2020-08-14T06:23:45-05:00 2019-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2018-10-01 042297845 SOUTH SHORE MEDICAL CENTER INC SOUT 7818785200 143 LONGWATER DRIVE NORWELL MA 02061 STEPHEN COCO TREASURER 7818785200 2020-08-13 1 CHRISTINE A KAWECKI P00743140 5169187000 106.207.252.159 2020-08-13 01:15:55 US P F8AE3CF70B6D5343795F499A8FB4AE99E74455CD F8AE3CF70B6D5343795F499A8FB4AE99E74455CD 2018 2020-09-23 17:36:50Z STEPHEN COCO 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 75197951 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 11 695 13 10 0 0 0 67573879 74114339 222997 208081 235957 751580 68032833 75074000 3251 925 0 0 50953402 61184946 0 0 0 19922633 17780753 70879286 78966624 -2846453 -3892624 21164756 24590759 17425058 17243685 3739698 7347074 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 60700472 925 74831005 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. 60700472 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 45 0 1 695 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 11 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X MICHAEL KAPLAN CFO 7816811646 143 LONGWATER DRIVE NORWELL MA 02061 GENE E GREEN MD PRESIDENT/CEO 0.50 44.00 X X 0 1099790 509441 KENNETH KIRKLAND CHAIR 0.50 4.00 X X 0 0 0 BRIAN CONCANNON VICE CHAIR 0.50 4.00 X X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 0.50 4.00 X 0 0 0 EDWARD NALBAND MD DIRECTOR 40.00 4.00 X 381141 0 23726 HELEN GARVEY DIRECTOR 0.50 4.00 X 0 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 0.50 43.00 X 0 726820 34126 LINDA THOMPSON DIRECTOR 0.50 4.00 X 0 0 0 LISA WALSH DIRECTOR 0.50 4.00 X 0 0 0 PAMELA O'LEARY DIRECTOR 0.50 4.00 X 0 0 0 PAUL WATANABE 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 0.50 44.00 X 0 496848 28774 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 0.50 44.00 X 0 380256 29222 DAVID HALLE MD PAE CHIEF MEDICAL OFFICER 40.00 1.00 X 355768 0 29486 MICHAEL KAPLAN SSMC VP OF FINANCE 40.00 0.00 X 246327 0 8259 PEG HAFKEMEYER BUSH SSMC COO 40.00 0.00 X 250883 0 23011 CHRISTOPHER COX MD PHYSICIAN 40.00 0.00 X 366020 0 35086 INGRID KOTCH MD PHYSICIAN 40.00 0.00 X 343079 0 22546 KAREN ZEMEL MD PHYSICIAN 40.00 0.00 X 369918 0 28530 KYLEE EAGLES MD PHYSICIAN 40.00 0.00 X 388942 0 28534 MATTHEW HJORT MD PHYSICIAN 40.00 0.00 X 497811 0 29486 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 40.00 1.00 X 218608 85000 18057 LUKE O'CONNELL MD CHAIR THROUGH 12/31/17 0.00 41.00 X 0 255233 26461 PEG HOLDA CLERK THROUGH 11/10/17 0.00 0.00 X 0 314968 8435 PAMELA WHELTON TREASURER THROUGH 8/22/17 0.00 40.00 X 0 660080 1182530 RICHARD AUBUT SSHS CEO THROUGH 11/2/15 0.00 0.00 X 0 468433 0 3418497 4487428 2065710 92 1 1 0 FOXROCK LONGWATER II REALTY LLC C/O BRUNO PC 57 OBERY ST STE 4 PLYMOUTH MA 02360 MANAGEMENT COMPANY 3647325 SOUTH SUBURBAN GASTROENTEROLOGY PC 1085 MAIN STREET SOUTH WEYMOUTH MA 02190 PHYSICIAN SERVICES 821049 SOUTH SHORE ORTHOPEDICS LLC 2 POND PARK ROAD HINGHAM MA 02043 PHYSICIAN SERVICES 360567 BOSTON UNIVERSITY DERMATOLOGY 609 ALBANY ST ROOM J-100 BOSTON MA 02118 PHYSICIAN SERVICES 343900 RICHARD HORAN MD PC 850 BOYLSTON ST STE 450 CHESTNUT HILL MA 02467 PHYSICIAN SERVICES 248100 11 NET PATIENT SVCS. REV. 621110 69185405 69185405 PREMIUM REVENUE 621110 4928934 4928934 74114339 200213 10 200203 127525 92611 34914 34914 34914 39208 31340 7868 7868 7868 PHYSICIAN SERVICES 900099 70000 70000 PURCHASE DISCOUNTS 900099 28290 28290 MEDICAL RECORDS INCOME 900099 7023 7023 611353 611353 716666 75074000 74831005 10 242985 925 925 1220815 754345 466470 50113491 39326725 10786766 1931379 1507992 423387 5105694 3986451 1119243 2813567 2196792 616775 28100 28100 2239857 469627 1770230 19150 19150 6636153 6205875 430278 447395 447395 5149232 4193474 955758 5393 5393 277326 275675 1651 874014 699211 174803 1158055 937251 220804 EQUIP. MAINT. CONTRACT 333142 123382 209760 REPAIRS 120639 0 120639 DUES 96314 0 96314 PHYSICIAN BOARD FEES 70405 0 70405 325578 22747 302831 78966624 60700472 18266152 0 5003864 1569948 3913061 3672976 454007 596126 1060107 1478884 16556945 10015086 3253302 6541859 4491660 4860456 2988755 5870510 21164756 24590759 1674210 2728372 15750848 14515313 17425058 17243685 X 3739698 7347074 3739698 7347074 21164756 24590759 X -3892624 7500000 X 0 1 X 0 0 X 100644328 87977858 69070738 67782663 74831005 400306592 100644328 87977858 69070738 67782663 74831005 400306592 0 0 0 400306592 118367 456896 225636 250170 242985 1294054 10 10 118367 456896 225636 250170 242995 1294064 100762695 88434754 69296374 68032833 75074000 401600656 0.99680 0.99740 0.00320 0.00260 X SCHEDULE A, PART III SOUTH SHORE MEDICAL CENTER CHANGED ITS YEAR END FROM 12/31 TO 9/30 WHEN IT MERGED WITH COASTAL MEDICAL ASSOCIATES. COLUMN HEADINGS FOR SCHEDULE A, PART III ARE THEREFORE AMENDED AS FOLLOWS: COLUMN (A), 2015 SHORT YEAR; COLUMN (B), 2015 TAX YEAR (FISCAL YEAR ENDED SEPTEMBER 30, 2016); COLUMN (C), 2016 TAX YEAR (FISCAL YEAR ENDED SEPTEMBER 30, 2017); COLUMN (D), 2017 TAX YEAR (FISCAL YEAR ENDED SEPTEMBER 30, 2018); COLUMN (E), 2018 TAX YEAR (FISCAL YEAR ENDED SEPTEMBER 30, 2019). 3664925 2089584 1575341 9837197 7925502 1911695 3054823 3054823 6541859 A/R - OTHER 5245091 DUE FROM AFFILIATE 523343 SECURITY DEPOSITS 92840 RENT RECEIVABLE 9236 5870510 DUE TO THIRD PARTY PAYORS 848310 ACCRUED SALARIES, WAGES, & OTHER COMPENSATION 5230436 ACCRUED PENSION 860042 DEFERRED RENTAL EXPENSE 2109148 DUE TO AFFILIATES 596254 PHYSICIAN BENEFITS PAYABLE 4860456 SECURITY DEPOSITS 10667 14515313 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 GENE E GREEN MD PRESIDENT/CEO 0 856269 0 239909 0 3612 0 488205 0 21236 0 1609231 0 17393 EDWARD NALBAND MD DIRECTOR 367446 0 8800 0 4895 0 8250 0 15476 0 404867 0 0 0 KIMBERLY DEVER MD DIRECTOR/CHIEF OB/GYN 0 572204 0 115262 0 39354 0 8250 0 25876 0 760946 0 34085 STEPHEN COCO TREASURER 0 426240 0 49807 0 20801 0 8250 0 20524 0 525622 0 0 JOSEPH R DRISCOLL ESQ GENERAL COUNSEL/CLERK 0 328787 0 47778 0 3691 0 8250 0 20972 0 409478 0 38610 DAVID HALLE MD PAE CHIEF MEDICAL OFFICER 301928 0 52745 0 1095 0 8250 0 21236 0 385254 0 0 0 MICHAEL KAPLAN SSMC VP OF FINANCE 233952 0 0 0 12375 0 7327 0 932 0 254586 0 29398 0 PEG HAFKEMEYER BUSH SSMC COO 247300 0 0 0 3583 0 7535 0 15476 0 273894 0 31252 0 CHRISTOPHER COX MD PHYSICIAN 352381 0 13108 0 531 0 8250 0 26836 0 401106 0 0 0 INGRID KOTCH MD PHYSICIAN 341944 0 0 0 1135 0 8250 0 14296 0 365625 0 0 0 KAREN ZEMEL MD PHYSICIAN 358181 0 11206 0 531 0 8250 0 20280 0 398448 0 0 0 KYLEE EAGLES MD PHYSICIAN 388631 0 0 0 311 0 8250 0 20284 0 417476 0 0 0 MATTHEW HJORT MD PHYSICIAN 497030 0 250 0 531 0 8250 0 21236 0 527297 0 0 0 BENJAMIN C RYAN MD DIRECTOR THROUGH 12/31/17 215974 0 2300 0 334 85000 5617 0 12440 0 236665 85000 0 0 LUKE O'CONNELL MD CHAIR THROUGH 12/31/17 0 246365 0 8087 0 781 0 5225 0 21236 0 281694 0 0 PEG HOLDA CLERK THROUGH 11/10/17 0 0 0 0 0 314968 0 735 0 7700 0 323403 0 301474 PAMELA WHELTON TREASURER THROUGH 8/22/17 0 562299 0 86157 0 11624 0 1161294 0 21236 0 1842610 0 0 RICHARD AUBUT SSHS CEO THROUGH 11/2/15 0 0 0 178888 0 289545 0 0 0 0 0 468433 0 0 PART I, LINE 3 THE PRESIDENT, AMBULATORY CARE, RECEIVES COMPENSATION FOR SERVICES PERFORMED FOR A RELATED ORGANIZATION. HIS COMPENSATION PACKAGE WAS DETERMINED BY SOUTH SHORE HEALTH SYSTEM, PARENT COMPANY OF COASTAL MEDICAL ASSOCIATES, PRIOR TO THE MERGER BETWEEN CMA AND SOUTH SHORE MEDICAL CENTER IN AUGUST 2015. THE PRESIDENT'S COMPENSATION DID NOT CHANGE IN FY19. DURING THE MERGER PROCESS, SSHS ENGAGED AN INDEPENDENT OUTSIDE CONSULTANT TO PRESENT COMPARABLE INDUSTRY AND MARKET DATA TO DETERMINE THE PRESIDENT'S COMPENSATION. PART I, LINES 4A-B IN 2018, PEG HOLDA RECEIVED $298,657 RESPECTIVELY, 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, AND KIMBERLY DEVER PARTICIPATED IN THE PLAN. PART I, LINE 7 THE NON-FIXED PAYMENTS PROVIDED CONSISTS OF BONUSES AND STIPENDS. SUZANNE CARROLL FAMILY MEMBER OF THOMAS CARROLL 20062 EMPLOYMENT 0 LINDSAY CARROLL FAMILY MEMBER OF THOMAS CARROLL 10227 EMPLOYMENT 0 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 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 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, 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. THE PRESIDENT'S COMPENSATION DID NOT CHANGE IN FY19. 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 7,500,000. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1