2022-08-15T09:46:24-05:00 2021-09-30 BDO USA LLP ONE INTERNATIONAL PLACE BOSTON MA 02110 990 2020-10-01 222472997 Brockton Hospital Inc % ROBERT J HAFFEY BROC 5089417000 680 centre street Brockton MA 02302 ROBERT J HAFFEY PRESIDENT/CEO 5089417000 2022-08-15 true ROBERT J HAFFEY XXX-XX-XXXX Brian Vigneault P00540650 6174220700 2 2020 2022-09-23 18:48:47Z ROBERT J HAFFEY 680 centre street Brockton MA 02302 416980050 false X www.signature-healthcare.org X 1983 MA SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A COMMUNITY-BASED NOT-FOR-PROFIT (CONTINUED ON SCHEDULE O) 21 17 2474 19 23803 0 259768 15698150 288639590 301254279 -43491 3544198 21473605 20810354 310329472 341306981 0 0 0 0 168310156 181658503 0 0 0 125014050 142653641 293324206 324312144 17005266 16994837 329126341 312206864 262168406 219401050 66957935 92805814 X SEE SCHEDULE O false false 301549209 0 321480439 BROCKTON HOSPITAL IS AN ACUTE CARE HOSPITAL LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE 216 ACUTE CARE BEDS (COMPOSED OF 131 MEDICAL/SURGICAL, 16 INTENSIVE CARE, 8 PEDIATRIC, 20 OBSTETRIC, 22 PSYCHIATRIC), AND 19 BASSINETS (COMPOSED OF 13 WELLINFANT AND 6 SPECIAL CARE). THE HOSPITAL OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO MEET DIVERSE COMMUNITY NEEDS INCLUDING EMERGENCY CARE, ACUTE CARE (INCLUDING MEDICAL/SURGICAL, OBSTETRICS, PEDIATRIC, PSYCHIATRIC, CARDIAC AND CANCER CARE. THE HOSPITAL PROVIDES FREE CARE TO THOSE WHO ARE UNABLE TO PAY, SPONSORS FREE HEALTH SCREENINGS, VARIOUS SUPPORT GROUPS AND EDUCATIONAL PROGRAMS, INCLUDING PUBLIC HEALTH EDUCATION, WELLNESS PROGRAMS AND THE TRAINING OF HEALTH PROFESSIONALS SUCH AS FIRST RESPONDER EDUCATION AND TRAINING. DURING THE YEAR ENDED SEPTEMBER 30, 2021 THE HOSPITAL HAD 14,320 TOTAL DISCHARGES AND OBSERVATIONS, 53,872 TOTAL PATIENT DAYS, AND 174,273 OUTPATIENT CLINIC VISITS. THE HOSPITAL'S EMERGENCY DEPARTMENT HAD 51,451 VISITS DURING THE FISCAL YEAR AND IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR AND PROVIDES CARE REGARDLESS OF ONE'S ABILITY TO PAY. 301549209 true false false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false true false false false false false true false false false true 206 0 true 2474 true true true false false false false false false false false false false false X 21 17 true false false false true false false true true false false true true true true true true false false true true MA X X ROBERT J HAFFEY 5089417000 680 CENTRE STREET BROCKTON MA 02302 X KIM N HOLLON President/CEO 50.0 1.0 X X 683693 0 30024 DAVID DRINKWATER MD Physician Elect 1.0 50.0 X 0 615951 32659 KEVIN G MURPHY CFO 50.0 1.0 X 418313 0 26401 KAREN E MURPHY SENIOR VP GENERAL COUNSEL 50.0 1.0 X 375391 0 3021 KIMBERLY WALSH Senior VP/Chief Nursing ofcr 50.0 1.0 X 306678 0 12284 STEPHEN BORGES INTERIM CFO 50.0 1.0 X 241934 0 30218 ROBERT S GREENBERG MD TRUSTEE 1.0 50.0 X 0 263755 1130 JEFFREY C MILLER VP PHILANTHROPY 50.0 1.0 X 232290 0 30251 SUSAN L BOULANGER ASSOC VP ENTERPRISE RADIOLOGY 50.0 1.0 X 220786 0 9550 BARBARA CURLEY VP Quality/Chief Quality Ofcr 50.0 1.0 X 215379 0 2257 MICHAEL L DERN MD TRUSTEE 1.0 50.0 X 0 179260 1713 KHALED SOROUR MD President Medical Staff 1.0 1.0 X X 0 0 0 JOSEPH DRIER Chairman Board of Trustees 1.0 1.0 X 0 0 0 DAVID F ENGELKEMEYER TRUSTEE 1.0 1.0 X 0 0 0 MARIA FERNANDES TRUSTEE 1.0 1.0 X 0 0 0 DAVID FRENETTE TRUSTEE 1.0 1.0 X 0 0 0 MARIA HARRIS TRUSTEE 1.0 1.0 X 0 0 0 JAMES LEARY TRUSTEE 1.0 1.0 X 0 0 0 EUGENE MARROW TRUSTEE 1.0 1.0 X 0 0 0 LUKE MCCABE TRUSTEE 1.0 1.0 X 0 0 0 FRED NICCOLI CHAIR DEV. OFFICE BOARD OF GOV 1.0 1.0 X 0 0 0 DAVID OFFUTT TRUSTEE (AS OF 12/20) 1.0 1.0 X 0 0 0 PATTI ROLAND TRUSTEE (AS OF 12/20) 1.0 1.0 X 0 0 0 ROBERT SULLIVAN TRUSTEE (THRU 02/21) 1.0 1.0 X 0 0 0 MICHAEL SULLIVAN TRUSTEE 1.0 1.0 X 0 0 0 JOSEPH L TANSEY TRUSTEE 1.0 1.0 X 0 0 0 PATRICIA TORTORELLA TRUSTEE 1.0 1.0 X 0 0 0 DAVID WOLOHOJIAN Vice Chairman 1.0 1.0 X 0 0 0 2694464 1058966 179508 329 false true false MATRIX ANESTHESIA PD 1342 BELMONT STREET SUITE 205 BROCKTON MA 02302 PHYSICIAN SERVICES 4615192 PRATT PEDIATRIC ASSOCIATES 800 WASHINGTON STREET NEMC BOX 101 BOSTON MA 02111 PHYSICIAN SERVICES 1969186 SECURE AMERICA LLC PO BOX 16601 ATLANTA GA 30321 SECURITY SERVICES 1882506 TEGRIA SERVICES GROUP PO BOX 88597 MILWAUKEE WI 53288 CONSULTING 1505394 SOUTHWEST CONSULTING A 2805 N DALLAS PARKWAY STREET PLANO TX 75093 CONSULTING 1168127 40 15698150 15698150 PATIENT SERVICE REVENUE 900099 283820031 283820031 INTERCOMPANY REVENUE 900099 9702365 9702365 SCHOOL OF NURSING 900099 4099586 4099586 INTERCOMPANY RENT 900099 889416 889416 NONPATIENT LAB REVENUE 900099 23803 23803 2719078 2719078 301254279 1790467 1790467 0 0 584194 584194 0 584194 584194 77426800 0 75664105 8964 1762695 -8964 1753731 1753731 0 0 0 0 0 0 0 0 0 PHARMACY 900099 16495720 16495720 JOINT VENTURES 900099 624281 624281 ALL OTHER REVENUE 900099 3106159 3106159 20226160 341306981 321456636 23803 4128392 0 0 0 0 1650617 1568086 82531 0 146135462 136491628 9643834 5831430 5264825 566605 17711617 16416546 1295071 10329377 9719685 609692 4401338 4401338 843251 843251 336996 24996 312000 83522 46000 37522 0 0 0 673459 44781 628678 3241387 2611942 629445 1769173 1639582 129591 0 8634825 8097603 537222 33313 28447 4866 0 0 4440391 4129564 310827 0 13134788 12215353 919435 1892810 1560808 332002 PURCHASED SERVICES 24050599 20734886 3315713 0 DRUGS AND MEDICATIONS 22497477 22486379 11098 MEDICAL AND SURGICAL SUPPLIES 22580987 22580987 MD CONTRACTED SERVICES 12089504 12089504 21949821 19396269 2553552 324312144 301549209 22762935 0 2360 2360 46174535 22092189 0 0 24096426 31992729 0 0 0 0 1084663 1149504 3428328 4975434 4601929 5050761 263948950 136026244 122690369 127922706 0 0 4717723 4551409 0 0 990000 990000 121340008 113479772 329126341 312206864 48785802 58796776 0 0 49550092 30320788 48385000 64519621 0 0 0 0 32391100 13291062 0 0 83056412 52472803 262168406 219401050 X 59266257 84371376 7691678 8434438 66957935 92805814 329126341 312206864 X 16994837 7805348 1047694 X false true X true true true X false true false false false false true 46000 false true 37522 83522 false PART II-B, LINE I, LOBBYING ACTIVITIES: BROCKTON HOSPITAL PAID A LOBBYING FIRM $46,000 DURING FISCAL YEAR 2021 TO LOBBY ON ITS BEHALF ON VARIOUS FEDERAL AND STATE LEGISLATIVE ISSUES IMPACTING THE ORGANIZATION AND THE HEALTHCARE INDUSTRY AS A WHOLE. AS PART OF THE ORGANIZATION'S MEMBERSHIP IN THE MASSACHUSETTS AND AMERICAN HOSPITALS ASSOCIATION AND AMERICA'S ESSENTIAL HOSPITALS ASSOCIATION OF AMERICA, $83,522 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT-FOR-PROFIT ASSOCIATIONS WAS USED FOR LOBBYING ACTIVITIES. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF THE ORGANIZATION'S ACTIVITIES. 4969484 957323 5926807 4834543 134941 4969484 4717908 116735 4834643 4502193 25000 190715 4717908 4090994 411189 4502183 0.64000 0.36000 true true true 3519568 3519568 143973126 60789693 83183433 11655285 4865550 6789735 98663311 67457044 31206267 6137659 2913956 3223703 127922706 BOARD-DESIGNATED INVESTMENTS 93736143 AMOUNTS DUE FROM THIRD-PARTY 9060109 OTHER 6368296 ASSET HELD UNDER SPLIT-INTREST 2165224 ASSETS HELD AS COLLATERAL 2150000 113479772 0 ACCRUED PENSION LIABILITY 34381838 OTHER LONG-TERM LIABILITIES 8062690 AMOUNTS DUE TO THIRD-PARTY PAYORS 5516249 CURRENT PORTION OF LONG-TERM DEBT 4512026 52472803 X 349112329 7805348 7805348 341306981 341306981 324312144 324312144 324312144 PART V, LINE 4: THE HOSPITAL'S ENDOWMENT CONSISTS OF INDIVIDUAL DONOR RESTRICTED ENDOWMENT FUNDS HELD FOR A VARIETY OF PURPOSES AS WELL AS SPLIT INTEREST AGREEMENTS, WHICH HAVE BEEN DESIGNATED FOR ENDOWMENT. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE HOSPITAL QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. UNDER ASC 740, INCOME TAXES, AN ORGANIZATION MUST RECOGNIZE THE FINANCIAL STATEMENT EFFECTS OF A TAX POSITION TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY. THE CORPORATION DOES NOT BELIEVE IT HAS TAKEN ANY MATERIAL UNCERTAIN TAX POSITIONS; IT HAS NOT RECORDED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. true true true X 600. true X 600. true false true true 5688122 -43315 5731437 0.01770 92107011 77710990 14396021 0.04440 6217455 5927381 290074 0.00090 104012588 83595056 20417532 0.06300 171451 171451 0.00050 10405526 6122749 4282777 0.01320 23537315 18504932 5032384 0.01550 34114292 24627681 9486612 0.02940 138126880 108222737 29904144 0.09240 1495 1495 10550 10550 2759 2759 5000 5000 42332 42332 199 199 62335 128335 true 3955973 1290689 61196591 72210196 -11013605 X true true 1 1 SIGNATURE HEALTHCARE BROCKTON HOSPITA 680 CENTRE STREET BROCKTON MA 02302 HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/ X X X X PSYCH 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X X true 18 true SEE PART V, SECTION C false true X 200. 605. X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5: THE GOAL OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS TO IDENTIFY UNMET HEALTH NEEDS, VULNERABLE POPULATIONS AND GAPS IN EXISTING COMMUNITY HEALTH SERVICES. THIS NEEDS ASSESSMENT USED A MULTI-PRONGED APPROACH WHICH INCLUDED ANALYZING EXISTING DATA AS WELL AS HOLDING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS. THE PROCESS BEGAN WITH QUANTITATIVE DATA GATHERING AROUND DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH OTHER HEALTH RISK AND PROTECTIVE FACTORS, AND HEALTH OUTCOMES. THE QUALITATIVE DATA WAS COLLECTED THROUGH A SERIES OF KEY INFORMANT INTERVIEWS AND FOCUS GROUPS. TO ENSURE THE COMMUNITY VOICE WAS AT THE HEART OF THIS NEEDS ASSESSMENT, COMMUNITY MEMBERS AND KEY INFORMANTS WERE ASKED TO MAKE SUGGESTIONS FOR WHAT OTHER VOICES THEY WOULD LIKE REPRESENTED IN ADDITION TO THEIR OWN. THIS LED TO A SECONDARY SET OF QUALITATIVE DATA. THE FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WERE CONDUCTED IN PARTNERSHIPS WITH LOCAL COMMUNITY LEADERS. THE FOCUS GROUPS WERE DETERMINED BY FIRST EXAMINING QUANTITATIVE DEMOGRAPHIC DATA TO DETERMINE THE LARGEST DEMOGRAPHIC GROUPS IN SIGNATURE HEALTHCARE'S SERVICE AREA, ALONG WITH GROUPS THAT ARE GROWING MOST RAPIDLY. FOCUS GROUPS WERE CONDUCTED IN BROCKTON, WEST BRIDGEWATER, EAST BRIDGEWATER AND HOLBROOK. OVER 85 RESIDENTS PARTICIPATED IN THE FOCUS GROUPS AND RANGED IN AGES FROM 18-92. REPRESENTATIVES IDENTIFIED THEIR RACE/ETHNICITY AND DEMOGRAPHICS REPRESENTED WERE LARGELY REFLECTIVE OF THE COMMUNITIES IN SIGNATURE HEALTHCARE'S SERVICE AREA. THE FIVE FOCUS GROUPS HAD A MEAN SIZE OF 17. FOCUS GROUP PARTICIPANTS WERE ASKED TO IDENTIFY ADDITIONAL STAKEHOLDERS WHO SHOULD PROVIDE INPUT. THIS LED TO INTERVIEWS WITH POLICE HOSPITAL STAFF, A COUNCILWOMAN, CULTURALLY FOCUSED NON-PROFITS AND LOCAL SUBSTANCE USE PREVENTION EXPERTS. PART V, SECTION B, LINE 7A: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/2019-CO MMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF PART V, SECTION B, LINE 10A: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/2019- COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF PART V, SECTION B, LINE 11: HOUSING AND HOMELESSNESS: WE TREAT A LARGE POPULATION OF HOMELESS PATIENTS. THEY RECEIVE TREATMENT REGARDLESS OF THEIR RESIDENCY. WE ARE EXPLORING OPPORTUNITIES TO FURTHER SUPPORT THIS POPULATION WITH THEIR HOUSING NEEDS. For several years, Signature Healthcare offered "Housing 101even broadened that to include other benefits including but not limited to SNAP, Cash assistance, fuel assistance and more. Due to the pandemic, these in person opportunities were put on hold. Signature Healthcare is looking to begin hosting these opportunities once again starting September 2022. SIGNATURE HEALTHCARE BROCKTON HOSPITAL PARTNERS WITH FATHER BILLS AND MAINSPRING HOUSE JOB DEVELOPERS ALONG WITH OTHER SUPPORTERS OF LOCAL BUSINESSES INCLUDING BRIDGEWATER STATE UNIVERSITY, DEPARTMENT OF TRANSITIONAL ASSISTANCE, ARBELLA INSURANCE FOUNDATION, STATE STREET, UNITED WAY OF GREATER PLYMOUTH COUNTY AND CITIZENS BANK. WE RECRUIT GRADUATES FROM THE WORK EXPRESS AND WORK READY PROGRAM INTO PAYING JOBS WHERE THEY CAN WORK TO BROADEN THEIR SKILLS AND EXPERIENCE VARIOUS HEALTHCARE EMPLOYMENT OPPORTUNITIES. IN MANY CASES PARTICIPATION IN THIS PROGRAM HELPS REBUILD THEIR LIVES AND PROVIDE FOR THEIR FAMILIES . SIGNATURE HEALTHCARE HAS BEEN SUCCESSFUL IN HIRING GRADUATES FROM BOTH PROGRAMS INTO VARIOUS PART TIME, PER DIEM AND FULL TIME POSITIONS WITHIN THE HOSPITAL SETTING. Signature Healthcare supported the YMCA's Centers for Families Experiencing Homelessness by offering a free flu shot clinic.COVID-19 testing to all residents and staff. Signature Healthcare was able to eliminate potential barriers such as transportation and offered the vaccine to adults and children from the centers as well as YMCA staff. The YMCA was so appreciative that Signature Healthcare in partnership with Brewster Ambulance and the Brockton Fire Department were able to provide vaccines to their residents and staff. HEALTH CARE ACCESS: SIGNATURE HEALTHCARE AIMS TO LINK THOSE WHO FACE BARRIERS TO HEALTHCARE ACCESS OR DISPARITIES IN HEALTH OUTCOMES DUE TO THE SOCIAL DETERMINANTS OF HEALTH TO APPROPRIATE COMMUNITY BASED SERVICES, SCHEDULE APPOINTMENTS WITH PRIMARY AND SPECIALTY CARE PROVIDERS AND OFFER FREE SCREENINGS. SIGNATURE HEALTHCARE ALSO PROVIDES PHYSICIAN OUTREACH DIRECTLY IN THE COMMUNITIES WHERE SIGNATURE HEALTHCARE CORPORATION PATIENTS RESIDE FOR "ONE ON ONE" INTERACTION. In July, 2021, Signature Healthcare offered a free COVID vaccination event in partnership with Boston Medical Center. This event was offered on two occations, offering dates for both doses of the vaccine. Individuals between the ages of 12-17 were also offered the vaccine. This event not only provided an opportunity for the vaccine, but Signature Healthcare staff were also on hand promoting Pediatrics and Primary Care with an opportunity to schedule appointments. Each attendee was also eligible to receive a bag of fresh fruits and vegetables to take home in an effort to decrease food insecurity. SAFETY: DOMESTIC VIOLENCE WAS SEEN AS AN ISSUE IN THE BROCKTON AREA. OUR CLINICIANS HAVE PROVIDED EDUCATION ON HEALTHY RELATIONSHIPS TO AREA COMMUNITY GROUPS. MATERNAL AND CHILD HEALTH: SIGNATURE HEALTHCARE HAS A HEALTHY BEGINNINGS PROGRAM WHICH ASSISTS WOMEN THROUGHOUT THEIR PREGNANCY AND BEYOND. THEY CAN WALK IN AND RECEIVE A FREE PREGNANCY TEST AND IF THEY ARE EXPECTING, ARE SET UP WITH ALL PRE AND POST NATAL CARE. THE PATIENT NAVIGATORS FROM HEALTHY BEGINNINGS ARE TRAINED IN FINANCIAL COUNSELING, SO IF PATIENTS ARE IN NEED OF INSURANCE THEY CAN RECEIVE ASSISTANCE WITH APPLYING FOR HEALTH INSURANCE AS WELL. THIS PROGRAM HAS RELATIONSHIPS WITH A VARIETY OF COMMUNITY RESOURCES, SO IF THE EXPECTANT MOMS ARE IN NEED OF CLOTHING, DIAPERS, CAR SEATS ETC., WE WORK WITH THEM TO ASSIST WITH THESE NEEDS AS WELL. SIGNATURE HEALTHCARE HAS 12 OB/GYN PHYSICIANS WITHIN ALL SIGNATURE MEDICAL GROUP LOCATIONS ALONG WITH 6 PEDIATRICIANS IN BROCKTON, EASTON, and RANDOLPH. SIGNATURE HEALTHCARE BROCKTON HOSPITAL HAS AN INPATIENT PEDIATRICS DEPT. WHICH IS STAFFED 24/7 BY TUFTS FLOATING HOSPITALISTS. SIGNATURE HEALTHCARE IS A "BABY FRIENDLY DESIGNATED HOSPITALSTRIVES TO SUPPORT MOTHERS TO BREASTFEED BABIES FOR THE BEST START IN LIFE. SIGNATURE HEALTHCARE WROTE A BREASTFEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTHCARE STAFF AND PROVIDES EDUCATION AND INFORMATION TO ALL EXPECTING MOTHERS ON THE BENEFITS OF BREASTFEEDING .MATERNITY STAFF HELP MOTHERS INITIATE BREASTFEEDING WITHIN ONE HOUR OF BIRTH AND CONTINUE TO SHOW MOTHERS HOW TO BREASTFEED AND MAINTAIN LACTATION EVEN IF THEY ARE SEPARATED FROM THEIR INFANTS. SIGNATURE HEALTHCARE OFFERS BABE-E-NEWS A FREE; OPT-IN, ELECTRONIC NEWSLETTER PROVIDING EDUCATION, TOOLS AND RESOURCES FOR PREGNANCY INTO EARLY CHILDHOOD. THE INFORMATION IS TAILORED TO A MOTHER'S DUE DATE OR CHILD'S BIRTH DATE, MAKING THE WEEKLY INFORMATION RELEVANT AND USEFUL. THIS NEWSLETTER CAN ALSO BE SHARED WITH ANY NUMBER OF FAMILY MEMBERS WHO CAN SELECT TO READ THE NEWSLETTER IN MULTIPLE LANGUAGES. COMMUNICATING TO PATIENTS IN THEIR NATIVE LANGUAGE HELPS TO PROMOTE COMPLIANCE AND UNDERSTANDING OF THEIR PERSONAL HEALTHCARE. In FY 20, Signature Healthcare partnered with YoMingo, an online childbirth education program. By working with YoMingo, Signature Healthcare was able to help our patients eliminate the hurdle of fitting in-person childbirth classes into their schedule and practice social distancing and instead brings classes to them. This is a free program for our patients and is available in 14 languages. YoMingo's evidence-based online maternity education includes education on Labor and Birth and topics such as breastfeeding, newborn care, community health resources, support groups amongst various other tools. STD HIV/AIDS - REFER TO FAMILY PLANNING FOR EVALUATION AND TREATMENT AND WITH THE POSSIBILITY OF BEING REFERRED TO OUR INFECTIOUS DISEASE PHYSICIAN FOR FURTHER TREATMENT AND FUTURE HEALTH CARE NEEDS. RISKY BEHAVIORS AND HEALTH SCREENINGS: SIGNATURE HEALTHCARE CONTINUES TO WORK WITH STAFF FROM HIGH POINT THE BROCKTON AREA PREVENTION COLLABORATIVE AND THE PLYMOUTH COUNTY DRUG ABUSE TASK FORCE. SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT PHYSICIANS WORK WITH LOCAL POLICE AND FIRE DEPARTMENTS PROVIDING TRAINING AND MEDICAL GUIDANCE. POLICE DEPARTMENTS FROM NORFOLK, PLYMOUTH AND BRISTOL COUNTIES WERE TRAINED ON THE PROPER USE OF NASAL NARCAN. THE ED PHYSICIANS ALSO WORKED ON PROJECTS WITH THE NORFOLK PLYMOUTH AND MIDDLESEX COUNTY DISTRICT ATTORNEY'S OFFICES TO PROVIDE LECTURES TO STUDENTS, PARENTS TEACHERS AND OTHER HEALTHCARE PROFESSIONALS ON SUBSTANCE USE AND OTHER HEALTH CONCERNS FACING OUR AREA YOUTH. DR. MUSE SERVES AS THE EMS MEDICAL DIRECTOR FOR 14 LOCAL FIRE DEPARTMENTS, AND IS VERY ACTIVE IN OTHER MATTERS RELATED TO SUBSTANCE USE, INCLUDING THE BROCKTON MAYOR'S OPIOID COALITION INDEPENDENCE ACADEMY, AND PLYMOUTH COUNTIES SUBSTANCE ABUSE COALITION. DR. DAN MUSE, SIGNATURE HEALTHCARE ED PHYSICIAN, OF coordinates teaching rounds with local EMS teams. These include education on various topics including, Human Trafficking: Legal and Social Ramifications, Domestic Abuse, Adverse Childhood Events, Pediatric Trauma Care and Newborn Care in-field delivery, to name a few. EMS professionals delivering patients to the Signature Healthcare Emergency Department are invited to watch life-saving stenting procedures in one of two Brockton Hospital Cardiac Catheterization labs - closing the loop on what happens after they drop off a patient in cardiac arrest. SIGNATURE HEALTHCARE AND DR. DAN MUSE HAVE ESTABLISHED A VERY CLOSE RELATIONSHIP WITH THE CITY OF BROCKTON. DR. MUSE IS THE MEDICAL DIRECTOR FOR BROCKTON POLICE AND FIRE. HE ALSO SERVES AS THE MEDICAL DIRECTOR FOR THE BROCKTON FIRE DEPARTMENT DISPATCH . FOR THE LAST FOUR YEARS, DR. MUSE HAS BEEN PART OF THE BROCKTON POLICE DEPARTMENT'S YEARLY MENTAL HEALTH TRAINING. HE ALSO WORKS CLOSELY WITH LOCAL POLICE AND FIRE ON SPECIAL PROGRAMS IN THEIR DEPARTMENTS AND TOWNS. A NEW PROGRAM "SAVE A LIFE" IS BEING LAUNCHED IN 2020. THIS PROGRAMS WORKS IN CONJUNCTION WITH LOCAL EMS TO TRAIN CITIZENS OF THEIR COMMUNITIES IN LIFE SAVING TECHNIQUES OF CPR AED USE NARCAN ADMINISTRATION AND "STOP THE BLEED" SKILLS. WITHIN THE SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT OVERDOSE PATIENTS RECEIVE NASAL NARCAN, A LIST OF DETOX FACILITIES AND COUNSELING. THE ED PHYSICIANS ARE ALSO LIMITING THE NUMBER OF NARCOTICS THEY PRESCRIBE TO PATIENTS. THEY WILL NOT FILL LOST PRESCRIPTIONS AND ARE ADVANCING USE OF THE STATE'S "PRESCRIPTION MONITORING PROGRAM." SIGNATURE HEALTHCARE CREATED A PAIN AND OPIOID MANAGEMENT COMMITTEE WHO DEVELOPED A CHARTER TO GUIDE OUR PURPOSE AND ENSURE WE'RE MEETING THE REGULATORY REQUIREMENTS OF THE JOINT COMMISSION AS THEY RELATE TO PAIN AND OPIOID MANAGEMENT. WE STARTED BY ENSURING APPROPRIATE PAIN AND OPIOID MANAGEMENT POLICIES WERE DEVELOPED TO MEET THE NEEDS OF OUR PATIENT POPULATIONS . AT THE SAME TIME WE HAVE BEEN MONITORING THE EFFECTIVENESS OF PAT PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT FORMS/FINANCIAL-ASSISTANCE PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINAN CIAL-ASSISTANCE PART V, LINE 16C, FAP PLAN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINAN CIAL-ASSISTANCE PART V, SECTION B, LINE 16H: THE HOSPITAL, IN COLLABORATION WITH LOCAL NOT FOR PROFIT ORGANIZATIONS SUCH AS THE UNITED WAY AND MASSASOIT COMMUNITY COLLEGE, MAINTAINS COPIES OF ITS ONE-PAGE PLAIN LANGUAGE SUMMARY FINANCIAL ASSISTANCE POLICY ON-SITE AT THESE ORGANIZATIONS IN AN EFFORT TO NOTIFY MEMBERS OF ITS COMMUNITIES WHO ARE MOST LIKELY IN NEED OF FINANCIAL ASSISTANCE ABOUT THE AVAILABILITY OF SUCH ASSISTANCE. PART V, SECTION B, LINE 16J: WHEN REGISTERING FOR SERVICES OR IF RECEIVING A BILL, THE HOSPITAL ENCOURAGES PATIENTS TO CONTACT STAFF TO DETERMINE IF THEY AND/OR A FAMILY MEMBER ARE IN NEED OF AND ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL POSTS GENERAL NOTICES AT SERVICE DELIVERY AREAS WHERE THERE IS REGISTRATION OR A CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENTS AND AFFILIATED HEALTH CENTER LOCATIONS, CERTIFIED APPLICATION COUNSELORS ("CAC") OFFICES AND IN GENERAL BUSINESS OFFICE AREAS CUSTOMARILY USED BY PATIENTS THAT INFORM PATIENTS ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE AS WELL AS THE LOCATIONS WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC. PART I, LINE 7: COSTS FOR FIGURES USED IN THE LINE 7 TABLE ARE DERIVED USING WORKSHEET 2 FOR 7 A-D. DIRECT COSTS FOR 7E AND 7I, AND THE HOSPITAL'S COST ACCOUNTING SYSTEM FOR 7F-G. PART II, COMMUNITY BUILDING ACTIVITIES: SIGNATURE HEALTHCARE COLLABORATES WITH AND SUPPORTS AREA ORGANIZATIONS BOTH FINANCIALLY AND WITH OUR CLINICAL EXPERTISE. WE BELIEVE THAT BY SUPPORTING AND WORKING WITH COMMUNITY PARTNERS, WE ARE ABLE TO MAKE A LARGER IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY. PART III, LINE 2: THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE. PART III, LINE 3: THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE FOR THOSE PATIENTS ELIGIBLE FOR CHARITY CARE. PART III, LINE 4: THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO ESTIMATED BAD DEBT LOSSES. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES. THIS FOOTNOTE IS FOUND ON PAGE 36 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL CONTINUES TO SERVE ITS VULNERABLE INDIGENT POPULATION AMIDST RISING COSTS WHILE MANY AREAS OF REIMBURSEMENT CONTINUE TO ERODE. THE CHANGE IN DSH PAYMENT METHODOLOGY, AS ONE SIGNIFICANT EXAMPLE, HAS REDUCED THE HOSPITAL'S DSH PAYMENT BY NEARLY HALF OF WHAT IT WAS UNDER THE FORMER METHODOLOGY. THE HOSPITAL USES THE MEDICARE COST REPORT AS THE COST ACCOUNTING SYSTEM TO CALCULATE ITS MEDICARE COSTS. PART III, LINE 9B: THE FOLLOWING PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS AND POLICIES: PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN (EAEDC), CHILDREN'S MEDICAL SECURITY PLAN (CMSP), IF MAGI INCOME IS EQUAL TO OR LESS THAN 300% OF THE FPL; LOW INCOME PATIENTS AS DETERMINED BY MASSHEALTH AND SAFETY NET, INCLUDING THOSE WITH MAGI HOUSEHOLD INCOME OR MEDICAL HARDSHIP FAMILY COUNTABLE INCOME BETWEEN 150.1% TO 300% OF THE FPL; AND MEDICAL HARDSHIP, SUBJECT TO THE FOLLOWING EXCEPTIONS: (A) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY PATIENT ENROLLED IN THE ABOVE MENTIONED PROGRAMS FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM; (B) THE HOSPITAL MAY ALSO INITIATE BILLING OR COLLECTION FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM (INCLUDING RECEIPT OR VERIFICATION OF SIGNED APPLICATION) THE HOSPITAL SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES; (C) THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED EXPIRED OR NOT OTHERWISE IDENTIFIED ON THE STATE ELIGIBILITY VERIFICATION SYSTEM OR MEDICAID MANAGEMENT INFORMATION SYSTEM. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE ANO ENROLLED IN MASSHEALTH THE PREMIUM ASSISTANCE PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PLAN OR MEDICAL HARDSHIP, THE HOSPITAL WILL CEASE COLLECTION ACTIVITY FOR SERVICES (WITH THE EXCEPTION OF ANY COPAYMENTS ANO DEDUCTIBLES) PROVIDED PRIOR TO THE BEGINNING OF THEIR ELIGIBILITY. (D) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR SUCH SERVICE(S). HOWEVER, EVEN IN THESE CIRCUMSTANCES THE HOSPITAL MAY NOT BILL THE PATIENT FOR CLAIMS RELATED TO MEDICAL ERRORS OR CLAIMS DENIED BY THE PATIENT'S PRIMARY INSURER DUE TO AN ADMINISTRATIVE OR BILLING ERROR. PART VI, LINE 2: SIGNATURE HEALTHCARE WORKS COLLABORATIVELY WITH THE BROCKTON DEPARTMENT OF PUBLIC HEALTH THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER AND NUMEROUS COMMUNITY SOCIAL SERVICE AGENCIES TO COORDINATE PUBLIC HEALTH INITIATIVES TO ADDRESS THE NEEDS OF THE AT-RISK POPULATION. SIGNATURE HEALTHCARE FOLLOWS THE GUIDELINES BY PARTICIPATING IN A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. WE USE A FOUR PRONGED APPROACH TO THESE ASSESSMENTS THAT INCLUDES: CONDUCTING KEY INFORMANT INTERVIEWS WITH PEOPLE WHO WORK WITHIN OUR SERVICE AREA TO DETERMINE HOW THE NEEDS OF THE RESIDENTS ARE MET, BY REVIEWING EXISTING PROGRAMS/STRATEGIES AND SERVICES IN THE AREA, BY ANALYZING DATA TO DETERMINE HOW HEALTH OUTCOMES IN THE CITY AND SURROUNDING TOWNS COMPARED TO THE STATE AVERAGE AND LASTLY BY PARTICIPATING IN FOCUS GROUPS TO EXAMINE PERCEPTIONS ON HOW PARTICULAR ISSUES IMPACT THOSE INDIVIDUALS. PART VI, LINE 3: FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE. IN ADDITION, THE HOSPITAL ALSO POSTS GENERAL NOTICES AND MAKES PAPER COPIES OF THE FAP DOCUMENTS AVAILABLE UPON REQUEST AND WITHOUT CHARGE BOTH BY MAIL AND AT SERVICE DELIVERY AREAS WHERE THERE IS A REGISTRATION OR CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO, INPATIENT, OUTPATIENT EMERGENCY DEPARTMENTS, AND AFFILIATED COMMUNITY HEALTH CENTER LOCATIONS), IN CERTIFIED APPLICATION COUNSELOR ("CAC") OFFICES AND IN GENERAL BUSINESS OFFICE AREAS THAT ARE CUSTOMARILY USED BY PATIENTS (E.G., ADMISSIONS AND REGISTRATION AREAS OR PATIENT FINANCIAL SERVICES OFFICES THAT ARE ACTIVELY OPEN TO THE PUBLIC). IN ADDITION, THE HOSPITAL POSTS NOTICES IN LOCAL COMMUNITY HEALTH CENTERS, SENIOR AND EDUCATION FACILITIES. THE GENERAL NOTICE WILL INFORM THE PATIENT ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE (INCLUDING MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET AND MEDICAL HARDSHIP) AS WELL AS THE LOCATION (S) WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC. INFORMATION ABOUT APPLYING FOR FINANCIAL ASSISTANCE IS ALSO AVAILABLE ONLINE AT WWW.SIGNATURE-HEALTHCARE.ORG. THE GOAL OF THESE NOTICES IS TO ASSIST INDIVIDUALS IN APPLYING FOR COVERAGE WITHIN ONE OR MORE OF THESE PROGRAMS. PART VI, LINE 4: SHBH SERVES OVER 100,000 PATIENTS ON AN ANNUAL BASIS. AS A DISPROPORTIONATE SHARE HOSPITAL AND THE HUB AND SOLE HOSPITAL OF SIGNATURE HEALTHCARE, WE PROVIDE A FULL RANGE OF PRIMARY AND SPECIALTY CARE SERVICES FOR ECONOMICALLY DISADVANTAGED AND AT-RISK INDIVIDUALS. THE POVERTY IN OUR SERVICE AREA IS SO SEVERE (72% OF PATIENTS QUALIFY FOR GOVERNMENT INSURANCE) AND RESIDENTS LACK RESOURCES FOR BASIC LIVING EXPENSES. ADD TO THAT THE FEAR OF NAVIGATING A CANCER DIAGNOSIS. OUR SERVICE AREA ALSO INCLUDES LARGE NUMBERS OF IMMIGRANT AND FIRST-GENERATION FAMILIES FROM HAITI AND CAPE VERDE AMONG OTHERS FOR WHOM ENGLISH IS A STRUGGLE. MASSACHUSETTS HAS THE HIGHEST CAPE VERDEAN POPULATION - 53,174 - IN THE UNITED STATES. THE MAJORITY - 11,709 - RESIDE IN BROCKTON, MASSACHUSETTS. *MASSACHUSETTS IS ALSO A TOP STATE IN THE UNITED STATES FOR HAITIAN POPULATION AT NEARLY 37,000 OF LEGAL RESIDENCE. THE BROCKTON AREA IS IN FACT HOME TO THE LARGEST HAITIAN COMMUNITY IN THE UNITED STATES. (*SOURCE: CENTER FOR IMMIGRATION STUDIES) WITH EXTENSIVE TRANSLATION SERVICES A HIGH PERCENTAGE OF STAFF WHO SPEAK MORE THAN ONE LANGUAGE AND A FULL UNDERSTANDING OF THE MULTICULTURAL POPULATION IN OUR COMMUNITIES, SHBH IS UNIQUELY ABLE TO ASSIST PATIENTS AND THEIR FAMILIES THROUGHOUT THE COMMUNITIES WE SERVE. THE IMPORTANCE OF CLEAR COMMUNICATION, SUPPORT AND ACCESS TO QUALITY CARE WHEN FACING A MEDICAL CHALLENGE CANNOT BE OVERSTATED. PART VI, LINE 6: BROCKTON HOSPITAL (BH) IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. UNDER THE CONTROL OF ITS PARENT ORGANIZATION, SIGNATURE HEALTHCARE CORPORATION, INC. (SHC) AFFILIATES BH AND SIGNATURE HEALTHCARE MEDICAL GROUP, INC. (SMG) COORDINATE THE PROVISION OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF BROCKTON AND ITS SURROUNDING CITIES AND TOWNS. PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: MA false true false false false false false false false KIM N HOLLON President/CEO 647312 0 0 0 36381 0 0 0 30024 0 713717 0 0 0 MICHAEL L DERN MD TRUSTEE 0 175761 0 0 0 3499 0 0 0 1713 0 180973 0 0 DAVID DRINKWATER MD Physician Elect 0 610251 0 0 0 5700 0 0 0 32659 0 648610 0 0 ROBERT S GREENBERG MD TRUSTEE 0 258353 0 0 0 5402 0 0 0 1130 0 264885 0 0 STEPHEN BORGES INTERIM CFO 226388 0 0 0 15546 0 0 0 30218 0 272152 0 0 0 KEVIN G MURPHY CFO 414528 0 0 0 3785 0 0 0 26401 0 444714 0 0 0 KIMBERLY WALSH Senior VP/Chief Nursing ofcr 276546 0 0 0 30132 0 0 0 12284 0 318962 0 0 0 KAREN E MURPHY SENIOR VP GENERAL COUNSEL 348761 0 0 0 26630 0 0 0 3021 0 378412 0 0 0 JEFFREY C MILLER VP PHILANTHROPY 215141 0 0 0 17149 0 0 0 30251 0 262541 0 0 0 SUSAN L BOULANGER ASSOC VP ENTERPRISE RADIOLOGY 181749 0 27000 0 12037 0 0 0 9550 0 230336 0 0 0 BARBARA CURLEY VP Quality/Chief Quality Ofcr 203041 0 0 0 12338 0 0 0 2257 0 217636 0 0 0 PART I, LINE 3: THE ORGANIZATION'S BOARD OF TRUSTEES STANDING COMPENSATION COMMITTEE IS EMPOWERED BY THE BOARD OF TRUSTEES TO REVIEW AND APPROVE ALL MATTERS PERTAINING TO COMPENSATION AND SHALL REPORT ALL ACTIONS TAKEN BY IT ON THESE MATTERS TO THE BOARD OF TRUSTEES. THE COMPENSATION COMMITTEE SHALL REVIEW AND APPROVE THE OVERALL COMPENSATION PHILOSOPHY FOR THE HOSPITAL PRESIDENT AND CEO, MEMBERS OF THE HOSPITAL SENIOR MANAGEMENT TEAM, PHYSICIAN COMPENSATION FOR SMG AND HOSPITAL CHIEFS OF SERVICE, AND ANY INDIVIDUAL WHO FALLS WITHIN THE INTERNAL REVENUE SERVICE DEFINITION OF A DISQUALIFIED PERSON AND SHALL BE RESPONSIBLE FOR THE GENERAL OVERSIGHT OF ALL COMPENSATION RELATED DECISIONS WITH THE EXCEPTION OF THOSE INDIVIDUALS WHOSE SALARY AND BENEFITS ARE SUBJECT TO COLLECTIVE BARGAINING AGREEMENTS. THE COMMITTEE WILL BE RESPONSIBLE FOR REVIEWING, AT LEAST EVERY 3 YEARS, THE OVERALL COMPENSATION RANGE OF THE HOSPITAL AND ITS AFFILIATES AS COMPARED TO COMPARABLE ORGANIZATIONS AND SHALL ESTABLISH THE GENERAL PERCENTILE FOR AVERAGE COMPENSATION IN MAKING THIS DETERMINATION. THE COMMITTEE SHALL ENGAGE A BENEFIT CONSULTING FIRM TO CONDUCT MARKET ANALYSIS BASED ON THE RECOMMENDATIONS OF THE VICE PRESIDENT OF HUMAN RESOURCES. THE COMMITTEE SHALL HAVE THE POWER TO: APPROVE ALL FINAL DETERMINATIONS WITH RESPECT TO COMPENSATION; RETAIN AND TERMINATE A QUALIFIED COMPENSATION CONSULTANT TO ASSIST IN THE ASSESSMENT OF COMPENSATION; AND RETAIN AND TERMINATE LEGAL, ACCOUNTING OR OTHER EXPERTS NECESSARY TO CARRY OUT ITS DUTIES. THE MINUTES OF THE COMPENSATION COMMITTEE SHALL REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. PART I, LINE 4B: DURING THE YEAR ENDED 09/30/2021 THE ORGANIZATION MADE 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS FOR ELIGIBLE PLAN PARTICIPANTS. THE PLAN WAS CREATED BY SIGNATURE HEALTHCARE FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR A SELECT GROUP OF EMPLOYED PHYSICIANS UPON MEETING THE ELIGIBILITY REQUIREMENT OF COMPLETING TWO YEARS OF PLAN SERVICE. FOR YEARS IN WHICH THE ORGANIZATION MEETS ITS OPERATIONAL MARGIN GOAL THE ORGANIZATION WILL CONTRIBUTE TO THE PLAN. THE ORGANIZATION MAY CREDIT TO THE ACCOUNT OF EACH PARTICIPANT UP TO 4% OF THE PARTICIPANT'S TOTAL CARE COMPENSATION FOR THE PRIOR PLAN YEAR. PARTICIPANTS REMAIN PARTICIPANTS IN THE PLAN UNTIL FORFEITURE OR DISTRIBUTION OF HIS/HER ACCOUNT. COMMENCEMENT OF DISTRIBUTIONS BEGIN UPON THE LAPSE OF FORFEITURE RISK AND ARE MADE IN SINGLE LUMP-SUM DISTRIBUTIONS NET OF APPLICABLE FEDERAL AND STATE WITHHOLDING TAXES. NO DISTRIBUTIONS WERE MADE FROM THE PLAN TO ANY LISTED PERSONS DURING THE YEAR. PART II, COLUMN D - DEFINED BENEFIT PLAN: THE HOSPITAL MAINTAINS TWO DEFINED BENEFIT PENSION PLANS COVERING HOSPITAL EMPLOYEES WITH AT LEAST ONE YEAR OF SERVICE. PRIOR TO JANUARY 2016, ALL PARTICIPANTS WERE COVERED BY ONE PLAN. EFFECTIVE JANUARY 2016, ALL INACTIVE PARTICIPANTS AND ACTIVE PARTICIPANTS WITH FROZEN BENEFITS WERE SPUN OFF TO A NEW PLAN, THE SIGNATURE HEALTHCARE RETIREMENT PLAN. THE REMAINING PLAN IS FOR ACTIVE PARTICIPANTS WHO CONTINUE TO ACCRUE BENEFITS. IN DECEMBER 2008, THE BOARD APPROVED AMENDEMENTS TO FREEZE THE PENSION PLANS FOR CERTAIN EMPLOYEES EFFECTIVE MARCH 2009, AFTER WHICH NO BENEFIT WILL ACCRUE FOR THOSE EMPLOYEES. EFFECTIVE 2012 AND 2014, ANY NEW HIRES COVERED BY THE SERVICE EMPLOYEES INTERNATIONAL UNION AND MASSACHUSETTS NURSES ASSOCIATION AGREEMENTS, RESPECTIVELY, ARE NOT ELIGIBLE TO PARTICIPATE IN THE PENSION PLANS. PART II, COLUMN D - DEFINED CONTRIBUTION PLAN: IN APRIL 2009, THE CORPORATION IMPLEMENTED A DEFINED CONTRIBUTION 403(B) PLAN FOR CERTAIN HOSPITAL EMPLOYEES AND IN OCTOBER 2010, THE PLAN WAS MADE AVAILABLE TO CERTAIN SIGNATURE HEALTHCARE MEDICAL GROUP EMPLOYEES. THE CORPORATION MAINTAINS CONTRIBUTORY, DEFINED CONTRIBUTION PLANS THAT ARE AVAILABLE TO EMPLOYEES WHO MEET CERTAIN MINIMUM REQUIREMENTS. THE PLANS REQUIRE THAT THE CORPORATION MATCH SPECIFIED PERCENTAGES OF PARTICIPANT CONTRIBUTIONS UP TO CERTAIN MAXIMUM LEVELS. THE CORPORATION'S CONTRIBUTIONS WERE FUNDED PERIODICALLY DURING THE YEAR. PART II, COLUMN D - DEFERRED COMPENSATION PLANS: THE CORPORATION MAINTAINS A 457(B) DEFERRED COMPENSATION PLAN WHICH COVERS KEY EMPLOYEES. UNDER THIS PLAN, EMPLOYEES MAY ELECT TO DEFER A PORTION OF THEIR COMPENSATION. THE CORPORATION MAINTAINS A 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR ACTIVELY EMPLOYED ELIGIBLE PHYSICIANS. EMPLOYEES WILL BE VESTED IN THE CONTRIBUTION FOR A PLAN YEAR ON JANUARY 1 TEN YEARS FROM THE YEAR IN WHICH EMPLOYEE CONTRIBUTIONS ARE MADE OR ON JANUARY 1 IN THE YEAR IN WHICH THEY REACH THE RETIREMENT AGE OF 65 AND HAVE TWO YEARS OF PLAN SERVICE. PART II, COLUMN D: THE CORPORATION IS SELF-INSURED FOR ITS MEDICAL AND DENTAL INSURANCE PLANS. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY (MDFA) 043431814 NONEAVAIL 2017-12-21 50047441 SEE PART VI false false false B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY (MDFA) 043431814 NONEAVAIL 2021-08-23 20000000 SEE PART VI false false false A 0 0 50047441 0 0 0 483298 0 0 8376978 41670863 0 2019 true false true true B 0 0 20000000 0 0 0 631570 0 0 19368430 0 0 2021 false false true true A true true true false false 0.00710 0.00710 false false false true B false false false 0.00000 0.00000 0.00000 false false false true A false true false false true false 0 false 0 false true B false true false false false false 0 false 0 false true A true B true SCHEDULE K, PART I, COLUMN (F) Row A (A) ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCING AGENCY ("MDFA") (F) DESCRIPTION OF PURPOSE: REFINANCE DEBT ISSUED 9/30/2014 AND FINANCE CONSTRUCTION, RENOVATIONS AND ACQUISITIONS OF CAPITAL EQUIPMENT. Row B (A) ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCING AGENCY ("MDFA") (F) DESCRIPTION OF PURPOSE: acquire property NICCOLI BROTHERS OIL FRED NICCOLI GREATER THAN 35% CONTROLLED ENTITY 18989 SUPPLIES PURCHASE FORM 990, PART I, LINE I, DESCRIPTION OF ORGANIZATION MISSION: TEACHING HOSPITAL SERVING MORE THAN 460,000 RESIDENTS IN MORE THAN 20 SOUTHEASTERN MASSACHUSETTS COMMUNITIES. THE HOSPITAL HAS 216 LICENSED BEDS AND PROVIDES A FULL RANGE OF CLINICAL SERVICES INCLUDING MEDICAL/SURGICAL, PEDIATRICS, OBSTETRICS, INPATIENT AND OUTPATIENT PSYCHIATRY, RADIATION, AND MEDICAL ONCOLOGY, CARDIAC CATHERITIZATION, LEVEL II NURSERY AND MAGNETIC RESONANCE IMAGING. FORM 990, PART III, LINE I: SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-BASED TEACHING HOSPITAL SERVING MORE THAN 460,000 RESIDENTS IN MORE THAN 20 SOUTHEASTERN MASSACHUSETTS COMMUNITIES. OUR MISSION IS TO BE THE LEADING COMMUNITY BASED HEALTHCARE DELIVERY SYSTEM IN SOUTHEASTERN MASSACHUSETTS, PROVIDING THE FULL RANGE OF INTEGRATED PRIMARY CARE, SPECIALTY CARE, ACUTE HOSPITAL CARE AND RELATED ANCILLARY HEALTHCARE SERVICES. SIGNATURE HEALTHCARE PHYSICIANS AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL STRIVE TO BE RECOGNIZED AS THE "PROVIDERS OF CHOICE" BY STAFF, PATIENTS AND THE COMMUNITY. SIGNATURE HEALTHCARE IS GUIDED BY THESE PRINCIPLES: - TAKE A LEADERSHIP ROLE IN ASSESSING THE HEALTH CARE NEEDS OF THE METRO SOUTH AREA BY COMMITTING TO A HOSPITAL-COMMUNITY PARTNERSHIP AND BY COLLABORATING WITH OTHER PROVIDERS AND COMMUNITY MEMBERS TO OFFER A BROAD RANGE OF EDUCATION, HEALTH SERVICES AND OTHER ACTIVITIES FOR ALL PATIENTS AND, IN PARTICULAR, THE UNDERSERVED AND DISADVANTAGED POPULATIONS. - DEVELOP NEW SERVICES AND PROGRAMS AND PARTICIPATE IN ALTERNATIVE DELIVERY AND REGIONAL HEALTH CARE SYSTEM TO RESPOND TO COMMUNITY NEED AND ENHANCE ACCESS TO CARE. - PARTICIPATE IN THE EDUCATION OF HEALTH CARE PROFESSIONALS TO ENHANCE THE HOSPITAL'S ACCESS TO MEDICAL EXPERTISE AND TO ASSURE THE MOST UP-TO-DATE APPROACHES FOR PROVIDING CARE. - COMMIT TO AN ELECTRONIC MEDICAL RECORD ENVIRONMENT AIMED AT (1) REDUCING MEDICAL ERRORS WITH MORE ACCURATE AND TIMELY INFORMATION FOR PROVIDERS, (II) ENHANCING PHYSICIAN PRODUCTIVITY AND JOB SATISFACTION, (III) RESPONDING TO CONSUMER REQUESTS FOR ELECTRONIC COMMUNICATION. - BE AN EQUITABLE EMPLOYER THAT VALUES AND REWARDS EXCELLENCE IN ITS ASSOCIATES. - MANAGE FINANCES AGGRESSIVELY TO REMAIN COST EFFECTIVE AND FISCALLY SOUND. PART OF SIGNATURE HEALTHCARE BROCKTON HOSPITAL'S COMMUNITY FOCUS, AND INDEED THE VERY CORE OF OUR MISSION, IS TO CARE FOR THOSE IN GREATEST NEED. WE ARE ESPECIALLY PROUD OF OUR DISTINGUISHED, CENTURY-PLUS TRADITION OF REACHING OUT TO ALL PATIENTS IN OUR COMMUNITY. FROM EVERY WALK OF LIFE, REGARDLESS OF THEIR ABILITY TO PAY. FORM 990, PART VI, SECTION A, LINE 4: THE QUALITY IMPROVEMENT COMMITTEE WAS ESTABLISHED TO BRING COMBINED ENTERPRISE AND QUALITY OVERSIGHT BY THE CORPORATION OF THE ACO AND THE ACTIVITIES OF ITS AFFILIATES, AND CONSISTS OF THOSE INDEPENDENT TRUSTEES SERVING ALSO FROM TIME TO TIME AS THE MEMBERS OF THE SIGNATURE HEALTHCARE CORPORATION QUALITY IMPROVEMENT COMMITTEE AND AT LEAST (1) OF THE FOUR (4) TRUSTEES SHALL BE EITHER A CONSUMER ADVOCATE OR HAVE CONSUMED HEALTH CARE SERVICES DELIVERED BY THE CORPORATION THROUGH ITS AFFILIATES AND SHALL BE DESIGNATED THE "CONSUMER TRUSTEE". FORM 990, PART VI, SECTION A, LINE 6: SIGNATURE HEALTHCARE CORPORATION, A CHARITABLE ORGANIZATION ORGANIZED UNDER THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS, ACTING THROUGH ITS BOARD OF TRUSTEES, IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B: THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM AND IS PRESENTED TO AND REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER AND COPIES OF FORM 990 ARE PROVIDING TO EACH MEMBER OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C: COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES SHALL BE SUBMITTED TO THE PRESIDENT OR HIS DESIGNEE BY DECEMBER 1ST, PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR, THE PRESIDENT OR HIS DESIGNEE SHALL, IN WRITING, ADVISE MEMBERS (TRUSTEES, SENIOR MANAGEMENT, DEPARTMENT MANAGERS AND PHYSICIANS) AND INDIVIDUALS ON THE MEDICAL EXECUTIVE COMMITTEE WHO ARE NOT MEMBERS OF THE CONFLICT OF INTEREST POLICY AND REQUEST THAT EACH INDIVIDUAL COMPLETE AND SUBMIT TO THE PRESIDENT OR HIS DESIGNEE, A QUESTIONNAIRE OUTLINING ANY POSSIBLE CONFLICTS OF INTEREST OR INDICATING THAT NO SUCH CONFLICT OF INTEREST EXISTS. THE PRESIDENT OR HIS DESIGNEE SHALL REVIEW ALL CONFLICT-OF-INTEREST QUESTIONNAIRES AND AT LEAST ANNUALLY DISCLOSE TO THE EXECUTIVE COMMITTEE THE RESULTS OF THE QUESTIONNAIRES. AT LEAST ANNUALLY THE PRESIDENT OR HIS DESIGNEE SHALL REQUEST A COMMITTEE OF THE BOARD TO REVIEW STANDARD RELATIONSHIPS WITH LOCAL BANKS, INSURANCE FIRMS, VENDORS AND OTHER ENTITIES SERVING THE INSTITUTION TO ASSURE THAT THE RELATIONSHIP IS IN THE BEST INTEREST OF THE INSTITUTION AND IS OTHERWISE CONSISTENT WITH THE TERMS OF THE CONFLICT-OF-INTEREST POLICY. ANY MEMBER HAVING A POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE, USE HIS/HER PERSONAL INFLUENCE OR MAKE AN ADMINISTRATIVE DECISION ON THE MATTER, AND IN THE CASE OF A TRUSTEE, SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE ACTION OF THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A FULL AND ACCURATE DISCLOSURE WAS MADE, THAT THE MEMBER ABSTAINED FROM VOTING OR DECISION MAKING AND THE QUORUM OTHERWISE PRESENT. THE CONFLICT-OF-INTEREST POLICY SHALL BE REVIEWED ANNUALLY BY THE MEMBERS AND EACH NEW MEMBER SHALL BE ADVISED OF THE POLICY PRIOR TO THE INDIVIDUAL'S SELECTION AS A MEMBER AND SHALL BE REQUIRED TO FILE WITHIN 30 DAYS THEREAFTER A COMPLETED QUESTIONNAIRE. FORM 990, PART VI, SECTION B, LINE 15: THE STANDING COMMITTEE OF THE BOARD OF TRUSTEES OF THE ORGANIZATION'S PARENT, SIGNATURE HEALTHCARE CORPORATION, SERVES AS THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND IS EMPOWERED TO REVIEW AND APPROVE ALL MATTERS PERTAINING TO COMPENSATION AND SHALL REPORT ALL ACTIONS TAKEN BY IT ON THESE MATTERS TO THE BOARD OF TRUSTEES. ANNUALLY, THE COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM TO PREPARE AN EXECUTIVE COMPENSATION ANALYSIS WHICH INCLUDES A COMPETITIVE ASSESSMENT OF THE TOTAL COMPENSATION PROGRAM FOR THE ORGANIZATION'S EXECUTIVE POSITIONS (CEO, CFO AND VICE PRESIDENT) FOR REVIEW BY THE COMPENSATION COMMITTEE. THE MINUTES OF THE COMPENSATION COMMITTEE REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 18: FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE LOCATED AT WWW.MASS.GOV. FORM 990, PART VI, SECTION C, LINE 19: THE ARTICLES OF ORGANIZATION ARE OPEN TO THE PUBLIC ON THE MASSACHUSETTS SECRETARY OF STATE'S WEBSITE AND THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART XI, LINE 9, CHANGE IN NET ASSETS: PENSION-RELATED CHANGES $16,182,263 NET ASSETS RELEASED FROM DONOR RESTRICTIONS $874,731 CHANGE IN INTEREST IN NET ASSETS OF SHC $718,268 CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENTS $168,092 TRANSFER FROM (TO) AFFILIATES ($16,895,660) TOTAL TO LINE 9: $1,047,694 SIGNATURE HEALTHCARE CORPORATION INC 680 CENTRE STREET BROCKTON MA 02302 042103554 MGMT & FUNDRA MA 501(C)(3) 12B NA false SIGNATURE HEALTHCARE MEDICAL GROUP INC 680 CENTRE STREET BROCKTON MA 02302 043306782 PHYSICIAN PRA MA 501(C)(3) 10 SHC false BRIDGEWATER GODDARD PARK MEDICAL ASSOC 680 CENTRE STREET BROCKTON MA 02302 042530255 PHYSICIAN PRACTIC MA NA C CORP 0 0 false false false false false false false false false true true true true false false true true true true true