2013-08-06T13:56:48-07:00 2012-09-30 990 2011-10-01 042769210 SOUTH SHORE HOSPITAL INC SOUT 7816248000 55 Fogg Road South Weymouth MA 02190 Michael Cullen 7816248431 2013-08-15 2011 2016-02-24 21:20:13Z Michael Cullen 55 Fogg road South Weymouth MA 02190 458175076 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. 16 13 4235 613 516916 0 5625887 11306876 415901917 441000495 1651279 -1562437 12448178 5671150 435627261 456416084 8000 11000 0 0 273956739 286974680 0 0 2423600 148867086 155126357 422831825 442112037 12795436 14304047 382439885 451819921 270921378 320117578 111518507 131702343 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 328720807 11000 441424175 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 318 acute care beds (composed of 205 medical/surgical, 32 intensive/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 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 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, 2012, the Hospital had 25,553 discharges and 180,675 outpatient days. The Hospital's emergency center is open 24 hours a day, every day of the year, and had 84,316 visits during the year. The Hospital's home care division helps people maintain their independence at home. The visiting nurses coordinate the appropriate specialists, services and community resources for each patient. Our home care division provided over 150,656 home visits to patients in fiscal 2012. 0 0 0 328720807 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 0 1 1 0 1 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 1 1 1 0 0 1 421 0 4235 1 1 1 0 0 0 0 1 1 1 6 0 0 0 0 X 16 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MA X Michael Cullen SVP CFO Treasurer 7816248431 55 Fogg Road South Weymouth MA 02190 Thomas S Vangel 1 X 0 0 0 J Leonard Bicknell 1 X 0 0 0 Kimberly McLaughlin 1 X 0 0 0 John Feldman MD 1 X 20200 0 0 Colleen Tondorf 1 X 0 0 0 John C Boucher 1 X 0 0 0 Brian Hotarek 1 X 0 0 0 Sherry Livingston 1 X 0 0 0 Kenneth Kirkland 1 X 0 0 0 Laura Avakian 1 X 0 0 0 Paula Becker 1 X 0 0 0 Chris Oddleifson 1 X 0 0 0 Richard Aubut 45 X X 1075376 0 241441 Michael Ayers MD 1 X 56667 0 0 David C Howse 1 X 0 0 0 Michael Cullen 45 X 486724 0 48302 Joseph Cahill 45 X 673604 0 90483 Paul Taylor 45 X 383080 0 42114 Rose Dipietro 45 X 331688 0 67241 Timothy Quigley 45 X 338221 0 72998 John Stevenson MD 45 X 533908 0 95667 Kathleen Heffernan 45 X 255016 0 47993 Frederick Ayers MD 40 X 429418 0 40751 Richard Mirel MD 45 X 512423 0 18389 Kenneth McLaughlin MD 45 X 449706 0 34137 Pamela Whelton 45 X 345570 0 74550 Jeffrey Johnson MD 45 X 375386 0 38659 John Benanti MD 45 X 446208 0 31909 6713195 0 944634 561 1 1 0 Brigham Women's Hospital PO Box 3684 Boston MA 022413684 Physician Services 3748358 Aramark Corporation 12483 Collections Center Drive Chicago IL 60693 Facilities Maintenance 1818198 South Shore Anesthesia Associates Inc 163 Libbey Pkwy Weymouth MA 02189 Physician Services 1642500 MModal Services LTD PO Box 120467 Atlanta GA 30368 Transcription Services 1171498 Specialized Receivables Inc PO Box 12414 Newark NJ 071013514 Billing/Collection 959870 74 0 0 674521 0 64750 10567605 2516823 11306876 Net Patient Service Revenue 622000 426097823 426097823 0 0 Ambulatory Cancer Center 621000 8503730 8503730 0 0 Meaningful Use 622000 5076306 5076306 0 0 Rental Income from Affiliates 531390 393387 393387 0 0 Miscellaneous Clinics 621990 355532 355532 0 0 573717 573717 0 0 441000495 1531078 0 0 1531078 0 0 0 0 0 0 0 0 1292233 0 718540 0 573693 0 573693 0 0 573693 -2196557 143494 0 1040452 -2196557 -896958 -3093515 0 0 -3093515 0 0 Related Income 900099 389878 389878 0 0 Cafeteria Sales 722212 2680471 0 0 2680471 Shields Imaging Income 621000 1095994 0 0 1095994 931114 33802 516916 380396 5097457 456416084 441424175 516916 3168117 11000 11000 2167574 1319288 848286 2566379 2566379 221569567 168349000 51651698 1568869 13680587 10256852 3423735 30766858 23142677 7624181 16223715 12163531 4060184 488644 488644 2004863 2004863 314604 314604 44689 44689 16933545 6403579 9984073 545893 853213 794825 58388 57243282 54168077 2968757 106448 4858476 4857821 655 5775396 4042777 1727655 4964 880547 707374 165837 7336 357185 120013 236964 208 6558109 4590676 1967433 19849146 13894402 5954744 2824923 1956496 868427 Physician Services 13804182 13804182 0 0 Equipment Maintenance Contracts 5343112 2680910 2659985 2217 Leases 5210002 4492446 682111 35445 Food 3021908 1631224 1389561 1123 8760531 4986303 3682174 92054 442112037 328720807 110967630 2423600 12489108 15406100 7217394 10103103 46045837 57008864 4794768 4905982 2387967 2855011 407931414 220472930 159218754 187458484 130026783 144730611 7743725 8340580 12515549 21011186 382439885 451819921 50683024 60680470 567994 711838 119142473 128106462 916667 100527887 129702141 270921378 320117578 X 97141214 115041829 13079185 15352406 1298108 1308108 111518507 131702343 382439885 451819921 X 14304047 5879789 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 3250 0 1 44689 47939 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Item g: Amount represents the salaries of employees who engaged in lobbying activities on behalf of South Shore Hospital. Item i: Amount represents a percentage of the Hospital's annual apportionment of MHA/AHA dues attributable to lobbying expenses. MHA/AHA gives its members an annual percentage breakdown of member dues utilized for lobbying activities. For the year ended September 30, 2012, it was determined that 23.98% 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. 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 0.08 0.92 1 0 0 5009617 5009617 0 163646996 85046336 78600660 0 14550954 2298220 12252734 0 169054220 128775486 40278734 0 55669627 4352888 51316739 187458484 0 Accrued Pension & Retirement Benefits 56399000 Due to 3rd Party Payors 20890624 Loss on Swaps 15780761 Capital Leases 15306760 Malpractice Payable 9132539 Accrued Workers Compensation 6497375 Billing Reserves 1801273 Physician Benefits Payable 1732752 Executive Benefits Payable 1279406 Due to Affiliates 616710 FIN 47 Liability 264941 129702141 456416084 442112037 14304047 18190785 0 0 0 -12310996 5879789 20183836 447429034 0 0 0 1279682 1279682 446149352 0 10266732 10266732 456416084 443253354 0 0 0 1141317 1141317 442112037 0 0 0 442112037 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) No. 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_L08 Schedule D, Part XI, Line 8 Pension-related adjustment; -$17,310,996, transfer from affiliate; $5,000,000. SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Net assets released from restrictions; $1,279,682. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Contributions; $11,306,876, investment income; $101,173, cost of good sold - shops; -422,777, rental expense; -$718,540. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rental expense; $718,540, cost of goods sold - shops; $422,777. Moonlight & Miracles 375689 208017 167672 0 5795 22546 34450 82191 22690 Walk for Hospice 206972 137418 69554 0 0 6971 6870 0 55713 9 505838 329086 176752 0 4200 80743 43257 19099 29453 1088499 674521 413978 0 9995 110260 84577 101290 107856 413978 0 1 1 1 X 1 X 1 1 1 0 1 1 4262613 76090 4186523 0.0093 46330371 37961418 8368953 0.0187 2919375 0 2919375 0.0065 0 0 53512359 38037508 15474851 0.0345 821465 15146 806319 0.0018 785988 0 785988 0.0018 46822406 41696693 5125713 0.0114 221091 34151 186940 0.0004 46800 0 46800 0.0001 0 0 48697750 41745990 6951760 0.0155 0 0 102210109 79783498 22426611 0.0500 76989 0 76989 0.0002 55364 0 55364 0.0001 65462 0 65462 0.0001 159028 30746 128282 0.0003 810807 0 810807 0.0018 0 0 1167650 30746 1136904 0.0025 1 10401481 0 114112087 124149052 -10036965 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 1 200 1 400 1 X X X X X X 1 1 X X 1 0 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 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. 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 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 Fund (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 of 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. 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_L13 Schedule H, Part V, Section B, Line 13 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 couselors' 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_L19 Schedule H, Part V, Section B, Line 19 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 2011. 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 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 and the Kaiser Family Foundation. 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 health assessments. Data collected helps determine unmet health needs in the region. 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 days a week. In addition to helping patients understand eligibility for reduced or free care, during the fiscal year ended September 30, 2012 counselors assisted roughly 3,500 people in obtaining health insurance. Approximately half of those assisted in obtaining health insurance were not our patients. SchH_P06_S00_L04 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. 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: http://www.southshorehospital.org/community-benefits-reports. 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. 1 Friends Scholarships for students pursuing health care degrees. 11 11000 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. Eleven $1,000 scholarships were awarded in fiscal 2012. X X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Richard Aubut 740334 0 38109 0 296933 0 220760 0 20681 0 1316817 0 38109 0 Michael Cullen 402742 0 2840 0 81143 0 27621 0 20680 0 535026 0 2840 0 Joseph Cahill 474098 0 99236 0 100270 0 69801 0 20682 0 764087 0 99236 0 Paul Taylor 333396 0 9633 0 40051 0 26476 0 15638 0 425194 0 9633 0 Frederick Ayers MD 390089 0 23675 0 15654 0 22050 0 18700 0 470168 0 23675 0 Richard Mirel MD 456110 0 45645 0 10668 0 18389 0 0 0 530812 0 45645 0 John Benanti MD 389376 0 21232 0 35600 0 16272 0 15638 0 478118 0 21232 0 Rose Dipietro 300446 0 33569 0 -2327 0 57890 0 9351 0 398929 0 33569 0 Timothy Quigley 297504 0 29656 0 11061 0 48334 0 24664 0 411219 0 29656 0 Pamela Whelton 275644 0 65382 0 4544 0 53869 0 20681 0 420120 0 65382 0 John Stevenson MD 423653 0 89120 0 21135 0 74986 0 20681 0 629575 0 89120 0 Kathleen Heffernan 230554 0 28010 0 -3548 0 29292 0 18701 0 303009 0 28010 0 Kenneth McLaughlin MD 455030 0 0 0 -5324 0 15436 0 18701 0 483843 0 0 0 Jeffrey Johnson MD 380694 0 0 0 -5308 0 17978 0 20681 0 414045 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 executives. 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 (13 of 16) 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 and the former Chief of the Emergency Department received salary continuation payments in FY12. 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. Massachusetts Health and Educational Facilities Authority 042456011 57586CS22 2008-02-28 94585000 See Part VI for complete description 0 0 0 16255000 0 94994157 1306 430596 0 992237 1532325 0 37980165 46929086 0 2009 1 1 1 1 0 0 1 1 0 0.022 0 0.022 1 0 1 1 Deutche Bank 24.3 0 0 1 AIGMFC .6 1 0 1 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 investment earnings. SchK_P02_S00_L04 Schedule K, Part II, Line 4 The amount shown here consists of a debt service fund deposit. SchK_P04_S00_L05 Schedule K, Part IV, Line 5 This question is being answered without regard to a yield-restricted advance refunding escrow financed with proceeds of the bond. SchK_P05_S00_L00 Schedule K, Part V South Shore Hospital has not finalized written procedures to undertake corrective action as of September 30, 2012. Richard Aubut Split dollar insurance premiums X 5052989 5052989 0 1 1 Joseph Cahill Split dollar insurance premiums X 1798518 1798518 0 1 1 Michael Cullen Split dollar insurance premiums X 1489535 1489535 0 1 1 Paul Taylor Split dollar insurance premiums X 1238691 1238691 0 1 1 Frederick Ayers MD Split dollar ins premiums X 870183 870183 0 1 1 Timothy Quigley Split dollar ins premiums X 231469 231469 0 1 1 Pamela Whelton Split dollar ins premiums X 194939 194939 0 1 1 John Stevenson MD Split dollar ins premiums X 319304 319304 0 1 1 11195628 Michael Ayers MD SSH director and greater than 5% Member of South Shore Orthopedics, LLC 856700 Independent Contractor 0 Michael Ayers MD SSH director and greater than 5% Member of SurgiSouth, LLC 699996 Independent Contractor 0 Frederick Ayers MD Chairman SSH Department of Surgery and father of SSH director Michael Ayers 470170 Employment 0 X 7 2516823 See Part II 0 1 1 SchM_P01_S00_L09 Schedule M, Part I, Line 9 Valuations for stock transactions are sales price less commission. SchM_P01_S00_L32b Schedule M, Part I, Line 32b The Hospital liquidates contributions of publicly traded securities through a third party brokerage firm. Whenever possible, the brokerage firms sells stock on the next business day after receipt. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 J. Leonard Bicknell and John Boucher--business relationship. J. Leonard Bicknell and Christopher Oddleifson--business relationship. Frederick Ayers and Michael Ayers--family relationship. Many of the persons listed on Part VIII have a "business relationship" with each other by virtue of sitting on boards of entities related to South Shore Hospital. 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 President/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. 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_S0B_L15 Form 990, Part VI, Section B, Line 15 South Shore Hospital utilizes an outside consultant to determine compensation for Richard Aubut (CEO), Michael Cullen (CFO), and Joseph Cahill (COO). The consultant presents relevant data to the board for review and approval for these three individuals. All data presented, as well as compensation deliberations and votes, is documented in the board 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 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. 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_L05 Form 990, Part XI, Line 5 Transfer from affiliate; $5,000,000, change in net unrealized gains on investments; $18,190,785, pension-related adjustments; -$17,310,996. 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 South Shore Health & Educational Corporation 0 South Shore Physician-Hospital Organization Inc 55 Fogg Road South Weymouth MA 02190 043248480 Supports SSH Physicians MA N/A C 1622258 5832818 0.5 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 0 1 Coastal Medical Associates Inc a-iv 182056 Sublease of medical office space at lease amount. South Shore Property Inc a-iv 63250 Fair market value of Ambulatory Cancer Center property. South Shore Property Inc j 1634775 Fair market value for space leased in Ambulatory Cancer Center. South Shore Property Inc k 245737 Salaries and benefits of Hospital employees. Coastal Medical Associates Inc o 7982734 Reimbursed services of physicians. Health Provider Services Organization of the South Shore Inc o 302500 50% of executive salary per employement agreement. Coastal Medical Associates Inc p 1333440 Expenses reimbursed at actual cost.