Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
SOUTH SHORE HOSPITAL INC |
042769210 | Yes | 2,586,147 | 0 | ||
Total 1
|
2,586,147 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section A, Line 6 | South Shore Health System, Inc. (SSHS) is part of a health care system that includes South Shore Hospital, the specified supported organization, and other affiliates, all listed in Part II of Schedule R. SSHS provides support to all system affiliates in addition to South Shore Hospital, all of which are recognized as 501(c)(3) organizations that are not private foundations, and are operated, supervised or controlled directly by or in connection with South Shore Hospital. |
| Schedule A, Part IV, Section D, Line 1 | South Shore Health System (SSHS), formerly known as South Shore Health & Educational Corporation, changed its type of organization from Type I to Type III Functionally Integrated. This change was based on a review of the by-laws of the Corporation and its affiliates, and in consideration for how these corporations function now, and in recognition of SSHS's future as the head of a health system of corporations all supporting the charitable mission of South Shore Hospital. Type III Functionally Integrated supporting organizations have an obligation to provide annual notification of support to the supporting organization by the last day of the 5th month of its tax year. We believe SSHS met the criteria for notification of support to the supported organization, SSH. The corporations share officers, Richard Aubut; CEO, Joseph Cahill, President and Treasurers Michael Cullen (through 1/8/15) and Pamela Whelton (after 1/8/15), who are aware of, and often direct, the operations of both corporations. Messrs. Aubut, Cahill, and Cullen and Ms. Whelton routinely received copies of SSHS reports, which detailed the various management and supervisory activities of SSHS in support of the Hospital and its affiliates. The officers are provided with copies of Form 990 annually wherein the type and amount of support to the supported organization is documented. There were no changes in the Corporation's organizational documents during the reporting period. |
| Schedule A, Part IV, Section D, Line 3 | Officers of the supported organization also serve as officers of South Shore Health System (SSHS) and routinely attend board meetings of SSHS, at which they are able to make statements and proposals in connection with the conduct of SSHS's activities and the support of the supported organization. |
| Schedule A, Part IV, Section E, Line 3a | South Shore Health System, Inc. may appoint members of the governing bodies of South Shore Hospital and other entities in which the Corporation is the sole member. SSHS is the sole member of South Shore Hospital, South Shore Property and Health Provider Services Organization of the South Shore. SSHS has the power to appoint, directly or indirectly, the majority of officers and directors of Coastal Medical Associates. |
| Schedule A, Part IV, Section E, Line 3b | South Shore Health System, Inc. (SSHS) is actively involved in direction of the activities of all its supported organizations. The Corporation promotes patient care at South Shore Hospital and other affiliates through oversight of quality of service, performance improvements and patient satisfaction metrics. SSHS, in its capacity as sole member, appoints the governing boards of the Hospital and its affiliates. While not the sole member of the PAE, SSHS has the power to directly or indirectly control the appointment of a majority of the corporation's officers and directors. The Corporation directs its policies and business practices and those of its affiliates. SSHS is responsible for choosing an independent auditor for the health system. The Corporation is responsive to the needs of the community and acts on recommendations of the governing bodies of the Hospital and other affiliates. |
| Software ID: | 14000267 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Header, Line C | South Shore Health & Educational Corporation changed its name to South Shore Health System, Inc. effective April 1, 2016. The name change was recognized by the IRS in an affirmation letter dated June 7, 2016. |
| Form 990, Part VI, Section A, Line 2 | 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 Health System. |
| Form 990, Part VI, Section A, Line 6 | The Board of Directors are members of the corporation. |
| 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 President and Treasurer. Form 990 is presented for review to the governing body as a whole at the next regularly scheduled meeting prior to the filing deadline. The Board Chair and Vice Chair will review and comment to executive leadership regarding Form 990 prior to the filing deadline. |
| Form 990, Part VI, Section B, Line 12c | Board members are required to sign a conflict of interest form annually. The forms are reviewed for conflicts or potential conflicts. Board members abstain from voting on matters that present a conflict of interest. |
| Form 990, Part VI, Section B, Line 15 | South Shore Health System utilizes an outside consultant to determine executive compensation for Richard Aubut (CEO), Michael Cullen (SSH CFO thru 01/08/15) and Joseph Cahill (SSH President/COO). The consultant presents relevant data to the board for review and approval for these 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 Health System 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 Health System, Inc. 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 IX, Line 11g | Intercorporate salaries and fringe benefits; $431,200, recruitment; $19,968. |
| Form 990, Part XI, Line 9 | Transfer to Affiliate; -2,154,947, Transfer from Affiliate; 1,600,000. |
| Form 990, Part XII, Line 2b | South Shore Health System and its subsidiaries are audited by independent accountant Deloitte & Touche LLP. The governing body of South Shore Health System, acting as a committee of the whole, assumes responsibility for oversight of the audit of its financial statement and affiliate financial statements and selection of an independent auditor. In fiscal year 2015, prior to its name change, the audit of South Shore Health System was consolidated by Deloitte & Touche LLP into the annual audit of South Shore Health & Educational Corporation and Subsidiaries. The financial statements are prepared in accordance with GAAP. |
| Software ID: | 14000267 |
| Software Version: | v1.00 |