SIGNATURE HEALTHCARE CORPORATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE CORPORATION (EIN 04-2103554)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-13
- IRS object ID
- 202142259349301004
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-13T07:40:48-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE INTERNATIONAL PLACE | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02110 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042103554 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Signature Healthcare Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KEVIN MURPHY | InCareOfNm |
| Business Name Control | SIGN | BusinessNameControlTxt |
| Phone | 5089417000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 Centre Street | AddressLine1Txt |
| City | Brockton | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02302 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIM HOLLON | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 5089417000 | PhoneNum |
| Signature | 2021-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian Vigneault | PreparerPersonNm |
| PTIN | P00540650 | PTIN |
| Phone | 6174220700 | PhoneNum |
| Preparation | 2021-08-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KIM HOLLON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 Centre Street | AddressLine1Txt |
| City | Brockton | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,497,527 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SIGNATURE-HEALTHCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1890 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF BROCKTON HOSPITAL, INC. AND ITS (SEE SCHEDULE O) | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,303,015 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,111,887 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $234,900 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $351,921 | CYProgramServiceRevenueAmt |
| PY Investment Income | $384,677 | PYInvestmentIncomeAmt |
| CY Investment Income | -$3,351 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$33,744 | PYOtherRevenueAmt |
| CY Other Revenue | -$47,477 | CYOtherRevenueAmt |
| PY Total Revenue | $1,888,848 | PYTotalRevenueAmt |
| CY Total Revenue | $1,412,980 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $22,832 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $22,131 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $620,752 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $851,740 | PYOtherExpensesAmt |
| CY Other Expenses | $837,849 | CYOtherExpensesAmt |
| PY Total Expenses | $874,572 | PYTotalExpensesAmt |
| CY Total Expenses | $859,980 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,014,276 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $553,000 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,938,623 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,215,123 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,938,623 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,215,123 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $75,262 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $234,900 | RevenueAmt |
| Desc | SOLICIT, RECEIVE, INVEST AND HOLD CONTRIBUTIONS RECEIVED FROM ANY AND ALL SOURCES FOR THE BENEFIT OF ITS NON-PROFIT AFFILIATE BROCKTON HOSPITAL, INC. | Desc |
| Total Program Service Expenses | $75,262 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (true) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEVIN MURPHY | PersonNm |
| Phone | 5089417000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1Txt |
| City | BROCKTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02302 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| KIM N HOLLON | |||||||
| PRESIDENT/CEO | 1.0 | 40.0 | Yes (X) | Yes (X) | $0 | $724,407 | $30,075 |
| DAVID DRINKWATER MD | |||||||
| PHYSICIAN TRUSTEE | 1.0 | 40.0 | Yes (X) | $0 | $591,332 | $32,604 | |
| STEPHEN BORGES | |||||||
| INTERIM CFO (10/19 - 10/19) | 1.0 | 40.0 | Yes (X) | $0 | $256,280 | $30,151 | |
| ROBERT S GREENBERG MD | |||||||
| TRUSTEE | 1.0 | 40.0 | Yes (X) | $0 | $271,624 | $10,883 | |
| MICHAEL L DERN MD | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $184,592 | $13,613 | |
| KEVIN G MURPHY | |||||||
| CFO (10/19 - 9/20) | 1.0 | 40.0 | Yes (X) | $0 | $128,793 | $1,477 | |
| TIMOTHY CRUZ | |||||||
| TRUSTEE (UNTIL 12/10/2019) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| REV CHERYL HARRIS | |||||||
| TRUSTEE (UNTIL 12/10/2019) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| DAVID M OFFUTT | |||||||
| TRUSTEE (UNTIL 1/3/20) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| STEVEN LANE MD | |||||||
| PRES, MED STAFF (10/19 - 1/20) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| DAVID FRENETTE | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| PATTI ROLAND | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| ROBERT SULLIVAN | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| DAVID WOLOHOJIAN | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| JOSEPH DRIER | |||||||
| CHAIRMAN | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| JAMES LEARY | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL SULLIVAN | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| PATRICIA TORTORELLA | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| EUGENE MARROW | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| KHALED SOROUR MD | |||||||
| PRES, MED STAFF (1/20 - 9/20) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| FRED NICCOLI | |||||||
| CHAIR DEV OFFICE BOARD OF GOV | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| DAVID F ENGELKEMEYER | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| LUKE MCCABE | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| MARIA FERNANDES | |||||||
| TRUSTEE | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| JOSEPH L TANSEY | |||||||
| TRUSTEE (12/19 - 9/20) | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,157,028 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $118,803 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $171,146 | FundraisingAmt |
| All Other Contributions | $940,741 | AllOtherContributionsAmt |
| Total Contributions | $1,111,887 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RENT FROM AFFILIATES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $351,921 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $351,921 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $351,921 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,831 | TotalRevenueColumnAmt |
| Exclusion | $13,831 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$17,182 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$17,182 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$17,182 | TotalRevenueColumnAmt |
| Exclusion | -$17,182 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $37,070 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $171,146 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $84,547 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$47,477 | TotalRevenueColumnAmt |
| Exclusion | -$47,477 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,412,980 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $351,921 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | -$50,828 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,131 | TotalAmt |
| Fundraising | $22,131 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,078 | TotalAmt |
| Program Services | $66,819 | ProgramServicesAmt |
| Management And General | $8,259 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|---|
| FUNDRAISING EXPENSES | $598,621 | $598,621 | ||
| TRANSPORTATION EXPENSES | $74,733 | $74,733 | ||
| ADMINISTRATIVE EXPENSES | $29,040 | $20,597 | $8,443 | |
| SCHOLARSHIP EXPENSES | $13,500 | $13,500 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,877 | TotalAmt |
| Management And General | $46,877 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $859,980 | TotalAmt |
| Program Services | $75,262 | ProgramServicesAmt |
| Management And General | $163,966 | ManagementAndGeneralAmt |
| Fundraising | $620,752 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,176 | BOYAmt |
| EOY | $56,144 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,429,990 | BOYAmt |
| EOY | $1,159,799 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,053,978 | BOYAmt |
| EOY | $5,315,131 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,195 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,999,082 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,128,389 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,448,987 | BOYAmt |
| EOY | $1,870,693 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,956,297 | BOYAmt |
| EOY | $3,813,356 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,938,623 | BOYAmt |
| EOY | $12,215,123 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,909,099 | BOYAmt |
| EOY | $6,520,577 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,029,524 | BOYAmt |
| EOY | $5,694,546 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,938,623 | BOYAmt |
| EOY | $12,215,123 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,938,623 | BOYAmt |
| EOY | $12,215,123 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $553,000 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$276,500 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 2 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| BROCKTON HOSPITAL INC | ||||
| 222472997 | 3 | Yes (true) | $0 | $0 |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||
| 043306782 | 10 | false | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | false | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Qualified | false | SupportedOrgQualifiedInd |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Control Deciding Grnt Frgn Org | false | ControlDecidingGrntFrgnOrgInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Supported Org Class Designated | false | SupportedOrgClassDesignatedInd |
| Substitution Beyond Org Cntl | false | SubstitutionBeyondOrgCntlInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | false | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE A, PART IV, SECTION A, LINE 1: | MEMBERSHIP COMPOSITION OF THE BOARD OF TRUSTEES FOR THE ORGANIZATION AND ITS TAX EXEMPT AFFILIATE BROCKTON HOSPITAL, INC. ARE THE SAME. THE ORGANIZATION HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS FOR ITS TAX EXEMPT AFFILIATE SIGNATURE HEALTHCARE MEDICAL GROUP, INC. WHICH HAS BEEN GRANTED CERTAIN MANAGERIAL POWERS SUBJECT TO THE PRIOR APPROVAL OF THE ORGANIZATION. |
| SCHEDULE A, PART IV, SECTION C, LINE 1: | MEMBERSHIP COMPOSITION OF THE BOARD OF TRUSTEES ("BOT") FOR SHC AND ITS NON-PROFIT AFFILIATE BROCKTON HOSPITAL, INC. ARE THE SAME BUT DIFFERS FROM THE BOT OF IT'S NON-PROFIT AFFILIATE, SMG. SHC IS THE SOLE MEMBER OF SMG AND AS SUCH HAS ALL RIGHTS AND POWERS CONFERRED ON MEMBERS OF NON-PROFIT CORPORATIONS UNDER THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS INCLUDING BUT NOT LIMITED TO THE POWER TO APPOINT THE BOT FOR SMG. SUBJECT TO THE RIGHTS OF SHC THE SMG BOT HAS AND MAY EXERCISE ALL THE POWERS OF SMG RELATING TO AND IN CONNECTION WITH THE PRACTICE OF MEDICINE BY SMG. MAKE PHYSICIAN HIRING AND FIRING DECISIONS, CONDUCT PEER REVIEW SUBJECT TO SHC'S CREDENTIALING STANDARDS, OVERSEE PRACTICE STANDARDS AND QUALITY OF CARE DELIVERED THROUGH SMG. OVERSEE OPERATIONS AND PATIENT CARE POLICIES SUBJECT TO SHC'S POLICIES, AND OVERSEE OTHER CERTAIN MANAGERIAL POWERS SUBJECT TO THE PRIOR APPROVAL OF SHC. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,834,643 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $134,941 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,969,584 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,717,908 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $116,735 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,834,643 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,502,193 | BeginningYearBalanceAmt |
| Contributions | $25,000 | ContributionsAmt |
| Investment Earnings Or Losses | $190,715 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,717,908 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,090,994 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $411,199 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,502,193 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,763,490 | BeginningYearBalanceAmt |
| Contributions | $1,539 | ContributionsAmt |
| Investment Earnings Or Losses | $325,965 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,090,994 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.71000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.29000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $566,458 | OtherCostOrOtherBasisAmt |
| Book Value | $566,458 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,929,823 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,626,552 | DepreciationAmt |
| Book Value | $1,303,271 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $387,939 | OtherCostOrOtherBasisAmt |
| Depreciation | $387,939 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $114,862 | OtherCostOrOtherBasisAmt |
| Depreciation | $113,898 | DepreciationAmt |
| Book Value | $964 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,870,693 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| BOARD-DESIGNATED INVESTMENTS | -$93,430 | F |
| DONOR-RESTRICTED INVESTMENTS | $3,906,786 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,813,356 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,497,527 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $84,547 | OtherRevenueAmt |
| Revenue Not Reported | $84,547 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,412,980 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,412,980 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $239,277 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $239,277 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $620,703 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $620,703 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $859,980 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART V, LINE 4: | THE ORGANIZATION INTENDS TO USE ITS ENDOWMENT FUNDS TO SUPPORT ITS NOT-FOR-PROFIT AFFILIATE BROCKTON HOSPITAL, INC. IN FURTHERING ITS TAX EXEMPT PURPOSE OF PROVIDING HIGH QUALITY HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITIES IN WHICH IT SERVES AND TO SUPPORT BROCKTON HOSPITAL'S SCHOOL OF NURSING. |
| SCHEDULE D, PART X, LINE 2: | THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT SHC IS 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, AND ACCORDINGLY, IT HAS NOT RECORDED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. |
| SCHEDULE D, PART XI, LINE 2D: | DIRECT FUNDRAISING EXPENSES REPORTED IN REV $ 84,547 |
| SCHEDULE D, PART XII, LINE 4B: | FUNDRAISING EXPENSES PER AFS $ 705,299 DIRECT FUNDRAISING EXPENSES REPORTED IN REV ($ 84,547) OTHER ($ 49) TOTAL TO LINE 4B: $ 620,703 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (true) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | ActivityActivityTxt | Fundraiser Control Of FundsFundraiserControlOfFundsInd | Gross ReceiptsGrossReceiptsAmt | Retained By ContractorRetainedByContractorAmt | Net To OrganizationNetToOrganizationAmt |
|---|---|---|---|---|---|---|---|---|
| BLACKBAUD SYSTEMS | ||||||||
| 2000 DANIEL ISLAND DRIVE | CHARLESTON | SC | 29492 | ANALYSIS OF CONTRIBUTIO | false | $16,631 | $16,631 | $0 |
| CRESCENDO INTERACTIVE INC | ||||||||
| 110 CAMINO RUIZ | CAMARIELO | CA | 93012 | PLANED GIVING SVCS | false | $5,500 | $5,500 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $22,131 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $22,131 | TotalRetainedByContractorsAmt |
| Total Net To Organization | $0 | TotalNetToOrganizationAmt |
| Licensed States | MA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $130,386 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $112,637 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $17,749 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,482 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $20,563 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $14,145 | OtherDirectExpensesEvent1Amt |
| Event2 | RING OF CHAMPS | Event2Nm |
| Gross Receipts Event2 | $53,775 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $34,590 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $19,185 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $192 | NonCashPrizesEvent2Amt |
| Food And Beverage Event2 | $28,620 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $500 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $6,287 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $24,055 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $23,919 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $136 | GrossRevenueOtherEventsAmt |
| Non Cash Prizes Other Events | $718 | NonCashPrizesOtherEventsAmt |
| Food And Beverage Other Events | $0 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $11,040 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $208,216 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $171,146 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $37,070 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $3,392 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $49,183 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $31,472 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $84,547 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$47,477 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT S GREENBERG MD | ||||||||||||||
| TRUSTEE | $0 | $266,064 | $0 | $0 | $0 | $5,560 | $0 | $0 | $0 | $10,883 | $0 | $282,507 | $0 | $0 |
| DAVID DRINKWATER MD | ||||||||||||||
| PHYSICIAN TRUSTEE | $0 | $537,132 | $0 | $48,600 | $0 | $5,600 | $0 | $0 | $0 | $32,604 | $0 | $623,936 | $0 | $0 |
| KIM N HOLLON | ||||||||||||||
| PRESIDENT/CEO | $0 | $685,775 | $0 | $0 | $0 | $38,632 | $0 | $0 | $0 | $30,075 | $0 | $754,482 | $0 | $0 |
| MICHAEL L DERN MD | ||||||||||||||
| TRUSTEE | $0 | $180,812 | $0 | $0 | $0 | $3,780 | $0 | $0 | $0 | $13,613 | $0 | $198,205 | $0 | $0 |
| STEPHEN BORGES | ||||||||||||||
| INTERIM CFO (10/19 - 10/19) | $0 | $240,010 | $0 | $0 | $0 | $16,270 | $0 | $0 | $0 | $30,151 | $0 | $286,431 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 BENEFITS 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 12/31/2019 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. PARTICIPANT'S 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 C - 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 C - 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 C - 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 EMPLOYE 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. |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp | |
| Securities Publicly Traded | SecuritiesPubliclyTradedGrp | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp | |
| Real Estate Residential | RealEstateResidentialGrp | |
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp | |
| Food Inventory | FoodInventoryGrp | |
| Drugs And Medical Supplies | DrugsAndMedicalSuppliesGrp | |
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp |
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | SUPPLIES | 354 | $261,382 | OTHER |
| Yes (X) | GIFT CARDS | 7 | $845 | OTHER |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (true) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE M, PART I, COLUMN (B): | THE ORGANIZATION IS REPORTING BASED ON THE NUMBER OF ITEMS RECEIVED. |
| SCHEDULE M, LINE 32B: | STAFF OF SHC'S NON-PROFIT AFFILIATE, BROCKTON HOSPITAL, SOLICIT NONCASH CONTRIBUTIONS TO BE USED AT FUNDRAISING EVENTS HELD FOR THE BENEFIT OF HEALTHCARE RELATED PROGRAMS AND SERVICES OFFERED BY BH. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE I, DESCRIPTION OF ORGANIZATION MISSION: | AFFILIATED ORGANIZATIONS, INCLUDING MEDICAL CENTERS, HEALTH CARE CENTERS, NURSING CENTERS, LABORATORIES, CLINICS AND OTHER MEDICAL, SURGICAL OR DENTAL FACILITIES, IN THE CONDUCT OF THEIR CHARITABLE, EDUCATIONAL AND SCIENTIFIC FUNCTIONS. |
| FORM 990, PART III, LINE I: | TO BE THE LEADING COMMUNITY BASED HEALTHCARE DELIVERY SYSTEM IN SOUTHEASTERN MASSACHUSETTS PROVIDING THE FULL RANGE OF PRIMARY CARE, SPECIALTY CARE, HOSPITAL CARE AND RELATED ANCILLARY SERVICES ON A COORDINATED BASIS. SIGNATURE HEALTHCARE PHYSICIANS AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL STRIVE TO BE RECOGNIZED AS THE "PROVIDERS OF CHOICE" BY STAFF, PATIENTS AND THE COMMUNITY. |
| FORM 990, PART VI, SECTION A, LINE 2: | TIMOTHY CRUZ, DAVID FRENETTE, PATTI ROLAND, ROBERT SULLIVAN, DAVID WOLOHOJIAN, JOSEPH DRIER, III, JAMES LEARY, MICHAEL SULLIVAN, PATRICIA TORTORELLA, REV. CHERYL HARRIS, EUGENE MARROW, ROBERT S. GREENBERG, M.D., DAVID DRINKWATER, M.D., KIM N. HOLLON, MICHAEL L. DERN, M.D., DAVID ENGELKEMEYER, DAVID OFFUTT, LUKE MCCABE, STEVEN LANE, ALFRED NICCOLI, MARIA FERNANDES, KHALED SOROUR, MD, AND JOSEPH TANSEY, JR. HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS THEY ARE ALSO TRUSTEES OF BROCKTON HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 4: | THE CORPORATION'S BYLAWS WERE AMENDED TO REFLECT THE FOLLOWING CHANGES: (1) THE NUMBER OF ELECTED TRUSTEES REMAINED UNCHANGED AND WAS AMENDED TO INCLUDE AT LEAST TWO NUMBERS OF THE GREATER BROCKTON COMMUNITY (DESIGNATED "CONSUMER TRUSTEES"} WHO ARE EITHER CONSUMER ADVOCATES OR HAVE CONSUMED HEALTH CARE SERVICES DELIVERED BY THE CORPORATION THROUGH ITS AFFILIATES. (2) ALL TRUSTEES OF THE CORPORATION, WITH THE EXCEPTION OF THE CONSUMER TRUSTEES, ARE REPRESENTATIVES OF PROVIDERS PARTICIPATING IN THE SIGNATURE ACCOUNTABLE CARE ORGANIZATION ("ACO"). (3) THE POWERS AND PRINCIPAL FUNCTIONS OF THE CORPORATION WERE AMENDED TO INCLUDE TO GOVERN THE ACO. (4) THE QUALITY IMPROVEMENT COMMITTEE WAS ESTABLISHED TO BRING COMBINED EXPERTISE 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 MEMBERS OF THE BROCKTON HOSPITAL QUALITY IMPROVEMENT COMMITTEE. |
| 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 PROVIDED 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 DESIGNEEE 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 DESIGNEEE. 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 MASTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A FULL AND ACCURATE DISCLOSURE WAS MADE, THAT THE MEMBER ABSTAINED FORM VOTING OR DECISION MAKING AND THE QUORUM OTHERWISE PRESENT. THE CONFLICT OF INTEREST POLICY SHALLY 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 COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE FILING ORGANIZATION 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 PRESIDENTS) FOR REVIEW BY THE COMPENSATION COMMITTEE. THE MINUTES OF THE COMPENSATION COMMITTEE REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. THIS SECTION IS ANSWERED NO DUE TO THE FACT THAT THE CEO AND OTHER OFFICERS' COMPENSATION IS PAID DIRECTLY BY BROCKTON HOSPITAL. |
| 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 AND UPON REQUEST. |
| 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: | TRANSFER (TO)/FROM AFFILIATES ($ 947,637) OTHER $ 665,023 TOTAL CHANGES IN NET ASSETS ($ 282,614) |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 110 LIBERTY STREET REALTY COMPANY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1Txt |
| City | BROCKTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320048951 | EIN |
| Primary Activities | REALTY COMPAN | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| BROCKTON HOSPITAL INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 222472997 | HOSPITAL | MA | 501(C)(3) | 3 | SHC | Yes (true) |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043306782 | PHYS PRACTICE | MA | 501(C)(3) | 10 | SHC | Yes (true) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1Txt |
| City | BROCKTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042530255 | EIN |
| Primary Activities | PHYSICIAN PRACTIC | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Share Of Total Income | $0 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $0 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BROCKTON HOSPITAL | ||
| I | $20,110 | FAIR MKT VALUE |
| BROCKTON HOSPITAL | ||
| L | $621,217 | FAIR MKT VALUE |
| BROCKTON HOSPITAL | ||
| P | $31,987 | FAIR MKT VALUE |
| BROCKTON HOSPITAL | ||
| S | $1,616,578 | FAIR MKT VALUE |
| BROCKTON HOSPITAL | ||
| R | $195,499 | FAIR MKT VALUE |
| SIGNATURE HEALTHCARE MEDICAL GROUP | ||
| J | $234,900 | FAIR MKT VALUE |
Comments