2018-07-23T14:19:11-07:00 2017-09-30 990 2016-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 Fogg Road South Weymouth MA 02190 Stephen Coco SVP, CFO & Treasurer 7816248422 2018-08-15 2016 2022-09-23 18:48:47Z Stephen M Coco 55 Fogg Road South Weymouth MA 02190 611321824 0 X www.southshorehospital.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. 8 6 5143 506 759049 0 5490965 8797169 561327044 581903445 -621885 11198111 7317086 7770381 573513210 609669106 14500 54163 0 0 337627307 396480194 0 0 3213399 216105202 197660704 553747009 594195061 19766201 15474045 680007348 673557545 420531587 384883805 259475761 288673740 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 430035999 54163 582464991 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 370 acute care beds (composed of 265 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, pediatric, 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, 2017, the Hospital had 29,292 discharges and approximately 206,838 outpatient days. (Continued on Schedule O) 0 0 0 430035999 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 1 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 1 396 0 1 5143 1 1 1 0 0 0 0 1 1 0 0 0 0 X 8 6 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 M Coco 7816248422 55 Fogg Road South Weymouth MA 02190 Gene Green MD SSH President and SSHS President & CEO 40 9 X X 1040024 0 155692 Chris Oddleifson Chairman 1 1 X X 0 0 0 Thomas McCarthy Vice Chairman 1 0 X X 0 0 0 Kenneth Kirkland Immediate Past Chair 1 1 X 0 0 0 Lisa Walsh Director 1 0 X 0 0 0 John Maguire Director 1 0 X 0 0 0 Pamela O'Leary Director 1 0 X 0 0 0 Kimberly Dever MD President Medical Staff beginning 2/17 40 2 X 608362 24345 84489 John Walsh MD President Medical Staff thru 1/17 40 2 X 80000 262208 32158 Sherry Penney Director thru 12/31/16 1 0 X 0 0 0 Matthew Weiss MD Director thru 12/31/16 1 46 X 0 620465 89075 Stephen Coco SVP, CFO & Treasurer beginning 8/23/17 40 10 X 265170 0 80469 Margaret Holda Clerk 40 5 X 340161 0 73756 Pamela Whelton EVP, COO 40 11 X 563152 0 104761 Joseph Driscoll JD General Counsel 40 1 X 78866 0 4714 John Stevenson MD Vice President, Chief Medical Officer thru 5/16/17 40 9 X 579147 0 551077 Rose Dipietro President Home & Community Care 40 2 X 452983 0 88179 Timothy Quigley VP Acute Care Operations and CNO 42 0 X 406814 0 81848 Frederick Millham MD Chief of Surgery 40 0 X 751610 0 57136 Timothy Lynch MD Chief of Medicine 40 4 X 403898 131363 83000 Christopher OConnor SVP External Affairs 42 0 X 349300 0 63563 Matthew Whalen ED/VP South Shore PHO 40 4 X 347322 0 15007 Thomas Cameron VP Support Services and Site Management 42 2 X 322971 0 81755 Richard Aubut CEO through 11/2/15 0 0 X 738132 0 33221 Joseph Cahill SSH President & COO through 7/15/16 0 0 X 857863 0 134630 E Delroy Dixon SVP, Chief Information Officer thru 7/15/16 0 0 X 571626 0 85508 Robert Wheeler SVP Human Resources thru 3/10/16 0 0 X 387656 0 15335 Michael Cullen SVP, CFO & Treasurer thru 1/8/15 0 0 X 106936 0 1937 Richard Mirel MD Chief of Medicine thru 12/15 0 0 X 437062 0 10638 9689055 1038381 1927948 686 1 1 0 Impact Advisors 931 W 75th Street Suite 137-304 Naperville IL 60565 Consulting 4534822 Brigham & Women's Physician Organization PO Box 3684 Boston MA 022413684 Physician Services 2659784 Tro Jung Brannen Corporation 100 High Street Suite 1800 Boston MA 02110 Architects 2139930 Specialized Receivables PO Box 12414 Newark NJ 071013514 Billing/Collection 1476819 Cain Brothers & Company LLC 360 Madison Avenue 5th Floor New York NY 10017 Investment Bankers 1302653 63 0 0 887340 0 125295 7784534 200855 8797169 Net Patient Service Revenue 622000 563097948 563097948 0 0 Ambulatory Cancer Center 621000 15165852 15165852 0 0 Medicare Bundled Services 622000 2483066 2483066 0 0 Clinician Services 622000 397850 187658 210192 0 Rental Income from Affiliates 531390 231250 231250 0 0 527479 527479 0 0 581903445 1751706 0 0 1751706 0 0 0 0 0 0 0 0 1236750 0 1118299 0 118451 0 118451 0 0 118451 9412450 78000 0 44045 9412450 33955 9446405 0 0 9446405 488878 887340 488878 0 0 0 19820 1496 18324 0 18324 0 Food Service Sales 722212 4421612 0 0 4421612 Shields Imaging Income 621000 1267134 0 0 1267134 Gift Shop/Cancer Center Boutique 900099 393892 43574 0 350318 1550968 728164 530533 292271 7633606 609669106 582464991 759049 17647897 43663 43663 10500 10500 1945404 1945404 3061892 3061892 311838771 226803740 83247882 1787149 23782588 17169999 6612589 32671313 23290551 8813382 567380 23180226 16735120 6445106 491503 491503 964731 964581 150 361404 361404 50952 50952 0 30883860 11371885 19352055 159920 880251 872185 8066 75612161 72360472 3217628 34061 8167504 8167504 7826190 5478333 2347857 826814 751828 66488 8498 651255 330769 316481 4005 6105830 4274081 1831749 20933071 14653150 6279921 2721008 1828205 892803 Physician Services 14356275 14356275 0 0 Equipment Maintenance Contracts 7354300 3229143 4125157 0 Uncompensated Care 5790511 5790511 0 0 Leases 3882772 3543232 269018 70522 9800312 6069138 3157526 573648 594195061 430035999 160945663 3213399 11763330 29173223 60438370 11698059 4335562 8119666 72520689 71069426 225000 225000 7102319 7116304 5335574 6655096 551356167 294547158 194327990 256809009 297599505 249615928 4892356 3632019 21466653 29443815 680007348 673557545 71653926 77185784 2112225 2340604 222746033 213611966 124019403 91745451 420531587 384883805 X 246677645 270238635 11414958 17031947 1383158 1403158 259475761 288673740 680007348 673557545 X 15474045 8420384 0 0 0 5303550 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 50952 50952 0 Schedule C, Part II-B, Line 1 Item i: Amount represents a percentage of the Hospital's annual apportionment of MHA/AHA dues attributable to lobbying expenses. For the year ended September 30, 2017, it was determined that 18.94% of dues was 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. 12798116 7826451 242623 0 2010991 421094 18435105 10612198 4890558 189932 0 2386792 507780 12798116 10698272 3096501 -51363 0 2753182 378030 10612198 12105141 3593941 209640 0 4841905 368545 10698272 16660514 -549950 213862 0 3837515 381770 12105141 0 0.08 0.92 1 0 0 5483563 5483563 0 208325243 122292518 86032725 0 15868227 6608196 9260031 0 262556996 155615027 106941969 0 59122138 10031417 49090721 256809009 0 Due to 3rd Party Payors 38210897 Capital Leases 12324524 Accrued Pension 10049202 Loss on Swaps 9011557 Malpractice Payable 7234840 Executive and Physician Benefits Payable 6100072 Accrued Workers Compensation 5825490 Community Health Initiatives 2200960 Post Retirement Benefits 358217 Fin 47 Liability 264941 Due to Affiliates 102414 Other Long Term Liabilities 57560 Security Deposits 4777 91745451 X 604386013 0 0 0 1943590 1943590 602442423 0 7226683 7226683 609669106 595660072 0 0 0 1465011 1465011 594195061 0 0 0 594195061 Schedule D, 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. Schedule D, Part X, Line 2 The Hospital 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. Schedule D, Part XI, Line 2d Net assets released from restrictions; $1,943,590. Schedule D, Part XI, Line 4b Contributions; $8,691,694, Cost of goods sold - shops; -$345,216, Rental expense; $-1,118,299; Gaming expenses; -$1,496. Schedule D, Part XII, Line 2d Cost of goods sold - shops; $345,216, Rental expense; $1,118,299, Gaming expenses; $1,496. Moonlight & Miracles 506092 266710 239382 0 0 70768 62332 23780 82502 Golf Classic 204012 127531 76481 0 0 29400 20076 0 27005 7 666114 493099 173015 0 0 32280 62557 2495 75683 1376218 887340 488878 0 0 132448 144965 26275 185190 488878 0 19820 379 1117 1 1 19820 379 0 0 1117 1496 18324 MA 0 The Hospital obtains permits from each town raffles are held in, in accordance with Massachusetts state law. 0 1 0 0.33 0.67 Chris O'Connor SVP Philanthropy 30 Reservoir Park Drive Rockland MA 02370 0 Christopher O'Connor 0 See Part IV X 0 0 Schedule G, Part III, Line 16 Christopher O'Connor is the SVP, Philanthropy of South Shore Health System Foundation, a department of South Shore Hospital. The SSHS Foundation oversees all gaming and fundraising activities. 1 1 1 X 1 X 1 1 1 0 1 1 2968490 36140 2932350 0.0049 66682292 52510386 14171906 0.0239 3176615 0 3176615 0.0053 0 0 72827397 52546526 20280871 0.0341 1003233 0 1003233 0.0017 685654 0 685654 0.0012 90180521 70149309 20031212 0.0337 195070 59836 135234 0.0002 385000 0 385000 0.0006 0 0 92449478 70209145 22240333 0.0374 0 0 165276875 122755671 42521204 0.0715 749686 0 749686 0.0013 145612 0 145612 0.0002 71869 0 71869 0.0001 569851 10688 559163 0.0009 398204 398204 0.0007 0 0 1935222 10688 1924534 0.0032 1 12994346 0 156335267 179007127 -22671860 X 1 1 1 1 South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 southshorehospital.org License #2107 X X X X See Part V, Section D. All non-hospital facilities are included in the Hospital's license. South Shore Hospital Inc 1 0 0 1 X X X X X X X X 15 1 0 1 1 X http://www.southshorehospital.org/workfiles/About/Community_Health_Needs_Assessment_2016.pdf X 1 16 1 http://www.southshorehospital.org/workfiles/About/FY2017_Community_Benefits_Plan.pdf 0 0 1 X 200 300 X X X X X X X 1 1 X X X X 1 X http://www.southshorehospital.org/workfiles/Patients_and_Visitors/Credit_and_Collection_Policy.pdf X http://www.southshorehospital.org/workfiles/Patients_and_Visitors/Credit_and_Collection_Policy.pdf X http://www.southshorehospital.org/workfiles/Patients_and_Visitors/financialassistancenotice.pdf X X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-South Shore Hospital Inc The Hospital developed its current Community Health Needs Assessment by holding a workgroup with representatives from the 34 communities it serves. The nineteen 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: Bay State Community Services, CHNA 20 (Blue Hills Community Health Alliance), Dana-Farber/Brigham and Women's Cancer Center, GateHouse Media New England, Hingham Health Department, James M. Hurley Senior and Veterans Center, Manet Community Health Center, Marshfield Public School District, Office of Congressman Bill Keating, Quincy Asian Resources, Quincy Health Department, Scituate Council on Aging, South Shore Elder Services, South Shore YMCA, Weymouth Health Department, 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. Schedule H, Part V, Section B, Line 6b-South Shore Hospital Inc 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 Alliance (CHNA 22). Schedule H, Part V, Section B, Line 7a-South Shore Hospital Inc South Shore Hospital's CHNA report can be found at http://www.southshorehospital.org/workfiles/About/Community_Health_Needs_Assessment_2016.pdf. Schedule H, Part V, Section B, Line 11-South Shore Hospital Inc South Shore Hospital Inc - South Shore Hospital identified seventeen health and social issues through its ongoing data collection and the CHNA workgroup findings. Access to health services, behavioral health (including mental health and substance abuse) and cardiovascular care were identified as priority areas. The Hospital continues to address the need for access to health services by providing translation and courtesy shuttle services, and assisting any individual in our service area in obtaining health insurance. SSH plans to work with community leaders and CHNAs to develop programs to address ongoing obstacles contributing to lack of access to care. Behavioral health issues are significant in our service area with demand for mental health services exceeding the supply of providers. Substance abuse, frequently a co-morbid behavioral health condition, increases emergency room visits. Education around the topics of behavioral health and substance abuse was identified as critical in addressing these issues. SSH plans on expanding initiatives to address behavioral health problems by utilizing internal clinicians, supporting local police and fire departments to mitigate substance abuse and partnering with our communities and local groups to increase educational programs. SSH plans to reduce cardiovascular disease by educating people in the communities it serves about the importance of physical activity. We host free programs dedicated to the prevention and treatment of heart disease, stroke and peripheral vascular conditions. SSH will continue to offer rehabilitation services and is partnering with the South Shore YMCA to offer a cardiac rehabilitation maintenance exercise program for individuals with stable heart disease. The Hospital initiated and supported the South Shore Moves! Wellness Challenge to promote wellness and physical activity. Although oral health was identified as a health need during the assessment process, it will not be addressed due to a lack of clinical expertise at South Shore Hospital. The assessment identified dementia as a community health concern but, outside of programs aimed at vulnerable populations, SSH does not plan to offer specific programs at this time. Violence/safety is another area identified that the Hospital cannot fully address as it is beyond our scope as a healthcare provider. Schedule H, Part V, Section B, Line 13h-South Shore Hospital Inc Other factors used to determine amounts charged to patients are eligibility in Medicare/Medicaid programs or through the Commonwealth's Health Connector. Schedule H, Part V, Section B, Line 16a-South Shore Hospital Inc South Shore Hospital's FAP and FAP application form can be found at http://www.southshorehospital.org/workfiles/Patients_and_Visitors/Credit_and_Collection_Policy.pdf. Schedule H, Part V, Section B, Line 16c-South Shore Hospital Inc The Hospital's FAP plain language summary can be found at http://www.southshorehospital.org/workfiles/Patients_and_Visitors/financialassistancenotice.pdf. Schedule H, Part V, Section B, Line 16i-South Shore Hospital Inc The Hospital is in the process of identifying LEP populations in its service area meet Section 501(r) requirements for translation of the FAP, FAP application and FAP plain language summary. A review of prior years' requests for translation services and Massachusetts LEP populations identified in Section 1557 of the Affordable Care Act will be used to make this determination, with the expected completion date to be no later than the end of calendar year 2018. Schedule H, Part V, Section B, Line 16j-South Shore Hospital Inc 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. Schedule H, Part V, Section B, Line 20e-South Shore Hospital Inc 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 Ambulatory Cancer Center 101 Columbian Street South Weymouth MA 02190 Breast care and multispecialty care center Center for Orthopedics Spine and Sports Medicine 2 Pond Park Road Hingham MA 02043 Orthopedic rehabilitation and outpatient surgical satellite clinic Center for Wound Healing 90 Libbey Industrial Parkway South Weymouth MA 02190 Wound care and hyperbaric medicine Cohasset Radiology 233 Chief Justice Cushing Highway Lower Level Cohasset MA 02025 Imaging services Outpatient Services 780 Main Street South Weymouth MA 02190 Outpatient surgery center Center for Physical Wellness 51 Performance Drive 3rd Floor Weymouth MA 02189 Offers exercise, rehabilitation and physical conditioning programs Pre-surgery Evaluation 797 Main Street 1st Floor South Weymouth MA 02190 Pre-surgical testing and evaluation clinic Schedule H, 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. Schedule H, Part I, Line 7, Column f The Hospital does not include bad debt in its Statement of Functional Expenses, Form 990, Part IX; not applicable. Schedule H, Part II 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. Schedule H, Part III, Section A, 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 uncollectable amounts and the percentage is applied to aged accounts receivable. Schedule H, Part III, Section A, 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. Schedule H, Part III, Section B, 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. One in 8 people in our area lives 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 burdens of government and therefore providing a valuable community benefit. Schedule H, Part III, Section C, Line 9b The Hospital does not bill the following categories of patients (except that the Hospital will bill patients for any applicable co-pays 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 FPL are exempt from collection action. Low income patients, determined pursuant to 114.6 CMR 13.04(2), are exempt from collection action 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. SSH 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. Schedule H, Part VI, Line 2 The Hospital's most recent Community Health Needs Assessment was completed in March 2016. 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 from the Department of Public Health's Massachusetts Community Health Information Profile (Mass CHIP) as well as information collected by the Massachusetts Hospital Association, Massachusetts Health Data Consortium, Federal Centers for Disease Control, the Kaiser Family Foundation and Sg2, a national health care information company. Schedule H, 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 its entirety, on its website and copies are also available upon request. This document 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. Schedule H, Part VI, Line 4 South Shore Hospital serves an area south of Boston with a population of approximately 725,000. The majority of patients identify themselves as Caucasian (94%), followed by Black/African American (1.8%), Other (1.8%) and Asian (.9%). After English, the next most common languages that patients reported speaking as a primary language are Portuguese, Spanish, Vietnamese and Arabic. Schedule H, 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 http://www.southshorehospital.org/communitybenefits. Schedule H, Part VI, Line 6 South Shore Hospital is part of an affiliated health care system. Under the control of its parent organization, South Shore Health System (SSHS), affiliates South Shore Hospital, South Shore Property, Health Provider Services Organization of the South Shore and Coastal Medical Associates (including its subsidiary, South Shore Medical Center) coordinate the provision of health care services to the residents of Southeastern Massachusetts. Schedule H, Part VI, Line 7 South Shore Hospital filed its Community Benefits Report in Massachusetts. 1 United Way of Greater Plymouth County 934 W Chestnut Street Brockton MA 02301 042103940 501(c)(3) 220000 0 Community Healthcare Support Bay State Community Services 1120 Hancock Streeet Quincy MA 02169 042468492 501(c)(3) 165000 0 Community Healthcare Support Manet Community Health Center 110 West Squantum Street Quincy MA 02171 042646695 501(c)(3) 21000 0 Community Healthcare Support 3 0 Friends scholarships for students pursuing health care degrees 10 10500 0 Cash See Part IV Schedule I, 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 II, Line 1 United Way and Bay State Community Services grants are obligations from a prior year's community healthcare initiative. 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 an BSN degree 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. The Ann Peters Memorial Scholarship is for a Scituate, Massachusetts resident pursuing a career in nursing. Ten scholarships totaling $10,500 were awarded in fiscal 2017. The Friends is a department of South Shore Hospital; funds and oversight of Friends scholarships come from the Hospital. X 1 1 1 1 0 0 0 0 0 1 0 John Walsh MD Director, President Medical Staff 0 255808 0 11156 80000 1244 0 18975 0 7183 80000 294366 0 0 Richard Aubut CEO through 11/2/15 0 0 144648 0 593484 0 33221 0 0 0 771353 0 0 0 Matthew Weiss MD SSPAE Director 0 619079 0 0 0 1386 0 65084 0 23991 0 709540 0 0 Gene Green MD SSH President and SSHS President & CEO 800810 0 237282 0 1932 0 135825 0 19867 0 1195716 0 225000 0 Joseph Cahill SSH President & COO through 7/15/16 295108 0 50041 0 512714 0 111086 0 23544 0 992493 0 285057 0 Margaret Holda Clerk 289335 0 37006 0 13820 0 54482 0 19274 0 413917 0 34502 0 Pamela Whelton EVP, CFO & Treasurer 499584 0 57938 0 5630 0 103369 0 1392 0 667913 0 57931 0 Rose Dipietro President Home & Community Care 377167 0 50190 0 25626 0 78542 0 9637 0 541162 0 50184 0 Timothy Quigley VP Acute Care Operations and CNO 349443 0 37395 0 19976 0 61981 0 19867 0 488662 0 36611 0 John Stevenson MD Vice President, Chief Medical Officer 503509 0 69331 0 6307 0 525664 0 25413 0 1130224 0 69322 0 Kimberly Dever MD Chief, OB and GYN 584869 0 0 0 23493 24345 59077 0 25412 0 692851 24345 0 0 Frederick Millham MD Chief of Surgery 685421 0 62577 0 3612 0 55744 0 1392 0 808746 0 54717 0 Timothy Lynch MD Chief of Medicine 399846 99656 0 1000 4052 30707 61952 0 18459 2589 484309 133952 0 0 E Delroy Dixon SVP, Chief Information Officer thru 7/15/16 177830 0 72678 0 321118 0 64306 0 21202 0 657134 0 223595 0 Richard Mirel MD Chief of Medicine 80902 0 38206 0 317954 0 10638 0 0 0 447700 0 252595 0 Robert Wheeler SVP Human Resources 62521 0 60659 0 264475 0 0 0 15335 0 402990 0 313789 0 Michael Cullen SVP, CFO & Treasurer thru 1/8/15 0 0 0 0 106936 0 0 0 1937 0 108873 0 44386 0 Christopher OConnor SVP External Affairs 293609 0 36829 0 18862 0 38150 0 25413 0 412863 0 36885 0 Matthew Whalen ED/VP South Shore PHO 346156 0 0 0 1166 0 0 0 15007 0 362329 0 0 0 Stephen Coco SVP, CFO & Treasurer 258534 0 0 0 6636 0 61195 0 19274 0 345639 0 0 0 Joseph Driscoll JD General Counsel 78591 0 0 0 276 0 0 0 4713 0 83580 0 0 0 Schedule J, Part I, Line 1a Schedule J, 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 ($6,604), Joseph Cahill ($50,084) and Michael Cullen ($4,785) received gross-up payments in tax year 2016 related to imputed income. Schedule J, Part I, Line 3 The Hospital's parent company, South Shore Health System, parent company of South Shore Hospital, 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. Schedule J, Part I, Line 4 For the year that ended December 31, 2016 the following individuals received salary continuation payments; the former SVP/CFO, Michael Cullen, received $44,386, E. Delroy Dixon, former CIO received $142,992, Robert Wheeler, former SVP, Human Resources received $253,133, Joseph Cahill, former President/COO received $235,022 and Richard Mirel, former Chief of Medicine, $257,650. 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. The individuals with asterisks are 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* Michael Cullen* Margaret Holda Timothy Quigley John Stevenson Pamela Whelton Kimberly Dever Stephen Coco Jason Tracy Thomas Cameron Christopher O'Connor Joseph Driscoll Matthew Weiss Schedule J, Part I, Line 7 The CEO and other key employees have the ability to earn bonues based upon certain metrics that the Board of Trustees approve. In addition, certain physicians can earn incentive payments based upon quality and other metrics. A Massachusetts Development Finance Agency 043431814 000000000 2012-09-14 78330000 See Part VI for complete description 0 0 0 B Massachusetts Development Finance Agency 043431814 57584XNN7 2016-05-10 155229109 See Part VI for complete description 0 0 0 A 14690833 0 78330000 0 0 0 739129 0 0 0 77590871 0 1 0 1 1 B 0 0 155999351 1962075 0 0 0 0 0 89894826 35226666 30877859 1 0 0 1 A 0 0 1 1 0 0.022 0 0.022 0 0 1 B 0 0 1 1 0 0 0 0 0 0 1 A 0 0 1 0 1 1 Deutsche Bank 20.0 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-09/14/2012 78,330,000 Massachusetts Development Finance Agency Series 2012 refunded bonds issued 02/28/08. Schedule K, Part I, Column f-05/10/2016 155,229,109 Massachusetts Development Finance Agency Series H will be used to construct a new critical care unit and renovate the existing critical care unit; Series I will be used to construct a new critical care unit, renovate the existing critical care unit and for other miscellaneous capital projects. The financing will also be used to upgrade the Hospital's electronic health record system, 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 4-05/10/2016 155,229,109 Massachusetts Development Finance Agency Amounts reported here consist entirely of bona fide debt service fund deposits. Gene E Green MD President/CEO Bridge Loan X 225000 175000 0 1 1 Richard Aubut CEO through 11/2/15 Split dollar life insurance policy X 6584825 6584825 0 1 1 Joseph Cahill President through 7/15/16 Split dollar life insurance policy X 2627209 2627209 0 1 1 Michael Cullen SVP, CFO through 1/8/15 Split dollar life insurance policy X 1186950 1186950 0 1 1 Margaret Holda Clerk/VP Marketing Split dollar life insurance policy X 259305 259305 0 1 1 Timothy Quigley VP Nursing/CNO Split dollar life insurance policy X 379867 379867 0 1 1 John Stevenson MD VP/CMO Split dollar life insurance policy X 760112 760112 0 1 1 Pamela Whelton EVP/COO Split dollar life insurance policy X 282248 282248 0 1 1 Kimberly Dever MD Chief of OB/GYN Split dollar life insurance policy X 212988 212988 0 1 1 Stephen Coco SVP, CFO, Treasurer Split dollar life insurance policy X 64986 64986 0 1 1 Jason Tracy MD Chief of Emergency Medicine Split dollar life insurance policy X 191280 191280 0 1 1 Thomas Cameron VP Support Services and Site Management Split dollar life insurance policy X 279442 279442 0 1 1 Christopher O'Connor SVP External Affairs Split dollar life insurance policy X 106680 106680 0 1 1 Joseph Driscoll General Counsel Split dollar life insurance policy X 57099 57099 0 1 1 Matthew Weiss SSPAE Director Split dollar life insurance policy X 120902 120902 0 1 1 13288893 Substantial Contributor Vendor 245177 Independent Contractor 0 Substantial Contributor Vendor 2181225 Independent Contractor 0 Substantial Contributor Vendor 482368 Independent Contractor 0 Substantial Contributor Vendor 8325445 Independent Contractor 0 Substantial Contributor Vendor 4534822 Independent Contractor 0 Substantial Contributor Vendor 388529 Independent Contractor 0 Substantial Contributor Vendor 110045 Independent Contractor 0 Substantial Contributor Vendor 630506 Independent Contractor 0 Substantial Contributor Vendor 156000 Independent Contractor 0 Substantial Contributor Vendor 288371 Independent Contractor 0 Substantial Contributor Vendor 868857 Independent Contractor 0 William Whelton Son of Pamela Whelton, COO 15421 Employment 0 X 5913 Donor Valuation X 13 173123 See Part II X 3 20784 Donor Valuation X Framed Print 1 100 Donor Valuation X Floral Arrangements/Venue Decor 2 935 Donor Valuation/Receipts 13 0 1 0 Schedule M, Part I, Line 9 Thirteen donations of publicly traded securities were received in FY17. Valuations for stock transactions are sales price less commission. Schedule M, Part I, Line 19 Three donations of food were made for various fundraising events. Donor valuation was used. Schedule M, Part I, Lines 25-28 One framed print was received in FY17. One donation of floral centerpieces for use during a fundraising event was received. Donor valuations were used for these items. One donation of venue decor for a wellness seminar was received. Valuation was based on receipts. Form 990, Part III, Line 4a The Hospital's emergency center is open 24 hours a day, every day of the year, and had 95,898 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 181,573 home visits to patients in fiscal 2017. Form 990, Part VI, Section A, Line 2 Kenneth Kirkland and Thomas McCarthy have a business relationship. John Walsh and Lisa Walsh have a family 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 Hospital's Form 990 is prepared internally and reviewed by the tax practice of its independent auditors, Deloitte Tax LLP. The complete Form 990 is provided to the entire governing body prior to the filing deadline. Form 990, Part VI, Section B, Line 12c Employees and 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, as well as all other members of the executive team. The consultant presents relevant data to the Committee for review and approval 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 Transfer to affiliate; -$15,000,000, Pension-related adjustments; $20,303,550. 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) 11c, Type III 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) 11a, Type I South Shore Health System Inc 0 Coastal Medical Associates Inc dba South Shore Physician Ambulatory Enterprise 55 Fogg Road South Weymouth MA 02190 043170333 Primary and 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 1 Atlantic Women's Health Inc 55 Fogg Road South Weymouth MA 02190 200156651 Specialized medical care MA 501(c)(3) 3 South Shore Hospital 1 Health Provider Services Organization of the South Shore Inc 55 Fogg Road South Weymouth MA 02190 452385865 Supports the charitable mission of SSH&E and affiliates MA 501(c)(3) 11c, Type III South Shore Health System Inc 0 Friends of South Shore Hospital Inc 55 Fogg Road South Weymouth MA 02190 042582248 Raises monies in support of South Shore Hospital and builds goodwill in the community MA 501(c)(3) 11a, Type I South Shore Hospital 1 South Shore Medical Center Inc 143 Longwater Drive Norwell MA 02061 042297845 Primary and specialized medical care MA 501(c)(3) 9 Coastal Medical Associates 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 1 0