2021-08-11T07:00:22-05:00 2020-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2019-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 STEPHEN COCO SVP, CFO & TREASURER 7816248000 2021-08-02 1 CHRISTINE A KAWECKI P00743140 5169187000 2019 2022-09-23 18:48:47Z STEPHEN COCO 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 749878033 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. 13 9 5759 411 1985963 0 14068607 43648022 639684083 629815965 1817985 65714329 8867649 8594517 664438324 747772833 232530 127876 0 0 441413812 465903344 0 0 2943573 207873846 225305723 649520188 691336943 14918136 56435890 684466670 833708503 343125939 464105991 341340731 369602512 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 523657129 127876 629885033 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, PEDIATRICS, 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, 2020, THE HOSPITAL HAD 28,664 DISCHARGES AND APPROXIMATELY 233,404 OUTPATIENT DAYS. THE HOSPITAL'S EMERGENCY CENTER IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR, AND HAD 86,399 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 162,508 HOME VISITS TO PATIENTS IN FY20. 523657129 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 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 1 370 0 1 5759 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 13 9 1 0 0 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 COCO 7816248422 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 ROSE DIPIETRO PRESIDENT/CEO 40.00 4.50 X X 291283 0 8720 KENNETH KIRKLAND CHAIR 1.00 3.50 X X 0 0 0 BRIAN CONCANNON VICE CHAIR THROUGH 12/31/19 1.00 3.50 X X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 1.00 3.50 X 0 0 0 JUSTIN CAMPBELL MD SSH MEDICAL STAFF PRESIDENT 1.00 3.50 X 75000 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 40.00 3.50 X 698615 0 35180 LINDA THOMPSON DIRECTOR 1.00 3.50 X 0 0 0 LISA WALSH DIRECTOR 1.00 3.50 X 0 0 0 PAMELA O'LEARY DIRECTOR 1.00 3.50 X 0 0 0 PAUL WATANABE DIRECTOR 1.00 3.50 X 0 0 0 PAULA L BECKER DIRECTOR 1.00 3.50 X 0 0 0 ROBERT PINEAU DIRECTOR 1.00 3.50 X 0 0 0 THOMAS MCCARTHY DIRECTOR 1.00 3.50 X 0 0 0 MICHAEL AYERS MD CHAIR, PROVIDER COUNCIL 40.00 4.50 X 272191 0 28620 STEPHEN COCO TREASURER 40.00 4.50 X 470649 0 29612 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 40.00 4.50 X 423525 0 30352 WAYNE STOCKBRIDGE VP OF HR THROUGH 10/4/19 40.00 0.00 X 579672 0 384679 TIMOTHY LYNCH MD CHIEF MEDICAL OFFICER 40.00 1.00 X 665992 0 36140 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 40.00 1.00 X 620533 0 30352 TIMOTHY QUIGLEY CNO 40.00 0.00 X 433693 0 30574 FREDERICK MILLHAM MD CHAIR, SURGERY 40.00 0.00 X 889322 0 19992 MARK HERSHEY MD CHAIR, CRITICAL CARE 40.00 0.00 X 667363 0 26924 JASON TRACY MD CHAIR, EMERGENCY SERVICES 40.00 0.00 X 612558 0 26000 KENNETH MCLAUGHLIN MD PHYSICIAN 40.00 0.00 X 565787 0 12640 JONATHAN D PIERCE PHYSICIAN 40.00 0.00 X 515705 0 30088 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 1.00 40.00 X 35417 345168 35180 PAMELA WHELTON COO THROUGH 8/3/19 0.00 0.00 X 651281 0 953305 GENE GREEN MD PRESIDENT/CEO THROUGH 8/12/19 0.00 0.00 X 1196267 0 144710 RICHARD AUBUT CEO THROUGH 11/2/15 0.00 0.00 X 300672 0 0 JOHN M STEVENSON MD FORMER CMO 0.00 40.00 X 0 268120 28848 PEG HOLDA CLERK THROUGH 11/10/17 0.00 0.00 X 132641 0 3170 JOSEPH CAHILL EXECUTIVE VP THOUGH 7/15/16 0.00 0.00 X 107558 0 0 10205724 613288 1895086 949 1 1 0 KPMG LLP PO BOX 120522 DALLAS TX 753120522 CONSULTING SERVICESS 5423419 BRIGHAM & WOMEN'S PHYSICIAN ORGANIZATION PO BOX 3684 BOSTON MA 022413684 PHYSICIAN SERVICES 4554232 RTT OPERATING COMPANIES HOLDCO LLC PAR 4 TECHNOLOGY GROUP LLC 100 MAR PORTSMOUTH NH 03801 PROFESSIONAL SERVICES 2616466 AW PERRY 20 WINTHROP SQUARE SUITE 500 BOSTON MA 02110 MANAGEMENT COMPANY 2570533 ALLEGIANCE MEDICAL PARTNERS LLC 85 STILES RD SUITE 203 SALEM NH 03079 PHYSICIAN SERVICES 1530915 949 1074492 38015218 4558312 1075062 43648022 NET PATIENT SVCS. REV. 622000 606177116 606177116 AMBULATORY CANCER CNTR 621000 19737913 19737913 MEDICARE BUNDLED SVCS. 622000 2000003 2000003 CLINICIAN SERVICES 622000 434026 242348 191678 RENTAL INC. FROM AFFL. 531390 262880 262880 1204027 1204027 629815965 5673591 5673591 1303654 1340453 -36799 -36799 -36799 60074899 311068 0 345229 60074899 -34161 60040738 60040738 419518 1074492 419518 0 FOOD SERVICE SALES 722212 3781887 0 0 3781887 SHIELDS IMAGING INCOME 621000 741483 0 0 741483 LABORATORY SERVICES 900099 492048 0 492048 0 3615898 260746 1302237 2052915 8631316 747772833 629885033 1985963 72253815 109376 109376 18500 18500 3488981 3057077 431904 3203331 3203331 377687907 306905800 68915634 1866473 4975109 4031487 943622 49141146 39596992 9268194 275960 27406870 22208646 5198224 864446 864446 203218 203218 430804 430804 76253 76253 29169468 9447450 19609915 112103 2613932 2613932 82163149 70574392 11519682 69075 14217024 14200592 16432 12310308 7804723 4435063 70522 805802 698542 97931 9329 878386 520986 352981 4419 8776284 6143399 2632885 29649929 20752229 8893813 3887 4079031 2851323 1227708 INVENTORY ADJUSTMENT 11077942 10884490 193452 0 EQUIP. MAIN. CONTRACTS 8837071 4204418 4632653 0 GROSS POOL ASSESSMENT 7359308 7359308 0 0 FOOD 3826889 3735806 91083 0 7966479 2752185 4698921 515373 691336943 523657129 164736241 2943573 22425392 112756049 17670192 0 6151685 4601969 54012455 47381505 11610740 11861218 0 0 7621605 15233180 7497291 7197082 560069824 292171515 266444317 267898309 250220139 283723086 5001009 5191749 35811845 77864356 684466670 833708503 81292733 96202476 4044523 96348925 197475498 188502267 60313185 83052323 343125939 464105991 X 310157650 340452236 31183081 29150276 341340731 369602512 684466670 833708503 X 56435890 -30494336 2320227 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 2000 0 1 74253 76253 0 PART II-B, LINE 1: LINE 1G: SALARY PAID TO SOUTH SHORE HEALTH SYSTEM EMPLOYEE AND REGISTERED LOBBYIST TO 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, 2020, IT WAS DETERMINED THAT 11.08% OF DUES WERE 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. 31183081 3126282 164025 0 4956693 366418 29150277 20955475 13842437 156623 0 3202899 568555 31183081 18435105 5059331 141509 0 2101725 578745 20955475 12798116 7826451 242623 0 2010991 421094 18435105 10612198 4890558 189932 0 2386792 507780 12798116 0.00000 0.06000 0.94000 1 0 5483563 5483563 267444481 149322844 118121637 14457062 7249327 7207735 251609477 124987486 126621991 21075241 10611858 10463383 267898309 PENSION ASSET 21092286 SECURITY DEPOSITS 334481 RIGHT OF USE ASSETS 23907737 OTHER ACCOUNTS RECEIVABLE 32529852 77864356 ACCRUED WORKERS COMP & SEPARATION 4134565 CAPITAL LEASES 32612090 DUE TO THIRD PARTY 16059959 DUE TO AFFILIATES 2078769 EXECUTIVE BENEFITS PAYABLE 5795995 FIN 47 LIABILITY 264941 MALPRACTICE PAYABLE 11219554 RETIREMENT 358217 SECURITY DEPOSITS 4778 OTHER LIABILITIES 10523455 83052323 X 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. 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. MOONLIGHT & MIRACLES 672592 371845 300747 0 0 76251 84419 49250 90827 GOLF CLASSIC 254980 228760 26220 0 0 420 11000 0 14800 4 566438 473887 92551 0 0 3200 28682 0 60669 1494010 1074492 419518 79871 124101 49250 166296 419518 0 1 1 1 X 1 X 1 1 1 0 1 1 3020048 20470 2999578 0.00430 57955879 38391613 19564266 0.02830 5564996 5564996 0.00800 66540923 38412083 28128840 0.04060 626678 626678 0.00090 619694 619694 0.00090 71177124 80718445 0 0.00000 238996 48809 190187 0.00030 72662492 80767254 1436559 0.00210 139203415 119179337 29565399 0.04270 626889 626889 0.00090 138174 138174 0.00020 16257 16257 0.00000 325341 5648 319693 0.00050 282802 282802 0.00040 1389463 5648 1383815 0.00200 1 18366395 0 171447088 209920503 -38473415 X 1 1 1 1 SOUTH SHORE HOSPITAL INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 SOUTHSHOREHEALTH.ORG 2107 X X X X SEE PART V SEC. D - ALL HOSP. FACILITIES ARE INCLUDED IN SSH'S LICENSE SOUTH SHORE HOSPITAL INC 1 0 0 1 X X X X X X X X 18 1 0 1 1 X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS X 1 19 1 HTTPS://WWW.SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X X 1 X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X HTTPS://WWW.SOUTHSHOREHEALTH.ORG/PATIENT-RESOURCES/BILLING-INSURANCE X X X X X X X 1 X 0 X X X X X 1 X 0 0 SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 5: THE HOSPITAL DEVELOPED ITS CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT BY HOLDING A WORKGROUP WITH REPRESENTATIVES FROM THE 33 COMMUNITIES IT SERVES. THE TWENTY 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: ASPIRE, BAY STATE COMMUNITY SERVICES, CHNA 20 (BLUE HILLS COMMUNITY HEALTH ALLIANCE), COHASSET SOCIAL SERVICE LEAGUE, FAMILY UNITED METHODIST CHURCH, HANOVER POLICE, INTERFAITH SOCIAL SERVICES, MANET COMMUNITY HEALTH CENTER, QUINCY ASIAN RESOURCES, QUINCY COMMUNITY ACTION PROGRAM, CITY OF QUINCY, SOUTH COVE COMMUNITY HEALTH CENTER, SOUTH SHORE COMMUNITY ACTION COUNCIL, SOUTH SHORE ELDER SERVICES, SOUTH SHORE YMCA, 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. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 6B: 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). SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 11: SOUTH SHORE HOSPITAL IDENTIFIED SIXTEEN HEALTH AND SOCIAL ISSUES THROUGH ITS ONGOING DATA COLLECTION AND THE CHNA WORKGROUP FILINGS. THESE ISSUES WERE FRAMED INTO FOUR PRIORITY STRATEGIC DOMAINS; BEHAVIORAL HEALTH & SUBSTANCE USE DISORDER, SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE, CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORS, AND HEALTH SYSTEM STRENGTHENING. TO ADDRESS THE ISSUES FRAMED IN THESE FOUR DOMAINS, SSH PLANS TO DEVELOP OUTREACH, EDUCATION, AND SUPPORT PROGRAMS FOR THOSE AT-RISK, INCREASE ACCESS TO BEHAVIORAL HEALTH AND SUBSTANCE ABUSE PROGRAMS, WORK TO DECREASE DEPRESSION AND SOCIAL ISOLATION THROUGH SUPPORT PROGRAMS, ENHANCE CAREGIVER SUPPORT, ENHANCE ACCESS TO THOSE WHO FACE BARRIERS TO HEALTH CARE, ENHANCE ACCESS TO TRANSPORTATION SERVICES, ADDRESS FOOD INSECURITY BY SUPPORTING LOCAL FOOD BANKS AND "POP-UP" FOOD PANTRIES, SUPPORT WORKFORCE DEVELOPMENT AND CREATION OF EMPLOYMENT OPPORTUNITIES, INCREASE AVAILABILITY OF TRANSITIONAL HOUSING, INCREASE PROGRAMS RELATED TO PHYSICAL ACTIVITY AND HEALTHY EATING, IMPROVE CHRONIC CARE MANAGEMENT THROUGH INCREASED SERVICES, AND PROMOTE COMMUNITY COLLABORATION AND COORDINATION. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 13H: OTHER FACTORS USED TO DETERMINE AMOUNTS CHARGED TO PATIENTS ARE ELIGIBILITY IN MEDICARE/MEDICAID PROGRAMS OR THROUGH THE COMMONWEALTH'S HEALTH CONNECTOR. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 16J: 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. SOUTH SHORE HOSPITAL INC PART V, SECTION B, LINE 20E: 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. 6 1 - AMBULATORY CANCER CENTER 101 COLOMBIAN STREET SOUTH WEYMOUTH MA 02190 BREAST CARE AND MULTISPECIALTY CARE CENTER 2 - CENTER FOR ORTHO SPINE & SPORTS MEDICIN 2 POND PARK ROAD HINGHAM MA 02043 ORTHOPEDIC REHABILITATION AND OUTPATIENT SURGICAL SATELLITE CLINIC 3 - CENTER FOR WOUND HEALING 90 LIBBEY INDUSTRIAL PARKWAY SOUTH WEYMOUTH MA 02190 WOUND CARE AND HYPERBARIC MEDICINE 4 - COHASSET RADIOLOGY 233 CHIEF JUSTICE CUSHING HIGHWAY COHASSET MA 02025 IMAGING SERVICES 5 - OUTPATIENT SERVICES 780 MAIN STREET SOUTH WEYMOUTH MA 02190 OUTPATIENT SURGERY CENTER 6 - PRE-SURGERY EVALUATION 797 MAIN STREET 1ST FLOOR SOUTH WEYMOUTH MA 02190 PRE-SURGICAL TESTING AND EVALUATION CLINIC 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.PART I, LINE 7G:SOUTH SHORE HOSPITAL RECEIVED $38,015,218 IN FUNDING FROM APRIL 2020 THROUGH SEPTEMBER 30, 2020 FROM THE CORONAVIRUS RESPONSE AND RELIEF SUPPLEMENTAL APPROPRIATIONS ACT (CARES ACT). THESE PAYMENTS WERE DISTRIBUTED BY HRSA THROUGH THE PROVIDER RELIEF FUND (PRF) PROGRAM TO REIMBURSE ELIGIBLE HEALTHCARE PROVIDERS FOR HEALTHCARE RELATED EXPENSES OR LOST REVENUES ATTRIBUTABLE TO CORONAVIRUS. ALL RECIPIENTS WILL BE REQUIRED TO REPORT THEIR USE OF ALL PRF PAYMENTS RECEIVED DURING THE 2020 CALENDAR YEAR BASED ON THE REPORTING SCHEDULE PUBLISHED BY HHS. RECIPIENTS WILL HAVE TO SUBMIT THE FOLLOWING INFORMATION:1. HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS THAT ANOTHER SOURCE HAS NOT REIMBURSED AND IS NOT OBLIGATED TO REIMBURSE, WHICH INCLUDES GENERAL AND ADMINISTRATIVE (G&A) AND/OR OTHER HEALTHCARE RELATED EXPENSES.2. PRF PAYMENT AMOUNTS NOT FULLY EXPENDED ON HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS ARE THEN APPLIED TO PATIENT CARE LOST REVENUES. DOCUMENTATION REQUIREMENTS FOR THESE CALCULATIONS HAVE BEEN PUBLISHED IN THE POST-PAYMENT NOTICE OF REPORTING REQUIREMENTS DATED JUNE 11, 2021.SOUTH SHORE HOSPITAL PLANS ON USING ALL PRF FUNDS TOWARDS LOST REVENUE AS ALL HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS HAVE BEEN SUBMITTED TO FEMA. THE HOSPITAL HAS PERFORMED CALCULATIONS BASED ON THE JUNE 11TH GUIDELINES AND DETERMINED THAT THE LOST PATIENT CARE REVENUES FROM JANUARY 2020 THROUGH SEPTEMBER 2020, AS PUBLISHED IN THE APRIL 1, 2021 HHS PROVIDER RELIEF GUIDELINES AS TO HOW THE PROVIDER RELIEF FUNDS CAN BE SPENT, EXCEEDED THE PRF FUNDS RECEIVED PRIOR TO SEPTEMBER 30. PART II, COMMUNITY BUILDING ACTIVITIES: 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. PART III, 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. PART III, 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. PART III, 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. ABOUT 7.5% OF PEOPLE IN OUR AREA LIVE 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. PART III, 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. PART VI, LINE 2: THE HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN MARCH 2019. 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 PRIMARILY FROM THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH AND THE U.S CENSUS BUREAU. 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. PART VI, LINE 4: SOUTH SHORE HOSPITAL SERVES AN AREA SOUTH OF BOSTON WITH A POPULATION OF APPROXIMATELY 615,000. THE MAJORITY OF PATIENTS IDENTIFY THEMSELVES AS CAUCASIAN (80.9%), FOLLOWED BY BLACK/AFRICAN AMERICAN (9.9%), ASIAN (6.8%) AND OTHER (2.4%). AFTER ENGLISH, THE NEXT MOST COMMON LANGUAGES THAT PATIENTS REPORTED SPEAKING AS A PRIMARY LANGUAGE ARE PORTUGUESE, SPANISH, VIETNAMESE, AND CHINESE. 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://SOUTHSHOREHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITS. PART VI, LINE 6: SOUTH SHORE HOSPITAL IS PART OF AN AFFILIATE HEALTH CARE SYSTEM. UNDER THE CONTROL OF ITS PARENT ORGANIZATION, SOUTH SHORE HEALTH SYSTEM (SSHS), AFFILIATES SOUTH SHORE HOSPITAL, SOUTH SHORE PROPERTY, CONNECTED CARE OF SOUTHEASTERN MASSACHUSETTS, 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. PART VI, LINE 7, REPORTS FILED WITH STATES MA 1 PHYSICIANS HEALTH SERVICES INC 860 WINTER STREET WALTHAM MA 02451 223234975 501(C)(3) 30000 SUPPORT PROVIDER WELLNESS SHE'S LOCAL INC 2 RIDGE AVENUE NATICK MA 01760 832916379 501(C)(3) 15000 COMMUNITY HEALTHCARE SUPPORT UMASS BOSTON 100 MORRISSEY BOULEVARD BOSTON MA 02125 046013152 501(C)(3) 6400 COMMUNITY HEALTHCARE SUPPORT UNITED STROKE ALLIANCE 2000 WPIONEER PKWY STE 16 PEORIA IL 61615 640954851 501(C)(3) 10000 COMMUNITY HEALTHCARE SUPPORT QUINCY ASIAN RESOURCES INC 1509 HANCOCK ST SUITE 209 QUINCY MA 02169 010556446 501(C)(3) 20000 COMMUNITY HEALTHCARE SUPPORT 5 0 FRIEND'S SCHOLARSHIPS FOR STUDENTS PURSUING HEALTH CARE DEGREES 18 18500 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 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 A BSN 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. EIGHTEEN SCHOLARSHIPS TOTALING $18,500 WERE AWARDED IN FISCAL 2020. 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 ROSE DIPIETRO PRESIDENT/CEO 289151 0 0 0 2132 0 8400 0 320 0 300003 0 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 604101 0 60923 0 33591 0 8400 0 26780 0 733795 0 0 0 MICHAEL AYERS MD CHAIR, PROVIDER COUNCIL 231030 0 40000 0 1161 0 8400 0 20220 0 300811 0 0 0 STEPHEN COCO TREASURER 445948 0 0 0 24701 0 8400 0 21212 0 500261 0 0 0 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 378813 0 38813 0 5899 0 8400 0 21952 0 453877 0 0 0 WAYNE STOCKBRIDGE VP OF HR THROUGH 10/4/19 410479 0 62430 0 106763 0 363207 0 21472 0 964351 0 95192 0 TIMOTHY LYNCH MD CHIEF MEDICAL OFFICER 623066 0 37382 0 5544 0 8400 0 27740 0 702132 0 0 0 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 543026 0 75575 0 1932 0 8400 0 21952 0 650885 0 0 0 TIMOTHY QUIGLEY CNO 367466 0 38583 0 27644 0 8622 0 21952 0 464267 0 0 0 FREDERICK MILLHAM MD CHAIR, SURGERY 855479 0 28299 0 5544 0 8400 0 11592 0 909314 0 0 0 MARK HERSHEY MD CHAIR, CRITICAL CARE 661429 0 390 0 5544 0 8400 0 18524 0 694287 0 0 0 JASON TRACY MD CHAIR, EMERGENCY SERVICES 540578 0 31436 0 40544 0 8400 0 17600 0 638558 0 0 0 KENNETH MCLAUGHLIN MD PHYSICIAN 398816 0 163359 0 3612 0 8400 0 4240 0 578427 0 0 0 JONATHAN D PIERCE PHYSICIAN 345763 0 169307 0 635 0 8400 0 21688 0 545793 0 0 0 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 0 294587 0 49883 35417 698 0 8400 0 26780 35417 380348 0 0 PAMELA WHELTON COO THROUGH 8/3/19 419736 0 0 0 231545 0 939797 0 13508 0 1604586 0 221654 0 GENE GREEN MD PRESIDENT/CEO THROUGH 8/12/19 797681 0 26913 0 371673 0 122758 0 21952 0 1340977 0 365597 0 RICHARD AUBUT CEO THROUGH 11/2/15 0 0 0 0 300672 0 0 0 0 0 300672 0 0 0 JOHN M STEVENSON MD FORMER CMO 0 248440 0 400 0 19280 0 8400 0 20448 0 296968 0 0 PEG HOLDA CLERK THROUGH 11/10/17 0 0 0 0 132641 0 750 0 2420 0 135811 0 132390 0 JOSEPH CAHILL EXECUTIVE VP THOUGH 7/15/16 0 0 0 0 107558 0 0 0 0 0 107558 0 0 0 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 AND JOSEPH CAHILL RECEIVED GROSS-UP PAYMENTS OF $14,008 AND $8,635, RESPECTIVELY, IN TAX YEAR 2019 RELATED TO IMPUTED INCOME. PART I, LINE 3 FOR FY20 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. PART I, LINES 4A-B FOR 2019, THE FOLLOWING INDIVIDUALS RECEIVED SALARY CONTINUATION PAYMENTS; GENE GREEN RECEIVED $190,597, PEG HOLDA RECEIVED $131,785, WAYNE STOCKBRIDGE RECEIVED $95,192, AND PAMELA WHELTON RECEIVED 221,654. 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, STEPHEN COCO, KIMBERLY DEVER, JOSEPH DRISCOLL, PEG HOLDA, TIMOTHY QUIGLEY, JOHN STEVENSON, JASON TRACY, AND PAMELA WHELTON ARE PARTICIPANTS. 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 PHYSICIANS MAY EARN INCENTIVE PAYMENTS BASED UPON QUALITY AND OTHER METRICS. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 000000000 2012-09-14 78330000 SERIES 2012 REFUNDED BONDS ISSUED 02/28/08. 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584XNN7 2016-05-10 155229109 SEE PART VI FOR COMPLETE DESCRIPTION 0 0 0 A 27358333 78330000 739129 77590871 1 0 1 1 B 13476389 156274667 1985886 121048000 35226666 1 0 1 1 A 0 0 1 1 0 0.02200 0.00000 0.02200 0 0 1 B 0 0 1 1 0 0 0 1 A 0 0 1 0 1 1 DEUTSCHE BANK 20.000000000000 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, BOND B SERIES H WAS USED TO CONSTRUCT A NEW CRITICAL CARE UNIT AND TO RENOVATE THE EXISTING CRITICAL CARE UNIT; SERIES I WAS USED TO CONSTRUCT A NEW CRITICAL CARE UNIT AND TO RENOVATE THE EXISTING CRITICAL CARE UNIT AND FOR OTHER MISCELLANEOUS CAPITAL PROJECTS. THE FINANCING ALSO UPGRADED THE HOSPITAL'S ELECTRONIC HEALTH RECORD SYSTEM AND 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 3, BOND B THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS DUE TO INTEREST INCOME. SCHEDULE K, PART II, LINE 4, BOND B AMOUNTS REPORTED HERE CONSIST OF ENTIRELY BONA FIDE DEBT SERVICE FUND DEPOSITS. RICHARD AUBUT PRESIDENT/CEO THROUGH 11/2/15 SPLIT DOLLAR LIFE INSURANCE POLICY X 6659999 6659999 0 1 1 JOSEPH CAHILL PRESIDENT THROUGH 7/15/16 SPLIT DOLLAR LIFE INSURANCE POLICY X 2971880 2971880 0 1 1 STEPHEN COCO SVP, CFO, & TREASURER SPLIT DOLLAR LIFE INSURANCE POLICY X 155512 155512 0 1 1 PEG HOLDA CLERK THROUGH 11/10/17 SPLIT DOLLAR LIFE INSURANCE POLICY X 35350 35350 0 1 1 TIMOTHY QUIGLEY VP NURSING/CNO SPLIT DOLLAR LIFE INSURANCE POLICY X 200484 200484 0 1 1 JOHN STEVENSON PHYSICIAN, CMO THROUGH 5/16/17 SPLIT DOLLAR LIFE INSURANCE POLICY X 711294 711294 0 1 1 PAMELA WHELTON COO THROUGH 8/3/19 SPLIT DOLLAR LIFE INSURANCE POLICY X 200350 200350 0 1 1 JOSEPH DRISCOLL CLERK/GENERAL COUNSEL SPLIT DOLLAR LIFE INSURANCE POLICY X 198533 198533 0 1 1 KIMBERLY DEVER CHIEF OB/GYN, DIRECTOR SPLIT DOLLAR LIFE INSURANCE POLICY X 416240 416240 0 1 1 JASON TRACY EMERGENCY DEPARTMENT CHAIR SPLIT DOLLAR LIFE INSURANCE POLICY X 311576 311576 0 1 1 11861218 SUBSTANTIAL CONTRIBUTOR VENDOR 2803821 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 550902 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 244532 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 30617478 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 755407 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 5455193 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 3107095 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 476440 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 983429 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 221357 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 1381737 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 1967748 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 321689 INDEPENDENT CONTRACTOR 0 X 15862 OTHER X 9 1049204 COST OR SELLING PRICE X 4 9996 OTHER 0 0 1 0 PART I, COLUMN (B): THE INFORMATION REPORTED ABOVE IS REPORTED AS THE NUMBER OF CONTRIBUTIONS RECEIVED. UNLESS OTHERWISE NOTED, DONOR VALUATION WAS USED TO DETERMINE THE AMOUNT OF THE NONCASH CONTRIBUTIONS. 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 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. 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 18,236,164. TRANSFERS -13,800,000. CONTRIBUTION-RELATED -2,117,936. MISCELLANEOUS 1,999. 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 1 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 1 SOUTH SHORE HEALTH EXPRESS 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 SSH AND BUILDS GOODWILL IN THE COMMUNITY MA 501(C)(3) 12A, I SOUTH SHORE HOSPITAL INC 1 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 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 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 1 1 SOUTH SHORE MEDICAL CENTER INC R 12000000 FMV SOUTH SHORE HEALTH EXPRESS INC R 1800000 FMV