2022-08-15T22:13:35-05:00 2021-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2020-10-01 042297845 SOUTH SHORE MEDICAL CENTER INC SOUT 7818785200 143 LONGWATER DRIVE NORWELL MA 02061 KRISTINE HANSCOM SVP & CFO 7816248000 2022-08-15 1 KRISTINE HANSCOM 999009999 CHRISTINE A KAWECKI P00743140 5169187000 2022-08-15 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z KRISTINE HANSCOM 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 83049032 0 X WWW.SOUTHSHOREHEALTH.ORG/LOCATIONS 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. 14 10 788 10 0 0 7511397 5939950 66821507 74531177 523574 1067430 1158887 1505182 76015365 83043739 50 0 0 0 61673067 65365768 0 0 0 20421837 21628531 82094954 86994299 -6079589 -3950560 67114601 68415013 53847116 56098088 13267485 12316925 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. 0 0 75087901 76000277 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. 75087901 1 1 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 1 788 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X KRISTINE HANSCOM 7816248166 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0.50 44.00 X X 0 802082 10232 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0.50 43.00 X 0 775556 36603 MICHAEL AYERS MD CHAIR PROVIDER COUNCIL THROUGH 12/31/21 0.50 44.00 X 0 281429 30502 JUSTIN CAMPBELL DIRECTOR 0.50 4.00 X 0 80000 0 KENNETH KIRKLAND CHAIR THROUGH 12/31/21 0.50 4.00 X X 0 0 0 PAMELA O'LEARY VICE CHAIR THROUGH 12/31/21 0.50 4.00 X X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 0.50 4.00 X 0 0 0 HELEN GARVEY DIRECTOR 0.50 4.00 X 0 0 0 LINDA THOMPSON DIRECTOR 0.50 4.00 X 0 0 0 LISA WALSH DIRECTOR 0.50 4.00 X 0 0 0 PAUL WANTANABE DIRECTOR 0.50 4.00 X 0 0 0 PAULA L BECKER DIRECTOR 0.50 4.00 X 0 0 0 ROBERT PINEAU DIRECTOR 0.50 4.00 X 0 0 0 THOMAS MCCARTHY DIRECTOR 0.50 4.00 X 0 0 0 STEPHEN COCO TREASURER & CFO THROUGH 11/12/21 0.50 44.00 X 0 702117 376023 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 0.50 44.00 X 0 479379 31485 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 40.00 1.00 X 495676 0 31485 MICHAEL KAPLAN VP OF FINANCE THROUGH 3/31/22 40.00 0.00 X 284913 0 8218 SERGIO FEFER MD PHYSICIAN 40.00 0.00 X 642923 0 31485 STEVEN STARR MD PHYSICIAN 40.00 0.00 X 575318 0 25811 YOUNG KIM MD PHYSICIAN 40.00 0.00 X 530384 0 24614 MATTHEW HJORT MD PHYSICIAN 40.00 0.00 X 508107 0 31485 JEFFREY BENNETT MD PHYSICIAN 40.00 0.00 X 499312 0 31485 PAMELA WHELTON TREASURER THROUGH 8/22/17 0.00 0.00 X 0 1222264 375293 RICHARD AUBUT CEO THROUGH 11/2/15 0.00 0.00 X 0 301848 0 GENE GREEN MD PRESIDENT/CEO THROUGH 8/12/19 0.00 0.00 X 0 113631 2906 3536633 4758306 1047627 104 1 1 0 FOXROCK LONGWATER II REALTY LLC C/O BRUNO 57 OBERY ST STE 4 PLYMOUTH MA 02360 MANAGEMENT COMPANY 2698029 SOUTH SUBURBAN GASTROENTEROLOGY PC 1085 MAIN STREET SOUTH WEYMOUTH MA 02190 PHYSICIAN SERVICES 849952 HANCOCK FLAG REALTY LLC C/O FOXROCK PROPERTIES PO BOX 69 QUINCY MA 02169 MANAGEMENT COMPANY 725688 BEALE'S LLC PO BOX 143 ACCORD MA 02018 CLEANING SERVICES 311981 BOSTON UNIVERSITY DERMATOLOGY 603 ALBANY STREET ROOM J-100 BOSTON MA 02118 PHYSICIAN SERVICES 246961 10 5939950 5939950 NET PATIENT SVCS. REV. 621110 70970236 70970236 PREMIUM REVENUE 621110 3560941 3560941 74531177 1067430 1067430 41375 5293 36082 36082 36082 SOUTH SHORE UROLOGY 900099 571560 571560 MEDICAL RECORDS INCOME 900099 82551 82551 LAB SERVICES 900099 56692 56692 758297 758297 1469100 83043739 76000277 0 1103512 727101 469210 257891 53476123 47672208 5803915 1849157 1564990 284167 6244005 5778491 465514 3069382 2641788 427594 8500 8500 20000 20000 2223170 1299998 923172 23920 23920 7275793 6957114 318679 308356 308356 7307962 5659579 1648383 103 22 81 706471 705618 853 1034824 679409 355415 1356411 1139967 216444 DUES 360456 1700 358756 EQUIP. MAINT. CONTRACT 350026 227193 122833 REPAIRS 182954 182954 MISCELLANEOUS EXPENSE 135602 102290 33312 333983 188324 145659 86994299 75087901 11906398 0 271267 7944792 2921073 3507690 627424 605961 1001432 2285035 14032838 7715112 6863445 6317726 5466077 6725099 36341677 34471848 13622206 6556862 67114601 68415013 7552439 9545495 1983574 970417 44311103 45582176 53847116 56098088 X 13267485 12316925 13267485 12316925 67114601 68415013 X -3950560 3000000 X 0 1 X 1 0 X 7511397 5939950 13451347 69070738 67782663 74831005 67914644 76000277 355599327 69070738 67782663 74831005 75426041 81940227 369050674 0 0 0 369050674 225636 250170 242985 593905 1108805 2421501 10 10 225636 250170 242995 593905 1108805 2421511 69296374 68032833 75074000 76019946 83049032 371472185 0.99350 0.99530 0.00650 0.00470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 77200 2252 74948 5504451 2376197 3128254 7678899 5336663 2342236 772288 772288 6317726 A/R - OTHER 6464022 SECURITY DEPOSITS 92840 6556862 DUE TO AFFILIATES 1756194 DUE TO THIRD PARTY 135967 PHYSICIAN BENEFITS PAYABLE 6725099 ROU LEASE LIABILITY 36964916 45582176 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 1 0 0 0 0 0 1 0 PAMELA WHELTON TREASURER THROUGH 8/22/17 0 0 0 650000 0 572264 0 354945 0 20348 0 1597557 0 576301 STEPHEN COCO TREASURER & CFO THROUGH 11/12/21 0 457749 0 221354 0 23014 0 358550 0 17473 0 1078140 0 0 ROSE DIPIETRO PRESIDENT/CEO THROUGH 12/31/20 0 705728 0 91450 0 4904 0 8550 0 1682 0 812314 0 0 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0 609002 0 137410 0 29144 0 8550 0 28053 0 812159 0 0 SERGIO FEFER MD PHYSICIAN 594068 0 46923 0 1932 0 8550 0 22935 0 674408 0 0 0 STEVEN STARR MD PHYSICIAN 544774 0 25000 0 5544 0 8550 0 17261 0 601129 0 0 0 YOUNG KIM MD PHYSICIAN 501772 0 25000 0 3612 0 8550 0 16064 0 554998 0 0 0 MATTHEW HJORT MD PHYSICIAN 305625 0 201240 0 1242 0 8550 0 22935 0 539592 0 0 0 JEFFREY BENNETT MD PHYSICIAN 470700 0 25000 0 3612 0 8550 0 22935 0 530797 0 0 0 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 438394 0 55372 0 1910 0 8550 0 22935 0 527161 0 0 0 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 0 397890 0 77277 0 4212 0 8550 0 22935 0 510864 0 0 MICHAEL AYERS MD CHAIR PROVIDER COUNCIL THROUGH 12/31 0 234210 0 45000 0 2219 0 8541 0 21961 0 311931 0 0 RICHARD AUBUT CEO THROUGH 11/2/15 0 301848 0 0 0 0 0 0 0 0 0 301848 0 0 MICHAEL KAPLAN VP OF FINANCE THROUGH 3/31/22 239528 0 41990 0 3395 0 7229 0 989 0 293131 0 0 0 GENE GREEN MD PRESIDENT/CEO THROUGH 8/12/19 0 113631 0 0 0 0 0 0 0 2906 0 116537 0 114358 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, LINES 4A-B IN 2020, PAM WHELTON RECEIVED $571,215, AND GENE GREEN RECEIVED $113,631 IN SALARY CONTINUATION PAY FROM SOUTH SHORE HOSPITAL, A RELATED ORGANIZATION. SOUTH SHORE HOSPITAL HAS ESTABLISHED SPLIT DOLLAR ARRANGEMENTS FOR THE INDIVIDUALS LISTED BELOW. THE PREMIUMS PAID INTO THESE POLICIES BY SOUTH SHORE HOSPITAL ARE DEEMED TO BE LOANED TO THESE INDIVIDUALS AND THEREFORE SUBJECT TO INCOME TAX ON THE IMPUTED INTEREST ASSOCIATED WITH THE LOANS. JOSEPH DRISCOLL, STEPHEN COCO, KIMBERLY DEVER, AND PAM WHELTON PARTICIPATED IN THE PLAN. PART I, LINE 7 THE NON-FIXED PAYMENTS PROVIDED CONSIST OF BONUSES AND 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. FORM 990, PART XI, LINE 9: AFFILIATE TRANSFER 3,000,000. 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 HEALHCARE SERV MA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1