2024-08-15T16:16:04-05:00 2023-09-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2022-10-01 042297845 SOUTH SHORE MEDICAL CENTER INC SOUT 7818785200 143 LONGWATER DRIVE NORWELL MA 02061 STEPHEN JENNEY SVP & CFO 7816248000 2024-08-15 1 0 SHAWNA M JANSONS P01222873 3174648600 2022 2024-08-08 14:25:15Z STEPHEN JENNEY 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 88675084 0 X WWW.SOUTHSHOREHEALTH.ORG X 2004 MA SOUTH SHORE MEDICAL CENTER CARES FOR PATIENTS COMPASSIONATELY AND EFFECTIVELY, WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS. WE BUILD A BETTER FUTURE FOR THE COMMUNITIES WE SERVE THROUGH TEACHING, LEADERSHIP IN HEALTH CARE INNOVATION AND PHILANTHROPY. 17 12 768 12 0 0 0 0 80625406 80599616 0 0 1172835 8075468 81798241 88675084 0 0 0 0 67515262 69105497 0 0 0 21018759 27861449 88534021 96966946 -6735780 -8291862 57053453 59822242 51472308 62532959 5581145 -2710717 X SOUTH SHORE MEDICAL CENTER DELIVERS EFFECTIVE AND COMPASSIONATE PATIENT CARE WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS. WE BUILD A BETTER FUTURE FOR THE COMMUNITIES WE SERVE THROUGH TEACHING AND LEADERSHIP IN HEALTHCARE INNOVATION. YOUR HEALTH, OUR PASSION, ONE COMMUNITY. 0 0 84722328 88653709 SOUTH SHORE MEDICAL CENTER PROVIDED MEDICAL, PREVENTATIVE AND OTHER CLINICAL SERVICES TO ITS PATIENTS. THE ORGANIZATION WORKS TO IMPROVE THE QUALITY OF HEALTH CARE SERVICES PROVIDED TO PATIENTS IN SOUTHEASTERN MASSACHUSETTS THROUGH CLINICAL INTEGRATION AND THE IMPLEMENTATION OF A UNIFIED ELECTRONIC MEDICAL RECORDS SYSTEM. SOUTH SHORE MEDICAL CENTER PARTICIPATED IN EDUCATIONAL AND TRAINING PROGRAMS FOR MEDICAL STUDENTS AND MEDICAL RESIDENTS AND FOR OTHER HEALTHCARE PROFESSIONALS INCLUDING PHYSICIAN ASSISTANTS AND NURSES. 84722328 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 768 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 12 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X STEPHEN JENNEY 7816248000 55 FOGG RD SOUTH WEYMOUTH MA 01290 ALLEN SMITH MD PRESIDENT & CEO 0.50 44.00 X X 0 944596 183703 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0.50 43.00 X 0 760671 39182 JUSTIN CAMPBELL DIRECTOR 0.50 4.00 X 0 181000 0 BRADFORD SAMPSON DIRECTOR 0.50 4.00 X 0 82000 0 MICHAEL AYERS MD DIRECTOR 0.50 5.00 X 0 73333 0 PAMELA O'LEARY CHAIR 0.50 4.00 X X 0 0 0 THOMAS MCCARTHY VICE CHAIR 0.50 4.00 X X 0 0 0 ALAN MCKIM DIRECTOR 0.50 4.00 X 0 0 0 CHRISTOPHER ODDLEIFSON DIRECTOR 0.50 4.00 X 0 0 0 ELLEN ESSENFELD DIRECTOR 0.50 4.00 X 0 0 0 HELEN GARVEY DIRECTOR 0.50 4.00 X 0 0 0 LINDA THOMPSON MPH DRPH RN FAAN DIRECTOR 0.50 4.00 X 0 0 0 LISA WALSH DIRECTOR 0.50 4.00 X 0 0 0 MICHAEL SHEEHAN DIRECTOR 0.50 4.00 X 0 0 0 PAMELA WHELTON DIRECTOR AS OF 1/1/22 0.50 4.00 X 0 0 0 PAUL WANTANABE PHD DIRECTOR 0.50 4.00 X 0 0 0 PAULA L BECKER DIRECTOR 0.50 4.00 X 0 0 0 JOSEPH R DRISCOLL ESQ SECRETARY 0.50 44.00 X 0 433280 33703 KRISTINE HANSCOM CPA MST CGMA TREAS. & CFO 6/14/22 THRU 5/31/23 0.50 44.00 X 0 329597 18439 STEPHEN JENNEY INT. CFO & TREAS. AS OF 6/1/23 0.50 44.00 X 0 0 0 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 40.00 1.00 X 494632 0 33703 SERGIO FEFER MD PHYSICIAN 40.00 0.00 X 756033 0 33703 YOUNG KIM MD PHYSICIAN 40.00 0.00 X 683128 0 26380 STEVEN STARR MD PHYSICIAN 40.00 0.00 X 609897 0 27036 MATTHEW HJORT MD PHYSICIAN 40.00 0.00 X 596636 0 33703 KEITH TRACY MD PHYSICIAN 40.00 0.00 X 533583 0 33703 MARY SHAUGHNESSY FORMER TREAS. & CFO THRU 6/13/22 0.00 0.00 X 0 499538 0 MICHAEL KAPLAN FORMER VP OF FINANCE THRU 3/31/22 0.00 0.00 X 273189 0 10910 3947098 3304015 474165 119 1 1 0 FOXROCK LONGWATER II REALTY LLC C/O BRUNO PC 57 OBERY ST STE 4 PLYMOUTH MA 02360 MANAGEMENT COMPANY 3682940 SOUTH SUBURBAN GASTROENTEROLOGY PC 1085 MAIN STREET SOUTH WEYMOUTH MA 02190 PHYSICIAN SERVICES 1449776 HANCOCK FLAG REALTY LLC C/O FOXROCK PROPERTIES PO BOX 69 QUINCY MA 02169 MANAGEMENT COMPANY 754000 BOSTON UNIVERSITY DERMATOLOGY 609 ALBANY STREET ROOM J-100 BOSTON MA 02118 PHYSICIAN SERVICES 528613 BEALE'S LLC PO BOX 143 ACCORD MA 02018 CLEANING SERVICES 336739 10 NET PATIENT SVCS. REV. 621110 76329707 76329707 PREMIUM REVENUE 621110 4269909 4269909 80599616 21375 0 21375 21375 21375 HOSPITAL SALARY SUPPOR 900099 7228260 7228260 MACRA MEDICARE PAYMENT 900099 334434 334434 BMC HEALTHNET PAYMENTS 900099 290668 290668 200731 200731 8054093 88675084 88653709 0 21375 592362 592362 56326043 49317589 7008454 12187092 10686476 1500616 1469005 1047916 421089 25939 25939 8002676 6634368 1368308 2579490 2225955 353535 7153149 6298384 854765 193961 193757 204 1195925 1035268 160657 1225693 1122608 103085 DRUGS & MED. SUPPLIES 5181381 5181381 DUES 330828 330828 EQUIP. MAINT. CONTRACT 218225 218225 ANSWERING SERVICE 98829 44292 54537 186348 123747 62601 96966946 84722328 12244618 0 3209933 5984918 4098821 5310531 412190 738981 1344420 1312021 15153238 10140371 5315814 5012867 5656155 5794049 0 37016120 35668875 57053453 59822242 8613656 7404515 4011 4011 42854641 55124433 51472308 62532959 X 5581145 -2710717 5581145 -2710717 57053453 59822242 -8291862 0 X 0 1 X 1 0 X 7511397 5939950 0 0 13451347 74831005 67914644 76000277 81787293 88653709 389186928 74831005 75426041 81940227 81787293 88653709 402638275 0 0 0 402638275 242985 593905 1108805 21375 21375 1988445 10 10 242995 593905 1108805 21375 21375 1988455 75074000 76019946 83049032 81808668 88675084 404626730 0.99510 0.99420 0.00490 0.00580 X 271208 31865 239343 5637820 3167392 2470428 9241777 6941114 2300663 2433 2433 5012867 A/R - OTHER 84659 SECURITY DEPOSITS 102840 DUE FROM THIRD PARTIES 6236277 ROU ASSETS 29245099 35668875 DUE TO AFFILIATES 17564456 DUE TO THIRD PARTY 73237 PHYSICIAN BENEFITS PAYABLE 5775062 ROU LEASE LIABILITY 31711678 55124433 X PART X, LINE 2: THE CORPORATION FOLLOWS THE PROVISIONS OF FASB ASC 740, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. IT PRESCRIBES AN UNCERTAINTY THRESHOLD AND MEASUREMENT ATTRIBUTES FOR FINANCIAL STATEMENT DISCLOSURE OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN. 1 0 0 0 0 0 0 1 0 ALLEN SMITH MD PRESIDENT & CEO 0 872900 0 65025 0 6671 0 159150 0 24553 0 1128299 0 0 KIMBERLY DEVER MD DIRECTOR, CHIEF OB/GYN 0 629868 0 73395 0 57408 0 9150 0 30032 0 799853 0 0 SERGIO FEFER MD PHYSICIAN 722861 0 31240 0 1932 0 9150 0 24553 0 789736 0 0 0 YOUNG KIM MD PHYSICIAN 679291 0 225 0 3612 0 9150 0 17230 0 709508 0 0 0 STEVEN STARR MD PHYSICIAN 604128 0 225 0 5544 0 9150 0 17886 0 636933 0 0 0 MATTHEW HJORT MD PHYSICIAN 348538 0 218010 0 30088 0 9150 0 24553 0 630339 0 0 0 KEITH TRACY MD PHYSICIAN 531426 0 225 0 1932 0 9150 0 24553 0 567286 0 0 0 DAVID HALLE MD AMBULATORY MEDICAL DIRECTOR 473692 0 17328 0 3612 0 9150 0 24553 0 528335 0 0 0 MARY SHAUGHNESSY FORMER TREAS. & CFO THRU 6/13/22 0 499538 0 0 0 0 0 0 0 0 0 499538 0 0 JOSEPH R DRISCOLL ESQ SECRETARY 0 413606 0 12351 0 7323 0 9150 0 24553 0 466983 0 0 KRISTINE HANSCOM CPA MST CGMA TREAS. & CFO 6/14/22 THRU 5/31/23 0 296902 0 30750 0 1945 0 9150 0 9289 0 348036 0 0 MICHAEL KAPLAN FORMER VP OF FINANCE THRU 3/31/22 97070 0 0 0 176119 0 10446 0 464 0 284099 0 0 0 JUSTIN CAMPBELL DIRECTOR 0 181000 0 0 0 0 0 0 0 0 0 181000 0 0 PART I, LINE 3 THE PRESIDENT OF AMBULATORY CARE RECEIVES COMPENSATION FOR SERVICES PERFORMED FOR A RELATED ORGANIZATION. THE COMPENSATION COMMITTEE OF SOUTH SHORE HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE PRESIDENT'S COMPENSATION. THE COMPENSATION COMMITTEE MEETS PERIODICALLY AND ENGAGES AN INDEPENDENT EXTERNAL COMPENSATION CONSULTING FIRM TO ESTABLISH THE COMPENSATION OF KEY SYSTEM 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 OF THE BOARD OF DIRECTORS. PART I, LINE 4A MICHAEL KAPLAN RECEIVED A SEVERANCE PAYMENT DURING THE YEAR IN THE TOTAL AMOUNT OF $175,046 PART I, LINE 7 THE NON-FIXED PAYMENTS PROVIDED CONSIST OF STIPENDS. FORM 990, PART VI, SECTION A, LINE 2 MANY OF THE PERSONS LISTED IN PART VII HAVE A "BUSINESS RELATIONSHIP" WITH ONE ANOTHER DUE TO THE OVERLAPPING BOARD STRUCTURE OF SOUTH SHORE HEALTH SYSTEM AND ITS RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 COASTAL MEDICAL ASSOCIATES, INC. D/B/A SOUTH SHORE PHYSICIAN AMBULATORY ENTERPRISE IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A OFFICERS AND DIRECTORS ARE ELECTED ANNUALLY BY A BOARD VOTE OF THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 IS PREPARED INTERNALLY AND REVIEWED BY THE TAX PRACTICE OF ITS INDEPENDENT AUDITORS. THE RETURN IS THEN REVIEWED BY THE CFO/TREASURER. FORM 990 IS UPLOADED TO THE GOVERNING BOARD'S WEB PORTAL FOR ALL BOD MEMBERS TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE THEN REVIEWED FOR CONFLICTS OR POTENTIAL CONFLICTS. BOARD MEMBERS ABSTAIN FROM VOTING ON MATTERS THAT PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15B THE PRESIDENT OF AMBULATORY CARE, IS CONSIDERED A SOUTH SHORE HEALTH SYSTEM EXECUTIVE; ALL EXECUTIVE COMPENSATION DECISIONS ARE MADE BY THE SSHS PRESIDENT/CEO, USING THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTOR'S APPROVED PHILOSOPHY AND PAY APPROACH FOR THE EXECUTIVE TEAM. THE COMPENSATION COMMITTEE IS INDEPENDENT AND CONSISTS SOLELY OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH REGARDS TO COMPENSATION MATTERS. ANNUAL COMPENSATION DECISIONS FOR COASTAL (SSPAE) PHYSICIANS AND ADVANCED PRACTICE CLINICIAN EMPLOYEES ARE ALSO MADE BY SSHS AND ARE BASED ON A COMBINATION OF ADVICE AND RESEARCH PROVIDED BY OUTSIDE CONSULTANTS, REVIEW OF COMPARABLE INDUSTRY DATA AND MARKET CONDITIONS. FORM 990, PART VI, SECTION C, LINE 19 SOUTH SHORE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR INSPECTION AT THE CORPORATION'S OFFICE. COPIES OF THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, CERTAIN GOVERNING DOCUMENTS ARE ALSO AVAILABLE THROUGH THE MASSACHUSETTS SECRETARY OF THE COMMONWEALTH'S CORPORATIONS DIVISION DATABASE. ATLANTIC WOMEN'S HEALTH INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 200156651 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HOSPITAL INC 0 COASTAL MEDICAL ASSOCIATES INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 043170333 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HEALTH SYSTEM INC 0 CONNECTED CARE OF SOUTHEASTERN MASSACHUSETTS INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 823503666 OPERATES AN ACOUNTABLE CARE ORGANIZATION MA 501(C)(3) 10 SOUTH SHORE HEALTH SYSTEM INC 0 METROSOUTH OBSTETRICS & GYNECOLOGY INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 330998957 PROVIDES SPECIALIZED MEDICAL CARE MA 501(C)(3) 3 SOUTH SHORE HOSPITAL INC 0 SOUTH SHORE HEALTH EXPRESS INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 452385865 OPERATES MEDICAL URGENT CARE CENTERS MA 501(C)(3) 10 COASTAL MEDICAL ASSOCIATES INC 1 SOUTH SHORE HEALTH SYSTEM INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 042105926 SUPPORTS THE CHARITABLE MISSION OF SOUTH SHORE HOSPITAL AND ITS AFFILIATES MA 501(C)(3) 12B, II N/A 0 SOUTH SHORE HOSPITAL INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 042769210 HOSPITAL MA 501(C)(3) 3 SOUTH SHORE HEALTH SYSTEM INC 0 SOUTH SHORE PROPERTY INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 050398822 DEVELOPS AND MANAGES REAL ESTATE PROPERTY FOR SOUTH SHORE HOSPITAL MA 501(C)(3) 12A, I SOUTH SHORE HEALTH SYSTEM INC 0 SOUTH SHORE HEALTH INTEGRATED DELIVERY NETWORK INC 55 FOGG ROAD SOUTH WEYMOUTH MA 02190 852785921 TO DEVELOP & MAINTAIN A NETWORK OF PROVIDERS FOR DELIVERY OF HEALTHCARE SERV MA N/A C 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0