2020-08-14T06:20:33-05:00 2019-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2018-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 STEPHEN COCO SVP, CFO & TREASURER 7816248000 2020-08-13 1 CHRISTINE A KAWECKI P00743140 5169187000 106.207.252.159 2020-08-13 01:47:17 US P F8AE3CF70B6D5343795F499A8FB4AE99E74455CD F8AE3CF70B6D5343795F499A8FB4AE99E74455CD 2018 2020-09-23 17:36:50Z STEPHEN COCO 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 667273536 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. 14 11 5684 413 1148508 0 7452160 14068607 596179079 639684083 5840842 1817985 13059058 8867649 622531139 664438324 121400 232530 0 0 400599656 441413812 0 0 2840651 207673155 207873846 608394211 649520188 14136928 14918136 666831990 684466670 362270073 343125939 304561917 341340731 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 479142652 232530 639549152 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, 2019, THE HOSPITAL HAD 30,466 DISCHARGES AND APPROXIMATELY 222,681 OUTPATIENT DAYS. THE HOSPITAL'S EMERGENCY CENTER IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR, AND HAD 98,548 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 181,326 HOME VISITS TO PATIENTS IN FY19. 479142652 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 1 373 0 1 5684 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 14 11 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 GENE E GREEN MD PRESIDENT/CEO 40.00 4.50 X X 1099790 0 509441 KENNETH KIRKLAND CHAIR 1.00 3.50 X X 0 0 0 BRIAN CONCANNON VICE CHAIR 1.00 3.50 X X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 1.00 3.50 X 0 0 0 EDWARD NALBAND MD DIRECTOR 1.00 43.00 X 0 381141 23726 HELEN GARVEY DIRECTOR 1.00 3.50 X 0 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 40.00 3.50 X 717320 9500 34126 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 STEPHEN COCO TREASURER 40.00 4.50 X 496848 0 28774 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 40.00 4.50 X 380256 0 29222 PAMELA WHELTON SSH COO 40.00 0.00 X 660080 0 1182530 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 40.00 1.00 X 255233 0 26461 ROSE DIPIETRO PRES., HOME & COMM. CARE & SVP, SSHS 40.00 0.00 X 242166 0 11691 TIMOTHY LYNCH MD SSH CMO 40.00 1.00 X 690634 0 35086 TIMOTHY QUIGLEY SSH CNO 40.00 0.00 X 439105 0 29704 WAYNE STOCKBRIDGE VP OF HR 40.00 0.00 X 370239 0 479486 FREDERICK MILLHAM MD CHIEF OF SURGERY 40.00 0.00 X 822027 0 10522 JASON TRACY MD CHAIR, EMERGENCY SERVICES 40.00 0.00 X 612812 0 28530 MARK HERSHEY MD CHAIR, CRITICAL CARE 40.00 0.00 X 651912 0 21236 MATTHEW WEISS MD PHYSICIAN 40.00 0.00 X 558632 0 28862 SHAY HERSHKOVITZ MD PHYSICIAN 40.00 0.00 X 541062 0 15950 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 1.00 40.00 X 85000 218608 18057 JOSEPH CAHILL EXECUTIVE VP THROUGH 7/15/16 0.00 0.00 X 750307 0 15216 PEG HOLDA CLERK THROUGH 11/10/17 0.00 0.00 X 314968 0 8435 RICHARD AUBUT SSHS CEO THROUGH 11/2/15 0.00 0.00 X 468433 0 0 JOHN STEVENSON MD FORMER CMO 0.00 40.00 X 0 254157 27009 10156824 863406 2564064 852 1 1 0 BRIGHAM & WOMEN'S PHYSICIAN ORGANIZATION PO BOX 3684 BOSTON MA 022413684 PHYSICIAN SERVICES 3881066 AW PERRY 20 WINTHROP SQUARE SUITE 500 BOSTON MA 02110 MANAGEMENT COMPANY 2775730 ARAMARK CORPORATIONS 10510 TWIN LAKES PARKWAY CHARLOTTE NC 282697658 SERVICE & MAINTENANCE AGREEMENT 2246422 ALLEGIANCE MEDICAL PARTNERS LLC 85 STILES RD SUITE 203 SALEM NH 03079 PHYSICIAN SERVICES 1310934 SOUTH SHORE ANESTHESIA ASSOCIATES INC 163 LIBBEY PARKWAY SUITE 301 WEYMOUTH MA 02189 PHYSICIAN SERVICES 1119650 71 851446 13217161 1268268 14068607 NET PATIENT SVCS. REV. 622000 613290140 613290140 AMBULATORY CANCER CNTR 621000 19036053 19036053 MEDICARE BUNDLED SVCS. 622000 5566770 5566770 CLINICIAN SERVICES 622000 475824 273496 202328 RENTAL INC. FROM AFFL. 531390 231250 231250 1084046 1084046 639684083 2593294 2593294 1309323 1348413 -39090 -39090 -39090 45450 722238 98521 -722238 -53071 -775309 -775309 664988 851446 664988 0 10940 1052 9888 9888 FOOD SERVICE SALES 722212 4279236 0 0 4279236 SHIELDS IMAGING INCOME 621000 1773303 0 0 1773303 LABORATORY SERVICES 900099 675568 0 675568 0 2168744 67397 260724 1840623 8896851 664438324 639549152 1148508 9672057 215530 215530 17000 17000 3124702 2490477 634225 2776054 2776054 360752133 273224957 85842105 1685071 15094978 11351113 3743865 34764531 25817048 8515071 432412 24901414 18725351 6176063 608038 608038 3634630 3634630 374000 374000 313686 313686 24022046 10765741 13171563 84742 2102862 2102862 85477027 83021695 2418265 37067 12142986 12139996 2990 8906639 6234648 2671991 1032271 743688 274465 14118 1134885 449942 681675 3268 9270638 6489447 2781191 28778384 20144869 8633515 2384782 1421857 962925 GROSS POOL ASSESSMENT 8177241 8177241 0 0 EQUIP. MAIN. CONTRACTS 8140026 3772897 4367129 0 LEASES 3801491 3332059 398910 70522 FOOD 3797015 2202183 1594684 148 3775199 544909 2719977 510313 649520188 479142652 167536885 2840651 13444483 22425392 19886889 17670192 7078588 6151685 57303443 54012455 12113844 11610740 175000 8721601 7621605 6868288 7497291 616212156 349767839 265264479 266444317 235985462 250220139 4903895 5001009 35086018 35811845 666831990 684466670 73898164 81292733 4280927 4044523 205475399 197475498 78615583 60313185 362270073 343125939 X 283606442 310157650 19250707 29452004 1704768 1731077 304561917 341340731 666831990 684466670 X 14918136 4464104 16896894 499680 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 4000 0 1 309686 313686 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, 2019, IT WAS DETERMINED THAT 44.47% 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. 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 10698272 3096501 -51363 0 2753182 378030 10612198 0.06000 0.94000 1 0 5483563 5483563 264070365 140432441 123637924 16596234 8416751 8179483 298460651 188010289 110450362 31601343 12908358 18692985 266444317 LIFE INSURANCE 15770358 PENSION ASSET 7831231 INSURANCE RECOVERIES 5191260 OTHER ACCOUNTS RECEIVABLE 4332530 DUE FROM AFFILIATES 2585880 SERIES G SWAP 89051 RENT RECEIVABLE 11535 35811845 ACCRUED WORKERS COMP & SEPARATION 4470276 CAPITAL LEASES 11326093 COMMUNITY HEALTH INITIATIVES 1236667 EXECUTIVE BENEFITS PAYABLE 5333084 FIN 47 LIABILITY 264941 DUE TO THIRD PARTY 20848208 LOSS ON SWAPS 8582517 MALPRACTICE PAYABLE 7888404 RETIREMENT 358217 SECURITY DEPOSITS 4778 60313185 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 560090 170698 389392 0 0 164868 52027 84417 88080 GOLF CLASSIC 272486 195624 76862 0 0 48960 18945 0 8957 6 683858 485124 198734 0 0 36078 43962 27364 91330 1516434 851446 664988 249906 114934 111781 188367 664988 0 1 1 1 X 1 X 1 1 1 0 1 1 3993581 20250 3973331 0.00610 53816343 37274637 16541706 0.02550 4940835 4940835 0.00760 62750759 37294887 25455872 0.03920 785880 785880 0.00120 621580 621580 0.00100 72144845 48738800 23406045 0.03600 257407 62947 194460 0.00030 247500 247500 0.00040 74057212 48801747 25255465 0.03890 136807971 86096634 50711337 0.07810 637697 637697 0.00100 138174 138174 0.00020 16257 16257 0.00000 302151 302151 0.00050 294824 294824 0.00050 1389103 1389103 0.00220 1 16242687 0 178290902 187047733 -8756831 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 18 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. 7 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 - CENTER FOR PHYSICAL WELLNESS 51 PERFORMANCE DRIVE 3RD FLOOR WEYMOUTH MA 02189 OFFERS EXERCISE, REHABILITATION AND PHYSICAL CONDITIONING PROGRAMS 7 - 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 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% 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 (81.4%), FOLLOWED BY BLACK/AFRICAN AMERICAN (9.6%), ASIAN (6.7%) AND OTHER (1.9%). 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 042911441 501(C)(3) 15000 SUPPORT PROVIDER WELLNESS QUINCY ASIAN RESOURCES INC 1509 HANCOCK STREET SUITE 209 QUINCY MA 02169 010556446 501(C)(3) 20000 COMMUNITY HEALTHCARE SUPPORT JEWISH VOCATIONAL SERVICES INC 75 FEDERAL STREET 3RD FLOOR BOSTON MA 02110 042104357 501(C)(3) 24480 COMMUNITY HEALTHCARE SUPPORT SHE'S LOCAL INC 2 RIDGE AVENUE NATICK MA 01760 832916379 501(C)(3) 20000 COMMUNITY HEALTHCARE SUPPORT 6 0 FRIEND'S SCHOLARSHIPS FOR STUDENTS PURSUING HEALTH CARE DEGREES 13 17000 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. THIRTEEN SCHOLARSHIPS TOTALING $17,000 WERE AWARDED IN FISCAL 2019. 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 GENE E GREEN MD PRESIDENT/CEO 856269 0 239909 0 3612 0 488205 0 21236 0 1609231 0 17393 0 EDWARD NALBAND MD DIRECTOR 0 367446 0 8800 0 4895 0 8250 0 15476 0 404867 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 572204 0 115262 0 29854 9500 8250 0 25876 0 751446 9500 34085 0 STEPHEN COCO TREASURER 426240 0 49807 0 20801 0 8250 0 20524 0 525622 0 0 0 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 328787 0 47778 0 3691 0 8250 0 20972 0 409478 0 38610 0 PAMELA WHELTON SSH COO 562299 0 86157 0 11624 0 1161294 0 21236 0 1842610 0 0 0 LUKE O'CONNELL MD CHIEF CLINICAL OFFICER 246365 0 8087 0 781 0 5225 0 21236 0 281694 0 0 0 ROSE DIPIETRO PRES., HOME & COMM. CARE & SVP, SSHS 224803 0 7040 0 10323 0 7251 0 4440 0 253857 0 47697 0 TIMOTHY LYNCH MD SSH CMO 558271 0 126819 0 5544 0 8250 0 26836 0 725720 0 33660 0 TIMOTHY QUIGLEY SSH CNO 362630 0 49677 0 26798 0 8468 0 21236 0 468809 0 38386 0 WAYNE STOCKBRIDGE VP OF HR 359820 0 7087 0 3332 0 458250 0 21236 0 849725 0 0 0 FREDERICK MILLHAM MD CHIEF OF SURGERY 781156 0 37259 0 3612 0 8250 0 2272 0 832549 0 28151 0 JASON TRACY MD CHAIR, EMERGENCY SERVICES 534857 0 50413 0 27542 0 8250 0 20280 0 641342 0 28872 0 MARK HERSHEY MD CHAIR, CRITICAL CARE 647690 0 610 0 3612 0 0 0 21236 0 673148 0 0 0 MATTHEW WEISS MD PHYSICIAN 474573 0 61925 0 22134 0 8250 0 20612 0 587494 0 26321 0 SHAY HERSHKOVITZ MD PHYSICIAN 504431 0 35963 0 668 0 8250 0 7700 0 557012 0 0 0 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 0 215974 0 2300 85000 334 0 5617 0 12440 85000 236665 0 0 JOSEPH CAHILL EXECUTIVE VP THROUGH 7/15/16 0 0 153293 0 597014 0 0 0 15216 0 765523 0 0 0 PEG HOLDA CLERK THROUGH 11/10/17 0 0 0 0 314968 0 735 0 7700 0 323403 0 301474 0 RICHARD AUBUT SSHS CEO THROUGH 11/2/15 0 0 178888 0 289545 0 0 0 0 0 468433 0 0 0 JOHN STEVENSON MD FORMER CMO 0 236014 0 0 0 18143 0 7229 0 19780 0 281166 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 RECEIVED A GROSS-UP PAYMENT OF $6,614 IN TAX YEAR 2018 RELATED TO IMPUTED INCOME. PART I, LINE 3 FOR FY19 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 THE YEAR ENDED DECEMBER 31, 2019 THE FOLLOWING INDIVIDUALS RECEIVED SALARY CONTINUATION PAYMENTS; JOSEPH CAHILL RECEIVED $432,936 AND PEG HOLDA RECEIVED $298,657. 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, MARGARET HOLDA, TIMOTHY QUIGLEY, JOHN STEVENSON, PAMELA WHELTON, KIMBERLY DEVER, STEPHEN COCO, JOSEPH DRISCOLL, MATTHEW WEISS, AND JASON TRACY 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 22279166 78330000 739129 77590871 1 0 1 1 B 9462222 156274667 2001785 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 0.00000 0.00000 0.00000 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 WILL ALSO BE USED TO RENOVATE THE EXISTING CRITICAL CARE UNIT; SERIES I WAS USED TO CONSTRUCT A NEW CRITICAL CARE UNIT, AND WILL ALSO BE USED 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 WILL BE USED 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. GENE GREEN PRESIDENT/CEO BRIDGE LOAN X 225000 0 0 1 1 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 203220 203220 0 1 1 KIMBERLY DEVER CHIEF OB/GYN, DIRECTOR SPLIT DOLLAR LIFE INSURANCE POLICY X 364210 364210 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 SPLIT DOLLAR LIFE INSURANCE POLICY X 315880 315880 0 1 1 JOSEPH DRISCOLL CLERK/GENERAL COUNSEL SPLIT DOLLAR LIFE INSURANCE POLICY X 193395 193395 0 1 1 11610740 SUBSTANTIAL CONTRIBUTOR VENDOR 200237 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 2358110 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 439077 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 24408680 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 472473 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 132239 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 304827 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 3794861 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 457302 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 665470 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 540138 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 326242 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 44322021 INDEPENDENT CONTRACTOR 0 SUBSTANTIAL CONTRIBUTOR VENDOR 2285251 INDEPENDENT CONTRACTOR 0 X 3521 OTHER X 1 50000 OTHER X 10 1204190 COST OR SELLING PRICE X 8 5097 OTHER X EVENT SUPPLIES 3 5460 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 499,680. 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