 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. 0 0 0 0 0 0 0 0 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 JOSEPH R DRISCOLL ESQ SECRETARY 0 397252 0 45287 0 17734 0 8700 0 23878 0 492851 0 0 JAMES MENSCHING MD PHYSICIAN 256313 0 24185 0 0 0 26000 0 61573 0 368071 0 0 0 MARK DURFEE MD PHYSICIAN 212582 0 37260 0 0 0 23291 0 61573 0 334706 0 0 0 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0 126869 0 200000 0 0 0 3806 0 0 0 330675 0 0 BARRY FISHER MD PHYSICIAN 244552 0 12220 0 0 0 0 0 24596 0 281368 0 0 0 ANTOINETTE ENG MD PHYSICIAN 249053 0 9440 0 0 0 19500 0 1907 0 279900 0 0 0 KATHERINE COMIS VP OF OPERATIONS 184000 0 20196 0 23519 0 19500 0 0 0 247215 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 COUN. 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. FORM 990, PART VI, SECTION A, LINE 2 KENNETH KIRKLAND AND THOMAS MCCARTHY HAVE A BUSINESS RELATIONSHIP. IN ADDITION, OTHER 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 ORGANIZATION. 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 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 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 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 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 HEALTH EXPRESS 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 SOUTH SHORE MEDICAL CENTER INC 143 LONGWATER DRIVE NORWELL MA 02061 042297845 PROVIDES PRIMARY AND SPECIALIZED MEDICAL CARE MA 501(C)(3) 10 COASTAL MEDICAL ASSOCIATES 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 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 SERV MA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0