2020-07-29T04:16:39-05:00 2019-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2018-10-01 222472997 BROCKTON HOSPITAL INC BROC 5089417000 680 CENTRE STREET BROCKTON MA 02302 KIM HOLLON PRESIDENT & CEO 5089417000 2020-07-28 1 CHRISTINE KAWECKI P00743140 5169187000 183.83.136.238 2020-07-28 07:24:18 US P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1BA7F11F8C184D0CB166ED8A071ADA6BBBB853D3 2018 2020-11-19 02:30:22Z SIGNATURE HEALTHCARE BROCKTON HOSP KIM HOLLON 680 CENTRE STREET BROCKTON MA 02302 401352486 0 X WWW.SIGNATURE-HEALTHCARE.ORG X 1983 MA SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A COMMUNITY-BASED NOT-FOR-PROFIT (SEE SCHEDULE O) 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 CATHETERIZATION, LEVEL II NURSERY AND MAGNETIC RESONANCE IMAGING. OUR MISSION IS TO BE THE LEADING COMMUNITY BASED HEALTHCARE DELIVERY SYSTEM IN SOUTHEASTERN MASSACHUSETTS, PROVIDING A FULL RANGE OF INTEGRATED PRIMARY CARE, SPECIALTY CARE, 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. 21 17 2449 110 16358 -1376 264538 383482 276873704 281676614 10440199 4943041 7644939 12169477 295223380 299172614 0 0 0 0 167256291 170197695 0 0 0 108021563 118378663 275277854 288576358 19945526 10596256 245000101 258092500 156180550 193908736 88819551 64183764 X SEE SCHEDULE O. 0 0 268529664 293056732 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 WELL INFANT 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). (SEE SCHEDULE O) SEE SCHEDULE O 268529664 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 242 0 1 2449 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 21 17 1 0 1 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 MA X X KIM HOLLON 5089417000 680 CENTRE ST BROCKTON MA 023023395 JOSEPH DRIER CHAIRMAN 1.00 1.00 X X 0 0 0 DAVID M OFFUTT VICE CHAIRMAN 1.00 1.00 X X 0 0 0 KIM N HOLLON PRESIDENT/CEO 40.00 2.00 X X 792516 0 29184 TIMOTHY CRUZ TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL L DERN MD TRUSTEE 1.00 41.00 X 0 441483 25664 DAVID DRINKWATER MD VICE PRESIDENT SPECIALTY CARE 1.00 41.00 X 0 619743 31141 DAVID F ENGELKEMEYER TRUSTEE 1.00 1.00 X 0 0 0 DAVID FRENETTE TRUSTEE 1.00 1.00 X 0 0 0 MARIA FERNANDES TRUSTEE (START 2/28/19) 1.00 1.00 X 0 0 0 ROBERT S GREENBERG MD TRUSTEE 1.00 41.00 X 0 275874 10420 REV CHERYL HARRIS TRUSTEE 1.00 1.00 X 0 0 0 STEVEN LANE MD PRES MEDICAL STAFF 1.00 1.00 X 0 0 0 JAMES LEARY TRUSTEE 1.00 1.00 X 0 0 0 EUGENE MARROW TRUSTEE 1.00 1.00 X 0 0 0 LUKE MCCABE TRUSTEE (START 12/13/18) 1.00 1.00 X 0 0 0 FRED NICCOLI CHAIRMAN DEV OFF BD OF GOVRNRS 1.00 1.00 X 0 0 0 WALLACE PECKHAM III TRUSTEE (RESIGNED 12/13/18) 1.00 1.00 X 0 0 0 PATTI ROLAND TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL SULLIVAN TRUSTEE 1.00 1.00 X 0 0 0 ROBERT SULLIVAN TRUSTEE 1.00 1.00 X 0 0 0 PATRICIA TORTORELLA TRUSTEE 1.00 1.00 X 0 0 0 DAVID WOLOHOJIAN TRUSTEE 1.00 1.00 X 0 0 0 JAMES PAPADAKOS SENIOR VP/CFO RESIGN 4/19/19 40.00 2.00 X 426403 0 25282 STEPHEN BORGES INTERIM CFO (START 4/19/19) 40.00 2.00 X 224425 0 28802 DAVID J FISHER VP CORPORATE SERVICES 40.00 0.00 X 247496 0 22407 KIMBERLY WALSH SENIOR VP PATIENT SERVICES 40.00 0.00 X 321808 0 30847 MITCHELL SELINGER MD VP POPULATION MEDICINE 40.00 1.00 X 523311 0 22371 KAREN E MURPHY SENIOR VP GENERAL COUNSEL 40.00 0.00 X 372428 0 3021 JEFFREY C MILLER VP PHILANTHROPY 40.00 0.00 X 222955 0 29006 BARBARA M CURLEY VP QUALITY/CHIEF QUALITY OFFICER 40.00 0.00 X 209837 0 23475 MICHELLE L TAUTKUS PHYSICIAN ASSISTANT 40.00 0.00 X 193295 0 24566 3534474 1337100 306186 235 0 1 0 MATRIX ANESTHESIA 1342 BELMONT ST STE 205 BROCKTON MA 02302 PHYSICIAN SERVICES 3610548 SECURAMERICA LLC 3399 PEACHTREE RD NE STE 1500 ATLANTA GA 30326 SECURITY SERVICES 1820029 PRATT PEDIATRIC ASSOCIATES 800 WASHINGTON ST NEMC BOX 1013 BOSTON MA 02111 PHYSICIAN SERVICES 1247462 ROUNDTOWER NORTHEAST LLC 200 QUANNAPOWITT PARKWAY WAKEFIELD MA 01880 IT TECHNICAL SERVICES 833278 CRAIG EQUIPMENT 35 PILGRIM WAY EAST WALPOLE MA 02032 CONSTRUCTION SERVICES 661114 42 383482 383482 PATIENT SERVICE REV. 900099 262229182 262229182 INTERCOMPANY REVENUE 900099 8742888 8742888 SCHOOL OF NURSING 900099 4579980 4579980 INTERCOMPANY RENT 900099 1955520 1955520 NONPATIENT LAB REVENUE 900099 16358 16358 4152686 4152686 281676614 1390364 1390364 773001 0 773001 773001 773001 105715249 17300 102052896 126976 3662353 -109676 3552677 3552677 PHARMACY 900099 8858939 8858939 VANTAGE JOINT VENTURE 900099 526585 526585 SHIELDS JOINT VENTURE 900099 284276 284276 1726676 1726676 11396476 299172614 293056732 16358 5716042 2012648 1912016 100632 138517870 128952798 9565072 4567801 4063963 503838 15326455 14232996 1093459 9772921 9173273 599648 5260897 5260897 448952 448952 343204 25204 318000 299269 299269 845273 31711 813562 3562505 3175329 387176 945595 872749 72846 7579520 7099855 479665 191722 126545 65177 3075894 2829822 246072 12033307 11070642 962665 1506833 1291102 215731 PURCHASED SERVICES 20920474 18933899 1986575 MEDICAL & SURGICAL SUPP 19423680 19415468 8212 DRUGS & MEDICATIONS 17458393 17458393 MD CONTRACTED SERVICES 9751804 9751804 14731341 12551929 2179412 288576358 268529664 20046694 0 2135 2360 8218858 11493160 31548383 34430208 1180331 1182903 3127889 3337332 5035724 3800093 241253853 116266127 112989547 124987726 3738570 3956297 990000 990000 78168664 73912421 245000101 258092500 43748663 46475685 4235191 3744224 50000000 48385000 22999529 40553685 35197167 54750142 156180550 193908736 X 81492448 57176340 3828486 3557424 3498617 3450000 88819551 64183764 245000101 258092500 X 10596256 -2325211 -32906832 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 299269 299269 0 PART II-B, LINE 1: BROCKTON HOSPITAL PAID A LOBBYING FIRM $60,000 DURING FISCAL YEAR 2019 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 $239,269 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT FOR PROFIT ASSOCIATIONS WAS USED FOR LOBBYING. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF THE ORGANIZATION'S ACTIVITIES. 4717908 116735 4834643 4502193 25000 190715 4717908 4090994 0 411199 4502193 3763490 1539 325965 0 0 0 4090994 4017169 82461 -288537 0 47603 0 3763490 0.00000 0.71000 0.29000 1 1 1 2947952 2947952 129595865 57711752 71884113 11562250 2953555 8608695 91699359 55600820 36098539 5448427 5448427 124987726 ASSETS WHOSE USE IS LIMITED 61800670 INVESTMENT IN JOINT VENTURES 783066 SECURITY DEPOSITS 382227 MALPRACTICE INSURANCE RESERVES 2393572 DUE FROM THIRD PARTY PAYORS 8552886 73912421 AMOUNTS DUE TO THIRD PARTY PAYORS 8646326 PENSION LIABILITY 46103816 54750142 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. 1 1 1 X 1 X 605.000000000000 1 0 1 1 4730343 1091324 3639019 0.01260 75326297 70438782 4887515 0.01690 6849681 5146512 1703169 0.00590 86906321 76676618 10229703 0.03540 151796 0 151796 0.00050 10180281 6601810 3578471 0.01240 14813568 11541803 3271765 0.01130 65000 65000 0.00020 25210645 18143613 7067032 0.02440 112116966 94820231 17296735 0.05980 6494 6494 0.00000 14350 14350 0.00000 3000 3000 0.00000 19230 19230 0.00010 1650 1650 0.00000 28410 28410 0.00010 73134 73134 0.00020 1 5038501 2351599 65762535 73193625 -7431090 X 1 1 1 1 SIGNATURE HEALTHCARE BROCKTON HOSPITAL 680 CENTRE STREET BROCKTON MA 02302 HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/ 2118 X X X X PSYCH SIGNATURE HEALTHCARE BROCKTON HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION C X 1 18 1 SEE PART V, SECTION C 0 1 X 200.000000000000 605.000000000000 X X X X X 1 1 X X X 1 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 1 X 0 X X X X 1 X 0 0 SIGNATURE HEALTHCARE BROCKTON HOSPITAL 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 REPRESENTATED 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-COMMUNITY-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 HOMELESSNESSWE 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. IN FEBRUARY 2018, SIGNATURE HEALTHCARE BEGAN HOSTING "HOUSING 101" A WORKSHOP AIMED TO HELP INDIVIDUALS APPLY FOR HOUSING AND, IN PARTICULAR, SECTION 8 HOUSING, AND OTHER BENEFITS THEY MAY BE ELIGIBLE FOR INCLUDING BUT NOT LIMITED TO; SNAP (FOOD STAMPS), CASH ASSISTANCE AND UTILITY DISCOUNTS. IN ADDITION, IF THE INDIVIDUAL IS CURRENTLY EXPERIENCING A HOUSING CRISIS AND/OR NEEDS LANDLORD MEDIATION ONE OF THE ADVOCATES CAN ASSIST AND CONNECT THE INDIVIDUAL WITH THE RESOURCES IN THEIR COMMUNITY. THIS IS A PARTNERSHIP BETWEEN SIGNATURE HEALTHCARE AND THE MASSACHUSETTS COALITION FOR THE HOMELESS. IN FY 19, SIGNATURE HEALTHCARE BROADENED THE OFFERINGS BY INCLUDING A REPRESENTATIVE FROM DTA (DEPARTMENT OF TRANSITIONAL ASSISTANCE) AND THE OLD COLONY YMCA SOCIAL SERVICE AND HEALTHY LIVING PROGRAMS. THROUGHOUT THE YEAR, 50 OF OUR SIGNATURE HEALTHCARE PATIENTS WERE ABLE TO TAKE ADVANTAGE OF THIS SERVICE. 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. 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. ONE EXAMPLE IS LADIES NIGHT, WHICH WE HOST EACH FALL IN RECOGNITION OF BREAST CANCER AWARENESS MONTH. WE HAVE CLINICIANS FROM SIGNATURE HEALTHCARE COME AND EDUCATE ATTENDEES ON TOPICS SUCH AS THE IMPORTANCE OF PRIMARY CARE, THE NEED FOR ANNUAL OB/GYN VISITS AND SCREENING CRITERIA INCLUDING WHEN TO HAVE MAMMOGRAMS AND COLONOSCOPIES. DURING THIS EVENT WE ALSO HAVE EDUCATION STATIONS WHICH INCLUDE OPPORTUNITIES TO MEET WITH OUR STAFF AND SCHEDULE APPOINTMENTS THAT ATTENDEES MIGHT NEED. WE PROVIDE INTERPRETER SERVICES WHEN NEEDED. 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 10 OB/GYN PHYSICIANS WITHIN ALL SIGNATURE MEDICAL GROUP LOCATIONS ALONG WITH 10 PEDIATRICIANS IN BROCKTON, HANSON, EASTON, RANDOLPH AND RAYNHAM. 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 HOSPITAL AND STRIVES 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. 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:IN FY 19, SIGNATURE HEALTHCARE OFFERED MULTIPLE TRAININGS TO OUR ASSOCIATES ON "VAPING: WHAT IS IT?" A CONVERSATION ABOUT VAPING PRESENTED BY THE GREATER BOSTON TOBACCO FREE PARTNERSHIP. THE PURPOSE OF THESE PRESENTATIONS WAS TO PROVIDE EDUCATION ON WHAT E-CIGARETTE AND VAPE PRODUCTS ARE, WHY THEY ARE HARMFUL, HOW THE TOBACCO AND VAPING INDUSTRY ARE TARGETING YOUTH, AND HOW TO PROTECT THEM FROM THE LATEST TRENDS. 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, IS A BOARD MEMBER OF PLYMOUTH COUNTY OUTREACH AND IS THE CHAIRMAN OF THE MEDICAL ADVISORY COMMITTEE. THE COMMITTEE PRODUCED A "WHITE PAPER" ON THE OPIOID EPIDEMIC ALONG WITH SPONSORING A CONFERENCE ON PAIN MANAGEMENT, "SCOPE OF PAIN". THIS CONFERENCE PROVIDED AN IN DEPTH TRAINING THAT FOCUSED ON EFFECTIVE COMMUNICATION SKILLS AND THE POTENTIAL RISKS AND BENEFITS OF OPIOIDS FOR MANAGING CHRONIC PAIN. THE TRAINING INCLUDES THE ASSESSMENT OF OPIOID MISUSE RISK AND HOW TO MANAGE OPIOID THERAPY INCLUDING OPIOID TAPERS USING A PATIENT CENTERED APPROACH. 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 PATIENT PAIN ASSESSMENTS AND PAIN MANAGEMENT THROUGHOUT THE ORGANIZATION. PART OF OUR EFFORT INCLUDES RAISING AWARENESS OF AVAILABLE SERVICES FOR CONSULTATION AND REFERRAL FOR PATIENTS WITH COMPLEX PAIN MANAGEMENT NEEDS AMONG STAFF AND OUR LICENSED INDEPENDENT PRACTITIONERS. THE COMMITTEE WORKS TO ENSURE EDUCATIONAL RESOURCES AND PROGRAMS ARE AVAILABLE TO IMPROVE PAIN ASSESSMENT, PAIN MANAGEMENT, AND SAFE USE OF OPIOID MEDICATIONS THROUGHOUT THE ORGANIZATION IN AN ONGOING BASIS.DUE TO THE ALARMING SPIKES IN ADDICTION AND UNINTENDED OVERDOSE DEATHS AND A DRAMATIC RISE IN DIVERSION AND NON-MEDICAL USE OF THESE DANGEROUS DRUGS, SIGNATURE HEALTHCARE ASKED "WHAT'S GOING ON WITH PRESCRIBING PHARMACEUTICALS WITHIN SIGNATURE MEDICAL GROUP?" A GROUP OF EMPLOYEES CAME TOGETHER WITH AN AIM TO ENCOURAGE RESPONSIBLE OPIOID PRESCRIBING PRACTICES FOR SIGNATURE HEALTHCARE PATIENTS WITH CHRONIC PAIN. THE GOAL WAS TO DECREASE THE NUMBER OF OPIOIDS PRESCRIBED BY SIGNATURE HEALTHCARE PRIMARY CARE PROVIDERS WHEN INDICATED BY SUPPORTING RESPONSIBLE OPIOID PRESCRIBING. THERE WERE SEVERAL ACTIONS TAKEN TO ENSURE FOR A SUCCESSFUL PROGRAM WHICH INCLUDED MEETING WITH AND EDUCATING ALL SIGNATURE MEDICAL GROUP PRIMARY CARE PROVIDERS WHO HAD PATIENTS AT HIGH RISK. A MEDICAL MANAGEMENT CLINIC WAS OPENED TO ASSIST PCP'S WITH THE HIGHEST RISK PATIENTS AND DEVELOPING NEW POLICIES. THE HIGH RISK PATIENTS WERE MONITORED EVERY 3-4 MONTHS FOR SUCCESSFUL WEANING FROM OPIOIDS AND BENZODIAZEPINES. DATA WAS PROVIDED TO PCP'S ABOUT THEIR PATIENT'S PROGRESS AND STORYTELLING WAS USED TO SHARE SUCCESSFUL WEANING WITH OTHER PCP'S AND COMMITTEE MEMBERS. THE RESULTS HELP TO TELL THE STORY, AS PCP'S WITH HIGH RISK PATIENTS SAW A 67% REDUCTION, AND OVERALL TOTAL MME (MORPHINE MILLIGRAM EQUIVALENTS) PRESCRIBED PER DAY SAW A 63% REDUCTION. THIS PROCESS SHOWS HOW A COMMUNITY HOSPITAL CAN SUCCESSFULLY, SIGNIFICANTLY, AND SAFELY REDUCE OPIOID PRESCRIBING.CHRONIC DISEASE:SIGNATURE HEALTHCARE IN AFFILIATION WITH BETH ISRAEL DEACONESS MEDICAL CENTER AND HARVARD MEDICAL SCHOOL TEACHING HOSPITAL WILL HOST "CONVERSATIONS ON CANCER WHAT YOU NEED TO KNOW ABOUT THE CHANGING LANDSCAPE." THIS EVENT WILL OFFER A FREE DINNER AND PRICELESS INFORMATION TO COMMUNITY MEMBERS IN ATTENDANCE. THEY WILL LEARN ABOUT DRAMATIC ADVANCES IN CANCER RESEARCH AND CLINICAL CARE. AN OPPORTUNITY TO JOIN THE CONVERSATION WITH LOCAL EXPERTS FROM THE CANCER CENTER AT BETH ISRAEL DEACONESS MEDICAL CENTER AND THE GREENE CANCER CENTER AT SIGNATURE HEALTHCARE WILL BE PROVIDED.SIGNATURE HEALTHCARE WILL CONTINUE TO OFFER "LADIES NIGHT", A FREE EVENING FOR WOMEN IN THE COMMUNITIES WE SERVE TO ENJOY DINNER, EDUCATION AND SCREENING OPPORTUNITIES. DURING THE EVENING, ATTENDEES WILL HAVE THE OPPORTUNITY TO HEAR FROM A PROVIDER ON THE IMPORTANCE OF PREVENTION AND ANNUAL SCREENINGS, ACCESS TO CLINICAL STAFF TO ANSWER THEIR QUESTIONS AND THE CHANCE TO SCHEDULE APPOINTMENTS FOR MAMMOGRAMS, PAP SMEARS AND PRIMARY CARE VISITS. THIS EVENT WILL INCLUDE LOCAL COMMUNITY PARTNERS IN THE AREA OF HEALTH INSURANCE AND CHRONIC DISEASE SELF MANAGEMENT. SIGNATURE HEALTHCARE WORKS WITH ENT ASSOCIATES TO PROVIDE A FREE HEAD & NECK CANCER SCREENING. ATTENDEES WILL RECEIVE A PERSONALIZED RISK ASSESSMENT ALONG WITH INFORMATION ON HOW TO PREVENT HEAD AND NECK CANCERS. WE WILL CONTINUE TO LOOK INTO OTHER OPTIONS FOR CANCER SCREENINGS TO SCHEDULE THROUGHOUT OUR SERVICE AREA.DIABETES/HYPERTENSION: BASED ON THE FINDINGS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNATURE HEALTHCARE CONTINUED ITS WELLNESS PROGRAM -WITH MANY ELEMENTS. THESE INCLUDE FREE EXERCISE CLASSES, FREE HEALTH SCREENINGS, HEALTHY COOKING DEMONSTRATIONS, AND FREE HEALTHY RECIPES. SIGNATURE HEALTHCARE OFFERS FREE ZUMBA AND YOGA CLASSES TO THE COMMUNITY AND EMPLOYEES EVERY TUESDAY AND WEDNESDAY EVENING FROM 5-6PM, TO COMBAT COST AND SAFETY CONCERNS CITED AS REASONS FOR A SEDENTARY COMMUNITY. THESE CLASSES, ATTENDED BY 20-30 PEOPLE WEEKLY, ARE WELL RECEIVED. MASSASOIT COMMUNITY COLLEGE HOSTS THE CLASSES, PROVIDING ADDITIONAL SPACE AND AFFORDING THE OPPORTUNITY TO FACULTY, STAFF AND STUDENTS FROM THE COLLEGE TO ATTEND. SIGNATURE HEALTHCARE CONTINUES TO WORK WITH "BLESSINGS IN A BACKPACK; A PROGRAM THAT SUPPORTS CHILDREN WHO ARE ON THE FREE AND REDUCED BREAKFAST AND LUNCH PROGRAM WITHIN BROCKTON PUBLIC SCHOOLS. SIGNATURE PROVIDES THE 50 CHILDREN, IDENTIFIED FROM THE KENNEDY SCHOOL, NUTRITIOUS FOOD TO TAKE HOME FOR THE WEEKEND.SIGNATURE HEALTHCARE CONTINUES TO BE PART OF THE LARGER COMMUNITY WIDE "BROCKTON KNOCKS DOWN DIABETES" INITIATIVE AND PROVIDES CLINICIANS WHEN NEEDED, ASSISTS WITH COORDINATION AND STAFFING FOR VARIOUS EVENTS AND OFFER HEALTHCARE EDUCATION CLASSES WHEN APPROPRIATE. WE WILL CONTINUE TO WORK WITH OUR COMMUNITY PARTNERS INCLUDING THE OLD COLONY YMCA, BROCKTON VNA, CAPE VERDEAN ADULT DAY HEALTH CENTER AND THE BROCKTON COA. SIGNATURE HEALTHCARE WILL, IN AN EFFORT TO ADDRESS THE COMMUNITY'S NUTRITION AND FITNESS NEEDS, CONTINUE TO SUPPORT "KIDS ROAD RACES", A GRASSROOTS PROGRAM LED BY A COMMUNITY RESIDENT FOR OVER 30 YEARS. SIGNATURE HEALTHCARE WILL CONTINUE TO PROVIDE FUNDING FOR THE INSURANCE COVERAGE FOR THE EVENT AND HEALTHY FOOD OPTIONS AT THE END OF EACH RACE.MENTAL HEALTHSIGNATURE HEALTHCARE CONTINUES TO WORK WITH MASSASOIT COMMUNITY COLLEGE ON HEALTH EDUCATION FOR THE STUDENTS AND FACULTY. SIGNATURE HEALTHCARE WORKS WITH THE WOMEN'S CENTER TO BUILD A CALENDAR EACH YEAR, WHERE EACH MONTH THROUGHOUT THE SEMESTER A DIFFERENT HEALTH TOPIC IS COVERED DURING THE LUNCH TIME. TOPICS TO BE COVERED INCLUDE SUBSTANCE USE, VAPING, NUTRITION, SLEEP AND STRESS AND A VARIETY OF OTHERS.SIGNATURE HEALTHCARE WORKS WITH LOCAL SENIOR CENTERS AND ADULT DAY HEALTH CENTERS AS PART OF THE "SIGNATURE SERIES". THIS IS A MONTHLY EDUCATION PRESENTATION TO OUR LOCAL SENIORS TO PROVIDE THEM WITH THE RESOURCES THEY NEED TO DEAL WITH MENTAL HEALTH AMONGST OTHER HEALTH CONCERNS.SIGNATURE HEALTHCARE WILL WORK WITH LOCAL CABLE ACCESS CHANNELS TO PROVIDE FREE EDUCATION FOR THOSE INDIVIDUALS IN SOCIAL ISOLATION, SPECIFICALLY SENIORS. SIGNATURE HEALTHCARE WILL WORK WITH A FITNESS INSTRUCTOR TO RECORD FITNESS CLASSES FOR LOCAL CABLE CHANNELS TO PROVIDE FREE PHYSICAL FITNESS ACTIVITIES AND EDUCATION TO THOSE IN ISOLATION.TRANSPORTATIONTHE NEED FOR TRANSPORTATION ASSISTANCE CONTINUES TO GROW SINCE SIGNATURE HEALTHCARE BEGAN HELPING WITH THIS NEED IN THE LATE 1990'S. PATIENTS WHO ARE HOSPITALIZED OR TREATED IN THE EMERGENCY DEPARTMENT ARE MOST OFTEN SENT BY AMBULANCE AND DO NOT HAVE PHYSICAL OR FINANCIAL MEANS TO GET HOME WHEN THEY ARE DISCHARGED. AT TIMES, PATIENTS ARE REFERRED FOR POST-HOSPITAL TREATMENT WHICH IS NOT MEDICALLY NECESSARY, AND THUS NOT COVERED BY INSURANCE.IN FY 19, SIGNATURE HEALTHCARE COVERED THE COST OF TRANSPORTATION VIA TAXI FOR 215 PATIENTS COSTING $2505 AND FOR AN ADDITIONAL 495 PATIENTS WHO WERE RELEASED FROM THE EMERGENCY DEPARTMENT; TOTALING $7109 FOR A COMBINED 710 PATIENTS COSTS $9614. 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/FINANCIAL-ASSISTANCE PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINANCIAL-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 OFITS 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. THE FOOTNOTE IS FOUND ON PAGE 32 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 AND 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 AND 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 COMPARE 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 ON LINE 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, REPORTS FILED WITH STATES MA 0 1 0 0 0 0 0 0 0 KIM N HOLLON PRESIDENT/CEO 681531 0 104230 0 6755 0 0 0 29184 0 821700 0 0 0 MICHAEL L DERN MD TRUSTEE 0 435983 0 0 0 5500 0 0 0 25664 0 467147 0 0 DAVID DRINKWATER MD VICE PRESIDENT SPECIALTY CARE 0 614243 0 0 0 5500 0 0 0 31141 0 650884 0 0 ROBERT S GREENBERG MD TRUSTEE 0 195374 0 75000 0 5500 0 0 0 10420 0 286294 0 0 JAMES PAPADAKOS SENIOR VP/CFO RESIGN 4/19/19 357218 0 55000 0 14185 0 0 0 25282 0 451685 0 0 0 STEPHEN BORGES INTERIM CFO (START 4/19/19) 191922 0 19100 0 13403 0 0 0 28802 0 253227 0 0 0 DAVID J FISHER VP CORPORATE SERVICES 205641 0 30000 0 11855 0 0 0 22407 0 269903 0 0 0 KIMBERLY WALSH SENIOR VP PATIENT SERVICES 241829 0 61700 0 18279 0 0 0 30847 0 352655 0 0 0 MITCHELL SELINGER MD VP POPULATION MEDICINE 447571 0 60000 0 15740 0 0 0 22371 0 545682 0 0 0 KAREN E MURPHY SENIOR VP GENERAL COUNSEL 329401 0 36000 0 7027 0 0 0 3021 0 375449 0 0 0 JEFFREY C MILLER VP PHILANTHROPY 192700 0 17000 0 13255 0 0 0 29006 0 251961 0 0 0 BARBARA M CURLEY VP QUALITY/CHIEF QUALITY OFFICER 179882 0 18000 0 11955 0 0 0 23475 0 233312 0 0 0 MICHELLE L TAUTKUS PHYSICIAN ASSISTANT 174217 0 11980 0 7098 0 0 0 24566 0 217861 0 0 0 PART I, LINE 3 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 PRESIDENTS) FOR REVIEW BY THE COMPENSATION COMMITTEE. THE MINUTES OF THE COMPENSATION COMMITTEE REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. PART I, LINE 4B: DURING THE YEAR ENDED 12/31/2018 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 CASH 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. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY(MDFA) 043431814 000000000 2017-12-21 50000000 SEE PART VI 0 0 0 A 50047441 483298 8376978 41670463 2019 1 0 1 1 A 0 1 1 1 0 0.00710 0.00000 0.00710 0 0 1 A 0 1 0 0 1 0 0 0 1 SCHEDULE K, PART I, COLUMN (F) (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. FORM 990, PART III, LINE 1: 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 SYSTEMS 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 (I) 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 III, LINE 4A: 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, 2019 THE HOSPITAL HAD 14,872 TOTAL DISCHARGES AND OBSERVATIONS, 52,429 TOTAL PATIENT DAYS, AND 86,519 OUTPATIENT CLINIC VISITS. THE HOSPITAL'S EMERGENCY DEPARTMENT HAD 59,325 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. 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, FRED NICCOLI, ROBERT S. GREENBERG, M.D., DAVID DRINKWATER, M.D., KIM N. HOLLON, MICHAEL L. DERN, M.D., DAVID ENGELKEMEYER, DAVID OFFUTT, MARIA FERNANDES, LUKE MCCABE AND STEVEN LANE, MD HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS THEY ARE ALSO TRUSTEES OF SIGNATURE HEALTHCARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 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 OT 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 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 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 PRESIDENTS) 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: TRANSFER (TO) FROM AFFILIATES -17,059,351. PENSION RELATED CHANGES -17,098,878. CHANGE IN INTEREST IN INVESTMENT 125,190. CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENT -48,793. NET ASSETS RELEASED FROM RESTRICTION 1,175,000. SIGNATURE HEALTHCARE CORPORATION INC 680 CENTRE STREET BROCKTON MA 02302 042103554 MANAGEMENT AND FUNDRAISING MA 501(C)(3) 12B N/A 0 SIGNATURE HEALTHCARE MEDICAL GROUP INC 680 CENTRE STREET BROCKTON MA 02302 043306782 PHYSICIAN PRACTICE MA 501(C)(3) 10 SIGNATURE HEALTHCARE CORPORATION 0 BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES 680 CENTRE STREET BROCKTON MA 02302 042530255 PHYSICIAN PRACTICE MA N/A C 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 FMV FMV FMV FMV FMV FMV FMV FMV FMV FMV FMV FMV FMV