2019-07-18T11:47:27-07:00 2018-09-30 990 2017-10-01 042297845 South Shore Medical Center Inc SOUT 7818785200 143 Longwater Drive Norwell MA 02061 Stephen Coco Treasurer 7816248626 2019-08-15 72.22.189.130 2017 2019-02-21 02:37:17Z Stephen Coco 55 Fogg Road South Weymouth MA 02190 68122887 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. 15 11 693 13 0 27701 0 0 69070738 67573879 162779 222997 244009 235957 69477526 68032833 3080 3251 0 0 50494926 50953402 0 0 0 26575229 19922633 77073235 70879286 -7595709 -2846453 21017168 21164756 20431017 17425058 586151 3739698 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 52979461 3251 67782663 South Shore Medical Center provided medical, preventative and other clinical services to its patients. For the year ended September 30, 2018 SSMC had 255,301 patient visits (including 21,664 Medicaid and 34,062 Medicare visits). 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. 0 0 0 52979461 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 48 0 1 693 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 1 0 1 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 0.5 45 X X 0 994038 45017 Kenneth Kirkland Chair 0.5 4 X X 0 0 0 Brian Concannon Vice Chair 0.5 4 X X 0 0 0 Christopher Oddleifson Director 0.5 4 X 0 0 0 John Maguire Director through 5/31/18 0.5 4 X 0 0 0 Paula L Becker Director 0.5 4 X 0 0 0 James McDonough Director through 4/30/18 0.5 4 X 0 0 0 Kimberly Dever MD Director, Chief OB/GYN 0.5 45 X 3500 677572 66841 Robert Pineau Director 0.5 4 X 0 0 0 Paul Watanabe Director 0.5 4 X 0 0 0 Thomas McCarthy Director 0.5 4 X 0 0 0 Pamela O'Leary Director 0.5 4 X 0 0 0 Lisa Walsh Director 0.5 4 X 0 0 0 Linda Thompson Director 0.5 4 X 0 0 0 Edward Nalband MD Director 0.5 4 X 372728 0 25828 Helen Garvey Director 0.5 4 X 0 0 0 Luke O'Connell MD Chair Provider Council 0.5 26 X 0 230201 21223 Thomas Carroll Director, President Ambulatory through 11/06/17 1 40 X 0 551170 564024 Benjamin C Ryan MD Director through 12/31/17 40 3 X 319287 0 7862 David Halle MD Director through 12/31/17 40 2 X 291371 0 27624 Richard A Kauff MD Director through 12/31/17 40 1 X 247274 0 26884 Ingrid E Kotch MD Director through 12/31/17 40 1 X 343271 0 26024 Stephen Coco Treasurer 0.5 47 X 0 429951 26992 Joseph R Driscoll Esq General Counsel/Clerk 0.5 46 X 0 345074 66174 Peg Holda Clerk through 11/10/17 1 43 X 0 433799 452930 Peg Hafkemeyer SSMC COO 40 0 X 258687 0 53657 Michael Kaplan SSMC VP Finance 40 0 X 236144 0 37298 Matthew Hjort MD Physician 40 0 X 489650 0 27624 Joseph Spychalski MD Physician 40 0 X 469587 0 16564 Kylee Eagles MD Physician 40 0 X 479147 0 25024 Joyce Imahiyerobo MD Physician 40 0 X 439104 0 8100 Karen Zemel MD Physician 40 0 X 402310 0 31464 Mark Flieger CIO through 4/16 0 0 X 159258 0 13160 Richard Aubut SSHS CEO through 11/2/15 0 0 X 0 295973 0 Pamela Whelton Treasurer through 8/22/17 0 40 X 0 720512 13097 4511318 4678290 1583411 92 1 1 0 Premier Diagnostic Services 54 Bodwell Street Avon MA 02322 Diagnostic Services 654168 South Shore Orthopedics LLC 2 Pond Park Road Hingham MA 02043 Physician Services 431794 Thomas J Kenney MD Inc 2110 Dorchester Avenue Ste 210 Boston MA 02124 Physician Services 262443 Tamsin A Knox MD 43 Chestnut Street Dedham MA 02026 Physician Services 241693 Richard Horan MD PC 850 Boylston Street Ste 540 Chestnut Hill MA 02467 Physician Services 220500 8 0 Net Patient Service Revenue 621110 62592733 62592733 0 0 Premium Revenue 621110 4478639 4478639 0 0 Discount Revenue 621110 384604 384604 0 0 Clinician Reimbursement Revenue 621110 117903 117903 0 0 0 0 0 0 67573879 222997 0 0 222997 0 0 0 0 0 0 0 0 117227 0 90054 0 27173 0 27173 0 0 27173 0 0 Purchase Discounts 900099 62858 62858 0 0 SSH Surgical Call Revenue 900099 52500 52500 0 0 Medical Records Income 900099 9809 9809 0 0 83617 83617 0 0 208784 68032833 67782663 0 250170 1751 1751 1500 1500 2032086 1527839 504247 39621455 29054737 10566718 1958885 1438239 520646 4706783 3455782 1251001 2634193 1934059 700134 58410 58410 3042679 1364542 1678137 177 177 6517674 6098477 419197 464121 464121 4787703 3902206 885497 5320 29 5291 223771 189926 33845 743585 594868 148717 978639 782351 196288 Physician Services 2532248 2532248 0 0 Equipment Maintenance Contracts 246868 87894 158974 0 Physician Board Fees 91349 0 91349 0 Dues 58824 0 58824 0 171265 13013 158252 70879286 52979461 17899825 0 5660335 5003864 4061577 3913061 500760 454007 1094698 1060107 12394374 9141072 3711715 3253302 4552939 4491660 1435144 2988755 21017168 21164756 1560172 1674210 18870845 15750848 20431017 17425058 X 586151 3739698 0 0 0 0 586151 3739698 21017168 21164756 X -2846453 0 0 0 0 6000000 X 0 1 X 0 0 X 156789324 100644328 87977858 69070738 67782663 482264911 156789324 100644328 87977858 69070738 67782663 482264911 482264911 195588 118367 456896 225636 250170 1246657 195588 118367 456896 225636 250170 1246657 156984912 100762695 88434754 69296374 68032833 483511568 0.99742 0.99777 0.00258 0.00223 X Schedule A, Part III, Line 2 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), 2014 calendar year; column (b), 2015 short year; column (c), 2015 tax year (fiscal year ended September 30, 2016); column (d), 2016 tax year (fiscal year ended September 30, 2017); column (e), 2017 tax year (fiscal year ended September 30, 2018). 0 0 0 0 0 0 0 0 3341296 1915449 1425847 0 8812585 7225623 1586962 0 240493 0 240493 3253302 A/R OTHER 2583404 DUE FROM AFFILIATE 311747 SECURITY DEPOSITS 92840 RENT RECEIVABLE 764 2988755 0 PHYSICIAN BENEFITS PAYABLE 4491660 DUE TO 3RD PARTY PAYORS 3924690 ACCRUED SALARIES, WAGES & OTHER COMPENSATION 3781676 DEFERRED RENTAL EXPENSE 1972265 ACCRUED PENSION 835840 DUE TO AFFILIATES 739050 SECURITY DEPOSITS 5667 15750848 X Schedule D, 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 825831 0 166275 0 1932 0 25493 0 19524 0 1039055 0 119925 Stephen Coco Treasurer 0 364101 0 50819 0 15031 0 8100 0 18892 0 456943 0 42645 Joseph R Driscoll Esq General Counsel/Clerk 0 313383 0 29944 0 1747 0 46710 0 19464 0 411248 0 40866 Kimberly Dever MD Director, Chief OB/GYN 0 560417 0 80560 3500 36595 0 42185 0 24656 3500 744413 0 43177 Edward Nalband MD Director 366883 0 950 0 4895 0 8100 0 17728 0 398556 0 0 0 Luke O'Connell MD Chair Provider Council 0 216849 0 5542 0 7810 0 2847 0 18376 0 251424 0 0 Thomas Carroll Director, President Ambulatory through 11/06/17 0 415174 0 113871 0 22125 0 544720 0 19304 0 1115194 0 52500 Benjamin C Ryan MD Director through 12/31/17 260575 0 1700 0 57012 0 7862 0 0 0 327149 0 0 0 David Halle MD Director through 12/31/17 290484 0 0 0 887 0 8100 0 19524 0 318995 0 0 0 Richard A Kauff MD Director through 12/31/17 245281 0 0 0 1993 0 7504 0 19380 0 274158 0 0 0 Ingrid E Kotch MD Director through 12/31/17 342135 0 0 0 1136 0 8100 0 17924 0 369295 0 0 0 Peg Hafkemeyer SSMC COO 246365 0 10000 0 2322 0 39053 0 14604 0 312344 0 31250 0 Michael Kaplan SSMC VP Finance 233975 0 0 0 2169 0 36454 0 844 0 273442 0 17149 0 Matthew Hjort MD Physician 488969 0 150 0 531 0 8100 0 19524 0 517274 0 0 0 Joseph Spychalski MD Physician 468701 0 0 0 886 0 8100 0 8464 0 486151 0 0 0 Kylee Eagles MD Physician 478871 0 0 0 276 0 8100 0 16924 0 504171 0 0 0 Joyce Imahiyerobo MD Physician 433659 0 5000 0 445 0 8100 0 0 0 447204 0 0 0 Karen Zemel MD Physician 391879 0 9900 0 531 0 8100 0 23364 0 433774 0 0 0 Peg Holda Clerk through 11/10/17 0 313625 0 80769 0 39405 0 436650 0 16280 0 886729 0 35225 Mark Flieger CIO through 4/16 0 0 0 0 159258 0 0 0 13160 0 172418 0 0 0 Richard Aubut SSHS CEO through 11/2/15 0 0 0 0 0 295973 0 0 0 0 0 295973 0 33221 Pamela Whelton Treasurer through 8/22/17 0 566786 0 146975 0 6751 0 8533 0 4564 0 733609 0 84395 Schedule J, 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 FY18. During the merger process, SSHS engaged an independent outside consultant to present comparable industry and market data to determine the President's compensation. Schedule J, Part I, Line 4 In 2017, Mark Flieger, former SSMC CIO, and Peg Holda, Clerk through 11/10/17, received salary continuation payments of $160,269 and $35,609, respectively. 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, Peg Holda, John Stevenson, Pamela Whelton, Stephen Coco, Joseph Driscoll and Kimberly Dever are participants in the plan. Schedule J, Part I, Line 7 Three employees received MVP/Wellness bonuses, one employee received a bonus as a participant in the System's successful EMR implementation. Suzanne Carroll Family member of Thomas Carroll, President thru 11/17 14160 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 4 South Shore Medical Center amended its bylaws to change its board composition, numbers, and qualifications, and annual meeting date. 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 reviewed for conflicts or potential conflicts. Board members abstain from voting on matters that present a conflict of interest. Form 990, Part VI, Section B, Line 15 The President, 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 FY18. 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, $6,000,000. South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 042769210 Hospital MA 501(c)(3) 3 South Shore Health System Inc 0 South Shore Health System Inc 55 Fogg Road South Weymouth MA 02190 042105926 Supports the charitable mission of South Shore Hospital and its affiliates MA 501(c)(3) 12b N/A 0 South Shore Property Inc 55 Fogg Road South Weymouth MA 02190 050398822 Develops and manages real property for South Shore Hospital and its affiliates MA 501(c)(3) 12a 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 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 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 Operate 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