2014-07-28T11:29:31-07:00 2013-09-30 990 2012-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 Fogg Road South Weymouth MA 02190 Michael Cullen 7816248431 2014-08-15 2012 2015-11-30 17:44:51Z Michael Cullen 55 Fogg Road South Weymouth MA 02190 481866623 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. 12 10 4229 600 585638 -250668 11306876 1855965 441000495 461287953 -1562437 8497588 5671150 7502865 456416084 479144371 11000 10000 0 0 286974680 294071788 0 0 2174950 155126357 163890773 442112037 457972561 14304047 21171810 451819921 461855710 320117578 270626900 131702343 191228810 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 338060645 10000 463295928 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 378 acute care beds (composed of 265 medical/surgical, 32 intensive care/coronary care, 53 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 officers 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 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, 2013, the Hospital had 24,955 discharges and 184,561 outpatient days. The Hospital's emergency center is open 24 hours a day, every day of the year, and had 85,940 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 160,345 home visits to patients in fiscal 2013. 0 0 0 338060645 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 0 0 1 358 0 1 4229 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 10 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 MA X Michael Cullen SVP CFO Treasurer 7816248431 55 Fogg Road South Weymouth MA 02190 John Feldman MD 1 0 X 6806 0 0 John C Boucher 1 0 X 0 0 0 Brian Hotarek 1 1 X 0 0 0 Sherry Livingston 1 0 X 0 0 0 Kenneth Kirkland 1 1 X 0 0 0 Lisa Constantino 1 0 X 0 0 0 Paula Becker 1 0 X 0 0 0 Chris Oddleifson 1 0 X 0 0 0 David C Howse 1 0 X 0 0 0 Thomas McCarthy 1 0 X 0 0 0 Richard Aubut 40 7.00 X X 1204508 0 100947 Maria Recaldo 1 0 X 0 0 0 Margaret Holda 40 1 X 272110 0 65470 Michael Cullen 40 5 X 521131 0 44873 Joseph Cahill 40 8.00 X 641108 0 87242 Paul Taylor 45 0 X 411162 0 36766 Rose Dipietro 45 0 X 363663 0 65406 Timothy Quigley 45 0 X 314783 0 73091 John Stevenson MD 40 5 X 507184 0 100719 Frederick Ayers MD 45 0 X 440191 0 38950 Richard Mirel MD 45 1 X 551670 0 36069 Kenneth McLaughlin MD 45 0 X 429705 0 18006 Jeffrey Johnson MD 45 0 X 360775 0 568 Wayne Chin MD 45 0 X 343780 0 0 Kathleen Heffernan 45 1 X 307688 0 21408 6676264 0 689515 1903 1 1 0 Brigham Women's Hospital PO Box 3684 Boston MA 022413684 Physician Services 4125785 Aramark Corporation 12483 Collections Center Drive Chicago IL 60693 Facilities Maintenance 1933740 South Shore Anesthesia Associates Inc 163 Libbey Pkwy Weymouth MA 02189 Physician Services 1646667 Foley & Lardner LLP 111 Huntington Aveenue 26th Floor Boston MA 02199 Legal 1631182 MModal Services LTD PO Box 120467 Atlanta GA 30368 Transcription Services 1131073 68 0 0 628738 0 111900 1115327 12544 1855965 Net Patient Service Revenue 622000 445485384 445485384 0 0 Ambulatory Cancer Center 621000 11249762 11249762 0 0 Meaningful Use 622000 2933136 2933136 0 0 Education & Other Community Services 621990 879822 879822 0 0 Rental Income from Affiliates 531390 269399 269399 0 0 470450 470450 0 0 461287953 546269 0 0 546269 0 0 0 0 0 0 0 0 1301061 0 1263847 0 37214 0 37214 0 0 37214 8830177 213202 0 1092060 8830177 -878858 7951319 0 0 7951319 366345 628738 366345 0 0 0 Food Service Revenue 722211 3106347 0 0 3106347 Related Income 900099 1971733 1971733 0 0 Shields Imaging Income 621000 1295228 0 0 1295228 1092343 36242 585638 470463 7465651 479144371 463295928 585638 13406840 10000 10000 2211221 1422436 788785 2580838 2580838 227696336 171699908 54512987 1483441 14401124 10723788 3677336 0 29552197 22044844 7507353 0 17630072 13128223 4501849 0 497739 0 497739 0 4492570 0 4492570 0 276859 0 276859 0 39385 0 39385 0 0 0 18192536 7049408 10638726 504402 481254 0 459292 21962 60447413 56902430 3482591 62392 5972701 0 5972006 695 6128468 4289928 1838540 0 986197 786191 188911 11095 348411 122468 225878 65 7388363 5171854 2216509 0 21180642 14826449 6354193 0 2528019 1628244 899775 0 Physician Services 12524513 12524513 0 0 Equipment Maintenance Contracts 5560181 2813332 2746626 223 Leases 4555485 3873374 682111 0 Food 3118513 1683923 1434452 138 9171524 7359332 1721655 90537 457972561 338060645 117736966 2174950 15406100 20203736 10103103 5626931 57008864 59067543 4905982 5229947 2855011 2834411 418126458 238595824 187458484 179530634 144730611 158013011 8340580 6386881 21011186 24962616 451819921 461855710 60680470 50077457 711838 939819 128106462 122781293 916667 366667 129702141 96461664 320117578 270626900 X 115041829 179123669 15352406 10781983 1308108 1323158 131702343 191228810 451819921 461855710 X 21171810 12517505 0 0 0 25837152 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 11031 0 1 39385 50416 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Item g: Amount represents salaries and related business expenses for employees who engages in lobbying activities on behalf of South Shore Hospital. Also included in this amount are legal fees related to lobbying activities. Item i: Amount represents a percentage of the Hospital's annual apportionment of MHA/AHA dues attributable to lobbying expenses. MHA/AHA provides its members with an annual percentage breakdown of member dues expended for lobbying purposes. For the year ended September 30, 2013, it was determined that 20.09% 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 nonelected officials to visit our hospital to discuss health care policy issues affecting our region, the Commonwealth and the nation. 16660514 -549950 213862 0 3837515 381770 12105141 14377293 9263114 291483 0 6836541 434835 16660514 15699262 4387199 9081 0 5718249 0 14377293 13850141 4476910 118349 0 2746138 0 15699262 12001684 3287147 159536 0 1598226 0 13850141 0 0.11 0.89 1 0 0 5009617 5009617 0 201996582 91589659 110406923 0 15013788 3148509 11865279 0 175807811 138725481 37082330 0 20298660 5132175 15166485 179530634 Life Insurance 11019425 Insurance Recoveries 7376907 Miscellaneous Other Revenue 4864315 Unamortized Issue Costs 1475219 Series G Swap 130957 Due from Affiliates 87435 Rent Receivable 8358 24962616 0 Due to 3rd Party Payors 27018024 Accrued Pension Liabilities 22914848 Capital Leases 14613362 Loss on Swaps 10262816 Malpractice Payable 7981662 Accrued Workers Compensation 6552320 Physician Benefits Payable 2055416 Billing Reserves 1801273 Executive Benefits Payable 1487954 Community Health Initiatives Payable 1402500 FIN 47 Liability 264941 Due to Affiliates 85266 Security Deposits 21282 96461664 X 472388892 0 0 0 2329836 2329836 470059056 0 9085315 9085315 479144371 459680823 0 0 0 1708262 1708262 457972561 0 0 0 457972561 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The Hospital maintains its endowment funds to further its charitable purposes and those of its affiliates. In the past, endowment funds have been used to expand and maintain the Hospital's infrastructure, purchase state-of-the-art medical equipment and provide health and wellness services to the community. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The Hospital follows the provisions of FASB Accounting Standards Codification (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. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d Net assets released from restrictions; $2,329,836. SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Gains on interest rate swaps; $5,510,961, gains on investments; $3,235,222, contributions; $1,855,965, investment income; $191,429, cost of good sold - shops; -$444,415, rental expense; -$1,263,847. SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Cost of goods sold - shops; $444,415, rental expense; $1,263,847. Moonlight & Miracles 356350 192327 164023 0 17395 10327 54719 43559 38023 Walk for Hospice 202942 154542 48400 0 0 8138 4225 0 36037 8 435791 281869 153922 0 2657 56790 45470 4100 44905 995083 628738 366345 0 20052 75255 104414 47659 118965 366345 0 1 1 1 X 1 X 1 1 1 0 1 1 3843453 72197 3771256 0.0082 49263658 42746492 6517166 0.0142 2919375 0 2919375 0.0064 0 0 56026486 42818689 13207797 0.0288 893529 12345 881184 0.002 821138 0 821138 0.0018 72142967 62206853 9936114 0.0217 247588 120980 126608 0.0003 335550 0 335550 0.0007 0 0 74440772 62340178 12100594 0.0265 0 0 130467258 105158867 25308391 0.0553 0 0 0 0 0 0 0 0 72877 0 72877 0.0001 0 0 0 0 0 0 0 0 119607 0 119607 0.0003 59656 0 59656 0.0001 253660 31427 222233 0.0005 531890 0 531890 0.0012 0 0 1037690 31427 1006263 0.0022 1 11486203 0 119630110 127915803 -8285693 X 1 1 1 1 South Shore Hospital Inc

55 Fogg Road South Weymouth MA 02190

X X X X See Schedule H, Part VI South Shore Hospital Inc 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X 0 0 1 1 200 1 400 1 X X X X X X 1 1 X X 1 0 X X X X X 1 X 0 0 6 Ambualtory 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. Pre-surgery Evaluation

797 Main Street 1st Floor South Weymouth MA 02190

Pre-surgical testing and evaluation clinic. Outpatient Services

780 Main Street South Weymouth MA 02190

Outpatient surgery center. SchH_P01_S00_L07 Schedule H, Part I, Line 7 South Shore Hospital uses the cost to charge ratio for calculating amounts inthe 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. SchH_P01_S00_L072f 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. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Not applicable. SchH_P02_S00_L00 Schedule H, Part II Community building activities are undertaken to meet the needs of the residents of southeastern Massachusetts. 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, clinical and medical workforce development programs insure the needs of the community are met. The Hospital provides services such as pastoral care to patients and their families. SchH_P03_S0A_L04 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 (HSN), net of recoveries from HSN for reimbursable bad debts. SchH_P03_S0B_L08 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 possible forgo medical treatment without the services the Hospital provides. The Hospital uses the Medicare 2552 Report for costs. SchH_P03_S0C_L09b 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 400% 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 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 201-400% 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. SchH_P05_S0A_L00 Schedule H, Part V, Section A Other medical services include: physician offices, outpatient surgical centers, radiology/mammography offices, wound care center, ambulatory cancer center and center for orthopedics, spine and sports medicine. Some of these services are provided at satellite locations, all of which are included in the Hospital's license. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 The Hospital relies on input from individuals and organizations within the community to develop its Needs Assessment. The Hospital is an active supporter of, and participant in, three Community Health Network Areas (CHNAs)--Blue Hills Community Health Alliance (CHNA 20), the Greater Brockton Community Health Network Area (CHNA 22) and the South Shore Community Partners in Prevention (CHNA 23). The CHNAs collected information by meeting with groups and individuals and also conducting surveys. The Hospital utilized data gathered by the CHNAs in its Needs Assessment. Our Patient and Family Advisory Council brings together patients and their families, South Shore Hospital administrators and healthcare professionals to develop new services and programs and improve the overall patient experience. The group meets monthly and issues an annual report of their findings and accomplishments. The Hospital also relies on the expertise of various physicians, nurses and other clinical and non-clinical professionals within our facility. Hospital colleague advisors, in groups and as individuals, have been instrumental in the development of the Needs Assessments. Finally, the Hospital gets input from community advisors. Local school, government, law enforcement and safety officials, social service and health and welfare agencies make up this group. While many of these agencies participate in the CHNAs, Hospital personnel also meet with representatives of various groups/agencies individually to seek their input in formulating the Needs Assessment. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 Fifteen community health and social issues were identified during the assessment process. While the Hospital offers programs that focus on adolescent mental health, specifically youth suicide prevention, it does not directly address mental health issues affecting adults and the community at large due to the scope of the problem and limited resources. Violence/safety was another area identified that the Hospital cannot fully address as it is beyond our scope as a healthcare provider. Lack of sleep is an identified area of need that the Hospital can address in a limited way via its sleep clinic. Oral health in the community will not be addressed due to lack of expertise and supporting clinical programs at the Hospital. The Hospital has identified dementia as a community health issue. Although the Hospital has various wellness in vulnerable population programs focusing on seniors, it does not plan to offer specific programs related to dementia at this time. SchH_P05_S0B_L14 Schedule H, Part V, Section B, Line 14 The Hospital makes its financial assistance policy available to the community, in its entirety, on its website. It is also available upon request. 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. Notification of financial assistance and counseling availability is printed on patient billing invoices. SchH_P05_S0B_L18 Schedule H, Part V, Section B, Line 18 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 during the admission process, a financial counselor may meet with the patient during his hospital stay. Counselors assist unisured 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. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 FAP-eligible individuals are billed at 70% of charges. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The Hospital's most recent Community Health Needs Assessment was completed in September 2013. South Shore Hospital utilizes information from many sources to determine the needs of individuals in the communities it serves. The Hospital reviews and analyzes health trends in our patient population. The Hospital also reviews data from the Town of Weymouth, Massachusetts Community Health Information Profile, American Hospital Association, Massachusetts Hospital Association, Massachusetts Health Data Consortium, Federal Centers for Disease Control, Trust for America's Health, Kaiser Family Foundation, Truven Health Analytics and Healthy Communities Institute. South Shore Hospital is involved with three Community Health Network Areas (CHNAs), serving 34 communities south of Boston, to address public health priorities. CHNAs were formed in 1992 by the Massachusetts Department of Public Health to encourage public, non-profit and private sectors to work together to build healthier communities. South Shore Hospital is working with these CHNAs to conduct community heath assessments. Data collected helps determine unmet needs in the region. Our Community Health Needs Assessment can be found at: http://www.southshorehospital.org/community-health-assessments. SchH_P06_S00_L03 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 provides its credit and collection policy on its website. 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 day 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. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 South Shore Hospital serves an area south of Boston with a population of approximately 700,000. 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. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 South Shore Hospital is committed to providing community building activities that promote the health and wellbeing 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 has partnered with towns in its service area to treat underserved and at-risk populations. The Hospital makes its Community Benefits Report and current year Community Benefits Plan available through mailings and on its website at http://www.southshorehospital.org/communitybenefits. For more information about South Shore Hospital's active role in meeting the needs of our community please visit our website: http://www.southshorehospital.org. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 South Shore Hospital is not part of an affiliated health care system. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 South Shore Hospital files its Community Benefits report in Massachusetts. SchH_P06_S00_L08 Schedule H, Part VI, Line 8 Not applicable. 1 Friends Scholarships for students pursuing health care degrees. 10 10000 0 Cash SchI_P01_S00_L02 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 the Hospital. SchI_P03_S00_L00 Schedule I, Part III The Friends of South Shore Hospital, an auxiliary Hospital organization, offers several scholarships to students pursuing health care degrees. Individuals must apply for these scholarships and present evidence that they meet the qualifications. The Nursing Scholarship is for a full-time or regular part-time employee of South Shore Hospital. The employee must be presently enrolled at an accredited school pursuing a 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 of South Shore Hospital 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. Ten $1,000 scholarships were awarded in fiscal 2013. As of October 1, 2010, the Friends is a department of South Shore Hospital; funds and oversight of Friends' scholarships comes from the Hospital. X X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Richard Aubut 765317 0 111564 0 327627 0 82290 0 18657 0 1305455 0 41429 0 Michael Cullen 419351 0 3180 0 98600 0 23135 0 21738 0 566004 0 3180 0 Joseph Cahill 491085 0 39007 0 111016 0 65504 0 21738 0 728350 0 39007 0 Paul Taylor 346173 0 34247 0 30742 0 20316 0 16450 0 447928 0 34247 0 Frederick Ayers MD 401448 0 23675 0 15068 0 22500 0 16450 0 479141 0 23675 0 Richard Mirel MD 469908 0 71915 0 9847 0 19619 0 16450 0 587739 0 71915 Kenneth McLaughlin MD 433727 0 0 0 -4022 0 18006 0 0 0 447711 0 0 0 John Stevenson MD 441405 0 52554 0 13225 0 78981 0 21738 0 607903 0 52554 0 Jeffrey Johnson MD 366334 0 0 0 -5559 0 568 0 0 0 361343 0 0 0 Margaret Holda 244533 0 22530 0 5047 0 49020 0 16450 0 337580 0 22530 0 Rose Dipietro 312220 0 40661 0 10782 0 57181 0 8225 0 429069 0 0 0 Timothy Quigley 318835 0 0 0 948 0 52493 0 20598 0 392874 0 0 0 Kathleen Heffernan 241476 0 40988 0 25224 0 4958 0 16450 0 329096 0 40988 0 Wayne Chin MD 347656 0 0 0 -3876 0 0 0 0 0 343780 0 0 0 SchJ_P01_S00_L01a 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. Health or social club dues or initiation fees are reported as income for reimbursement of health club memberships/dues up to a certain dollar level. Personal services are reported as income for reimbursement of financial services expenses up to a certain level. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Hospital has a Compensation Committee that meets periodically and engages an independent external compensation consulting firm to establish the compensation of the CEO and other key employees. The consulting firm develops and presents all materials including market trends, compensation studies and surveys, and adheres to best practice guidelines. The final recommendation for compensation changes is presented and approved by the entire independent community (12 of 14) of the Hospital Board of Directors. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The former VP Regulatory Affairs and Chief Risk Officer received salary continuation payments in FY13. South Shore Hospital offers a split dollar insurance plan to certain key employees/highly compensated employees. Richard Aubut, Joseph Cahill, Paul Taylor, Frederick Ayers, Michael Cullen, Timothy Quigley, Pamela Whelton and John Stevenson participate in this plan. A Massachusetts Health and Educational Facilities Authority 042456011 57586CS22 2008-02-28 94585000 See Part VI for complete description 0 0 0 A 20525000 0 94994157 0 430596 0 992237 1532325 0 37980165 54058834 0 2009 1 1 1 1 A 0 0 1 1 0 0.022 0 0.022 0 0 0 A 0 0 0 1 1 1 Deutche Bank 24.3 0 0 1 AIGMFC .6 1 0 0 A 0 SchK_P01_S00_L00f Schedule K, Part I, Column f Series G bond issue financed various hospital improvements and construction of the Ambulatory Cancer Center garage, refunded bonds issued 06/15/93 and 07/01/99. SchK_P02_S00_L03 Schedule K, Part II, Line 3 Differences between the issue price (Part I) and total proceeds (Part II, line 3) are due to investement earnings. SchK_P04_S00_L02c Schedule K, Part IV, Line 2c The rebate calculation was made 10/01/12; no rebate was due. SchK_P04_S00_L06 Schedule K, Part IV, Line 6 This question is being answered without regard to a yield-restricted advance refunding escrow financed with proceeds of the bonds. Richard Aubut CEO Split dollar insurance policy X 5693280 5693280 0 1 1 Joseph Cahill SSH President & COO Split dollar insurance policy X 2022908 2022908 0 1 1 Michael Cullen SVP, CFO & Treasurer Split dollar insurance policy X 1718374 1718374 0 1 1 Paul Taylor Clerk & VP thru 12/31/12 Split dollar policy X 1324853 1324853 0 1 1 Margaret Holda Clerk beginning 1/1/13 Split dollar insurance policy X 190520 190520 0 1 1 Timothy Quigley Vice President Nursing Services & Chief Nursing Officer Split dollar insurance policy X 264536 264536 0 1 1 John Stevenson MD Vice President Split dollar insurance loan X 399130 399130 0 1 1 Frederick Ayers MD Chief, Surgery Split dollar insurance policy X 966870 966870 0 1 1 12580471 John Feldman MD SSH Director and greater than 5% Member of South Shore Urology, Inc. 248100 Rental of Real Property from Hospital 0 John Feldman MD SSH Director and greater than 5% Member of South Shore Urology, Inc. 45000 Independent Contractor 0 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 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. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 South Shore Health and Educational Corporation, an affiliate, is the sole member of the corporation. F990_P06_S0B_L11b 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 CFO and CEO. Form 990 is presented for review to the governing body as a whole at the next regularly scheduled meeting prior to the filing deadline. The Board Chair and Vice Chair will review and comment to executive leadership regarding Form 990 prior to the filing deadline. F990_P06_S0B_L12c 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. F990_P06_S0C_L19 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 to the general public at the Corporation's office. Copies of these documents are available upon request. In addition, certain governing documents are available through the Massachusetts Secretary of the Commonwealth's Corporations Division database. F990_P11_S00_L09 Form 990, Part XI, Line 9 Pension related adjustments, $26,787,152; Transfers from affiliates, $1,500,000; Write off of uncollectible pledges from prior years, -$2,450,000. F990_P12_S00_L02b Form 990, Part XII, Line 2b The Hospital's financial statements are presented on both a consolidated and separate basis. South Shore Health and Educational Corporation and Subsidiaries is audited by independent accountant Deloitte & Touche LLP. The governing body of South Shore Health and Educational Corporation, acting as an audit committee of the whole, assumes responsibility for oversight of the audit of its (parent and affiliate) financial statements and selection of an independent auditor. The audit of South Shore Hospital, Inc. is issued separately and consolidated by Deloitte & Touche LLP into the annual audit of South Shore Health and Educational Corporation and Subsidiaries. The financial statements are prepared in accordance with GAAP. South Shore Health & Educational Corporation 55 Fogg Road South Weymouth MA 02190 042105926 Parent company of South Shore Hospital MA 501(c)(3) 11, Type I 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) 11, Type I South Shore Hospital 1 Coastal Medical Associates Inc 55 Fogg Road South Weymouth MA 02190 043170333 Primary and specialized medical care MA 501(c)(3) 3 South Shore Hospital 1 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) 11, Type III South Shore Health & Educational Corporation 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) 11, Type I South Shore Hospital 1 South Shore Physician-Hospital Organization Inc 55 Fogg Road South Weymouth MA 02190 043248480 Supports SSH Physicians MA N/A C 3202853 8088462 0.5 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 0 1 Coastal Medical Associates Inc a-iv 50632 Sublease of medical office space at lease amount. South Shore Property Inc a-iv 63250 Fair market value of Ambulatory Cancer Center. South Shore Property Inc a-iv 50934 Estimated revenue of 70 parking spaces at Ambulatory Cancer Center garage utilized by patients and their families. South Shore Property Inc k 1714162 Fair market value for space lease in Ambulatory Cancer Center. South Shore Property Inc l 256954 Salaries and benefits of Hospital employees. Coastal Medical Associates Inc p 7708270 Reimbursed services of physicians. Health Provider Services Organization of the South Shore Inc p 334976 50% of executive salary and physician director stipends per agreement. Coastal Medical Associates Inc q 1268138 Expenses reimburse at actual cost. South Shore Property Inc s 1000000 Transfer of cash from related organization.