SIGNATURE HEALTHCARE CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE CORPORATION (EIN 04-2103554)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-03
- IRS object ID
- 201702159349300345
- Schema version
- 2015v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-03T11:38:28-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | TWO JERICHO PLAZA | AddressLine1Txt |
| City | JERICHO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11753 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | 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) |
|---|---|---|
| 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 | JAMES PAPADAKOS | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 5089417000 | PhoneNum |
| Signature | 2017-07-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHRISTINE KAWECKI | PreparerPersonNm |
| PTIN | P00743140 | PTIN |
| Phone | 5169187000 | PhoneNum |
| Preparation | 2017-07-17 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE | BusinessNameLine1Txt |
| 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 | $23,392,166 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 300 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $545,709 | PYContributionsGrantsAmt |
| CY Contributions Grants | $764,947 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $654,288 | CYProgramServiceRevenueAmt |
| PY Investment Income | $30,818 | PYInvestmentIncomeAmt |
| CY Investment Income | $112,253 | CYInvestmentIncomeAmt |
| PY Other Revenue | $76,687 | PYOtherRevenueAmt |
| CY Other Revenue | -$5,772 | CYOtherRevenueAmt |
| PY Total Revenue | $653,214 | PYTotalRevenueAmt |
| CY Total Revenue | $1,525,716 | 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 | $82,684 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $276,851 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $745,581 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $542,978 | PYOtherExpensesAmt |
| CY Other Expenses | $1,430,617 | CYOtherExpensesAmt |
| PY Total Expenses | $625,662 | PYTotalExpensesAmt |
| CY Total Expenses | $1,707,468 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $27,552 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$181,752 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,646,413 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,492,621 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $438,930 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,175 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,207,483 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,470,446 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $721,415 | ExpenseAmt |
| Revenue | $654,288 | RevenueAmt |
| Desc | SOLICIT, RECEIVE, INVEST AND HOLD CONTRIBUTIONS FROM ANY AND ALL SOURCES FOR THE BENEFIT OF BROCKTON HOSPITAL, INC | Desc |
| Total Program Service Expenses | $721,415 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM HOLLON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 023023395 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| TIMOTHY CRUZ | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID FRENETTE | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PATTI ROLAND | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT SULLIVAN | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID WOLOHOJIAN | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WALLACE PECKHAM | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOSEPH DRIER | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES LEARY | |||||||
| VICE CHAIRMAN, BOARD OF TRUSTEES | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL SULLIVAN | |||||||
| CHAIRMAN, BOARD OF TRUSTEES | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARY WALRDON | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PATRICIA TORTORELLA | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| REV CHERYL HARRIS | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| EUGENE MARROW | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHERYL MCCALLION | |||||||
| PRES MEDICAL STAFF AS OF 1/25/16 | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| FRED NICCOLI | |||||||
| CHAIRMAN, BROCKTON HOSPITAL FDN | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT S GREENBERG MD | |||||||
| TRUSTEE | 1.00 | 40.00 | Yes (X) | $0 | $273,228 | $28,984 | |
| DAVID DRINKWATER MD | |||||||
| PHYSICIAN ELECT/TRUSTEE | 1.00 | 40.00 | Yes (X) | $0 | $525,812 | $25,886 | |
| KIM N HOLLON | |||||||
| PRESIDENT/CEO/CLERK | 1.00 | 40.00 | Yes (X) | $0 | $684,300 | $24,626 | Yes (X) |
| MICHAEL L DERN MD | |||||||
| TRUSTEE | 1.00 | 40.00 | Yes (X) | $0 | $600,072 | $43,493 | |
| JAMES PAPADAKOS | |||||||
| CFO AND TREASURER | 1.00 | 40.00 | Yes (X) | $0 | $348,867 | $26,522 | Yes (X) |
| KEITH MERLIN MD | |||||||
| PRES MEDICAL STAFF THROUGH 1/25/2016 | 1.00 | 1.00 | Yes (X) | $0 | $526,047 | $35,698 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,958,326 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $185,209 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $174,647 | FundraisingAmt |
| All Other Contributions | $590,300 | AllOtherContributionsAmt |
| Noncash Contributions | $62,210 | NoncashContributionsAmt |
| Total Contributions | $764,947 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RENT FROM AFFILIATES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $654,288 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $654,288 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $654,288 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,732 | TotalRevenueColumnAmt |
| Exclusion | $60,732 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $21,714,779 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $21,663,258 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $51,521 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,521 | TotalRevenueColumnAmt |
| Exclusion | $51,521 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $197,420 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $174,647 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $203,192 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,772 | TotalRevenueColumnAmt |
| Exclusion | -$5,772 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,525,716 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $654,288 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $106,481 | ExclusionAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,851 | TotalAmt |
| Fundraising | $276,851 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $687,522 | TotalAmt |
| Program Services | $515,641 | ProgramServicesAmt |
| Management And General | $171,881 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| FUNDRAISING EXPENSES | $468,730 | $468,730 | ||
| ADMINISTRATIVE EXPENSES | $274,365 | $205,774 | $68,591 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,707,468 | TotalAmt |
| Program Services | $721,415 | ProgramServicesAmt |
| Management And General | $240,472 | ManagementAndGeneralAmt |
| Fundraising | $745,581 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,443 | BOYAmt |
| EOY | $26,007 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,000 | BOYAmt |
| EOY | $36,250 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,802,400 | BOYAmt |
| EOY | $3,096,200 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500 | BOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,509,576 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,816,613 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,422,659 | BOYAmt |
| EOY | $2,692,963 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,241,411 | BOYAmt |
| EOY | $3,641,201 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,646,413 | BOYAmt |
| EOY | $9,492,621 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,401 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $421,529 | BOYAmt |
| EOY | $22,175 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,930 | BOYAmt |
| EOY | $22,175 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,560,199 | BOYAmt |
| EOY | $5,808,470 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,053,881 | BOYAmt |
| EOY | $2,067,034 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,593,403 | BOYAmt |
| EOY | $1,594,942 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,207,483 | BOYAmt |
| EOY | $9,470,446 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,646,413 | BOYAmt |
| EOY | $9,492,621 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$181,752 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $290,000 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$845,285 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 (1) | $331,190 | $0 |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||
| 043306782 | 9 | 0 | $244,401 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $575,591 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | 0 | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | 0 | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION A, LINE 1 | THE 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. |
| PART IV, SECTION C, LINE 1 | THE MEMBERSHIP COMPOSITION OF THE BOARD OF TRUSTEES (BOT) FOR SIGNATURE HEALTHCARE CORPORATION (SHC) AND ITS NON-PROFIT AFFILIATE BROCKTON HOSPITAL, INC. ARE THE SAME BUT DIFFERS FROM THE BOT OF IT'S NON-PROFIT AFFILIATE, SIGNATURE HEALTHCARE MEDICAL GROUP, INC. (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 BOARD OF DIRECTORS FOR SMG. SUBJECT TO THE RIGHTS OF SHC THE SMG BOARD OF DIRECTORS 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
CY Endwmt Fund CYEndwmtFundGrp
| 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 |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,017,169 | BeginningYearBalanceAmt |
| Contributions | $82,461 | ContributionsAmt |
| Investment Earnings Or Losses | -$288,537 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $47,603 | OtherExpendituresAmt |
| End Year Balance | $3,763,490 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,742,703 | BeginningYearBalanceAmt |
| Contributions | $82,000 | ContributionsAmt |
| Investment Earnings Or Losses | $192,466 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,017,169 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,507,330 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $235,373 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,742,703 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,166,498 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $340,832 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,507,330 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.81000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.19000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,069,674 | OtherCostOrOtherBasisAmt |
| Book Value | $1,069,674 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,051,963 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,440,913 | DepreciationAmt |
| Book Value | $1,611,050 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $387,939 | OtherCostOrOtherBasisAmt |
| Depreciation | $375,700 | DepreciationAmt |
| Book Value | $12,239 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,692,963 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| BOARD-DESIGNATED INVESTMENTS | $15,474 | F |
| DONOR-RESTRICTED INVESTMENTS | $3,625,727 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,641,201 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED ASSET RETIREMENT OBLIGATION | Desc |
| Amt | $22,175 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $22,175 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
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 |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp (5 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 | ||||||||
| PO BOX 930256 | ATLANTA | GA | 31193 | ANALYSIS OF CONTRIBUTIONS | 0 | $0 | $6,825 | -$6,825 |
| RIGHT TRACK SOLUTIONS LLC | ||||||||
| 340 ANAWAN ST | REHOBOTH | MA | 02769 | TRAINING - DATA ENTRY | 0 | $0 | $10,000 | -$10,000 |
| CRESCENDO | ||||||||
| 110 CAMINO RUIZ | CAMARILLO | CA | 93012 | PLANNED GIVING SERVICES | 0 | $0 | $5,500 | -$5,500 |
| KELLER MCINTYRE | ||||||||
| PO BOX 405 | FALLS CHURCH | VA | 22040 | GRANT WRITING | 0 | $0 | $76,236 | -$76,236 |
| GRAHAM-PELTON CONSULTING | ||||||||
| 39 BEECHWOOD RD | SUMMIT | NJ | 07901 | FUNDRAISING CONSULTING | 0 | $0 | $178,290 | -$178,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $276,851 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$276,851 | TotalNetToOrganizationAmt |
| Licensed States | MA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | RING OF CHAMPIONS | Event1Nm |
| Gross Receipts Event1 | $76,400 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $8,205 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $68,195 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $925 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $17,158 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $450 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $8,244 | OtherDirectExpensesEvent1Amt |
| Event2 | CANCER WALK | Event2Nm |
| Gross Receipts Event2 | $198,038 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $159,578 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $38,460 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $206 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $28,992 | NonCashPrizesEvent2Amt |
| Other Direct Expenses Event2 | $113,156 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $97,629 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $6,864 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $90,765 | GrossRevenueOtherEventsAmt |
| Cash Prizes Other Events | $186 | CashPrizesOtherEventsAmt |
| Non Cash Prizes Other Events | $5,504 | NonCashPrizesOtherEventsAmt |
| Food And Beverage Other Events | $16,407 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $11,964 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $372,067 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $174,647 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $197,420 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $392 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $35,421 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $33,565 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $450 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $133,364 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $203,192 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$5,772 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 | $267,928 | $0 | $5,300 | $0 | $0 | $0 | $11,095 | $0 | $17,889 | $0 | $302,212 | $0 | $0 |
| DAVID DRINKWATER MD | ||||||||||||||
| PHYSICIAN ELECT/TRUSTEE | $0 | $515,612 | $0 | $10,200 | $0 | $0 | $0 | $0 | $0 | $25,886 | $0 | $551,698 | $0 | $0 |
| KIM N HOLLON | ||||||||||||||
| PRESIDENT/CEO/CLERK | $0 | $553,378 | $0 | $114,747 | $0 | $16,175 | $0 | $0 | $0 | $24,626 | $0 | $708,926 | $0 | $0 |
| MICHAEL L DERN MD | ||||||||||||||
| TRUSTEE | $0 | $594,772 | $0 | $0 | $0 | $5,300 | $0 | $23,947 | $0 | $19,546 | $0 | $643,565 | $0 | $0 |
| JAMES PAPADAKOS | ||||||||||||||
| CFO AND TREASURER | $0 | $328,282 | $0 | $6,900 | $0 | $13,685 | $0 | $0 | $0 | $26,522 | $0 | $375,389 | $0 | $0 |
| KEITH MERLIN MD | ||||||||||||||
| PRES MEDICAL STAFF THROUGH 1/25/2016 | $0 | $521,227 | $0 | $0 | $0 | $4,820 | $0 | $17,085 | $0 | $18,613 | $0 | $561,745 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | 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. |
| PART I, LINE 4B | SIGNATURE HEALTHCARE CREATED THE 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR A SELECT GROUP OF EMPLOYED PHYSICIANS UPON MEETING THE ELIGIBILITY REQUIREMENT OF COMPLETING ONE YEAR OF PLAN SERVICE. 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 DURING THE YEAR. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NORMAN GOODMAN | PersonNm |
| Relationship With Org | FMR CEO | RelationshipWithOrgTxt |
| Loan Purpose | SPLIT DOLLAR LIFE | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $3,096,200 | OriginalPrincipalAmt |
| Balance Due | $3,096,200 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $3,096,200 | TotalBalanceDueAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | SUPPLIES | 201 | $60,080 | FMV |
| Yes (X) | GIFT CARDS | 31 | $2,130 | FACE VALUE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | 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, WALLACE PECKHAM, JOSEPH DRIER, JAMES LEARY, MICHAEL SULLIVAN, MARY WALRDON, PATRICIA TORTORELLA, REV. CHERYL HARRIS, EUGENE MARROW, CHERYL MCCALLION, FRED NICCOLI, ROBERT S. GREENBERG, M.D., DAVID DRINKWATER, M.D., KIM N. HOLLON, MICHAEL L. DERN, M.D., JAMES PAPADAKOS, AND KEITH MERLIN HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS THEY ARE ALSO TRUSTEES OF BROCKTON HOSPITAL, INC. |
| FORM 990, PART VI, SECTION B, LINE 11 | 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. 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 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. |
| 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: | TRANSFERS TO AFFILIATES -575,591. CHANGE IN FAIR VALUE OF SPLIT DOLLAR LIFE POLICY 293,800. ASSETS RELEASED FROM RESTRICTION -563,494. |
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 COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | 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 | 501C(3) | 3 | SIGNATURE HEALTHCARE CORPORATION | Yes (1) |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043306782 | PHYSICIAN PRACTICES | MA | 501C(3) | 9 | SIGNATURE HEALTHCARE CORPORATION | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | 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 PRACTICE | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (11 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BROCKTON HOSPITAL INC | ||
| I | $332,729 | FMV |
| BROCKTON HOSPITAL INC | ||
| A | $420,000 | FMV |
| BROCKTON HOSPITAL INC | ||
| O | $491,894 | FMV |
| BROCKTON HOSPITAL INC | ||
| P | $258,878 | FMV |
| BROCKTON HOSPITAL INC | ||
| Q | $64,239 | FMV |
| BROCKTON HOSPITAL INC | ||
| R | $1,989,338 | FMV |
| BROCKTON HOSPITAL INC | ||
| S | $1,390,077 | FMV |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||
| I | $244,401 | FMV |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||
| J | $234,288 | FMV |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||
| P | -$9,423 | FMV |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||
| S | -$690 | FMV |
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