SIGNATURE HEALTHCARE MEDICAL GROUP INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE MEDICAL GROUP INC (EIN 04-3306782)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-03
- IRS object ID
- 201722159349300632
- 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 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 | 043306782 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE MEDICAL GROUP INC | 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 | TREASURER | 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 MEDICAL GROUP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID DRINKWATER MD | 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 | $96,323,608 | 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 | 1996 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 743 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $75,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $88,059,309 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $95,516,690 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $9,398 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,530,692 | PYOtherRevenueAmt |
| CY Other Revenue | $797,520 | CYOtherRevenueAmt |
| PY Total Revenue | $89,665,001 | PYTotalRevenueAmt |
| CY Total Revenue | $96,323,608 | 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 | $75,808,747 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $82,244,693 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,985,761 | PYOtherExpensesAmt |
| CY Other Expenses | $26,699,782 | CYOtherExpensesAmt |
| PY Total Expenses | $98,794,508 | PYTotalExpensesAmt |
| CY Total Expenses | $108,944,475 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$9,129,507 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$12,620,867 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,500,520 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,328,742 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,693,191 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,619,748 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,807,329 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,708,994 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL BY IMPROVING ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $100,598,076 | ExpenseAmt |
| Revenue | $96,297,010 | RevenueAmt |
| Desc | SIGNATURE HEALTHCARE MEDICAL GROUP ("SMG") PHYSICIAN'S PROVIDED EFFICIENT AND HIGH QUALITY PRIMARY AND SPECIALTY HEALTH CARE SERVICES TO RESIDENTS OF ALL AGES, RACES AND ETHNIC BACKGROUNDS IN THE COMMUNITIES IN WHICH IT SERVES. | Desc |
| Total Program Service Expenses | $100,598,076 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | 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 | 0 | 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 | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | 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 | 60 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 743 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 0 | QuidProQuoContributionsInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVID DRINKWATER MD | ||||||||
| PRESIDENT | 40.00 | 2.00 | Yes (X) | Yes (X) | $525,812 | $0 | $25,886 | |
| MITCHELL SELINGER MD | ||||||||
| VP | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $487,093 | $18,007 | |
| SYED M IMAM MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $1,150,136 | $0 | $49,199 | ||
| SONJAY SHRINIVAS DO | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $334,783 | $0 | $25,459 | ||
| VIKAS TEWARI MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $500,984 | $0 | $43,022 | ||
| AMIN SABET MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $213,556 | $0 | $33,849 | ||
| ALEXANDER GEORGAKIS MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $537,213 | $0 | $45,222 | ||
| ROBERT WEINSTEIN MD | ||||||||
| CHIEF-FAMILY PRACTICE/EX-OFFICIO | 40.00 | 0.00 | Yes (X) | $650,701 | $0 | $49,120 | ||
| DAVID KASHMER MD | ||||||||
| CHIEF-SURGERY/EX-OFFICIO | 40.00 | 0.00 | Yes (X) | $449,050 | $0 | $7,265 | ||
| AMIT PRASAD MD | ||||||||
| CHIEF-QUALITY OFFICER/EX-OFFICIO | 40.00 | 0.00 | Yes (X) | $146,270 | $0 | $5,231 | ||
| WEI-CHIN SUNG MD | ||||||||
| DIRECTOR THROUGH 9/1/16 | 40.00 | 0.00 | Yes (X) | $502,750 | $0 | $49,452 | ||
| CATHERINE SCHMITT | ||||||||
| CLERK AS OF 3/1/2016 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES PAPADAKOS | ||||||||
| TREASURER/EX-OFFICIO | 1.00 | 40.00 | Yes (X) | $0 | $348,867 | $26,522 | ||
| ANN-MARIE HATCH | ||||||||
| CLERK THROUGH 3/1/16 | 1.00 | 0.00 | Yes (X) | $47,480 | $0 | $8,644 | ||
| KYUNG HEE CHANG MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,012,862 | $0 | $49,682 | Yes (X) | ||
| CRAIG WARNICK MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $661,944 | $0 | $41,697 | Yes (X) | ||
| JEAN-PIERRE GEAGEA MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $687,482 | $0 | $23,877 | Yes (X) | ||
| KERRY GIRARD MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $731,270 | $0 | $47,269 | Yes (X) | ||
| PAUL J PETTINATO MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $900,417 | $0 | $23,877 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,052,710 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $835,960 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $573,280 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 171 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ALLSCRIPTS LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 60673 | SOFTWARE | $718,339 |
| ALL STAR RECRUITING LOCUMS LLC | |||||
| PO BOX 823424 | PHILADELPHIA | PA | 19182 | TEMP PHYSICIAN SERVICES | $246,811 |
| GASTROINTESTINAL SPECIALISTS | |||||
| 189 QUINCY STREET | BROCKTON | MA | 03202 | PHYSICIAN SERVICES | $163,438 |
| INTEGRITY HEALTHCARE LOCUMS LLC | |||||
| 9785 S MAROON CIR STE G102 | ENGLEWOOD | CO | 80112 | PHYSICIAN SERVICES | $115,303 |
| CTI SYSTEMS LLC | |||||
| 95 POST OFFICE PARK | WILBRAHAM | MA | 01905 | SOFTWARE | $112,550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OUTPATIENT NET REVENUE | 900099 | $70,516,484 | $70,516,484 | |
| INTERCOMPANY REVENUES | 900099 | $23,803,976 | $23,803,976 | |
| INTERCOMPANY RENTS | 900099 | $920,940 | $920,940 | $0 |
| MEANINGFUL USE | 900099 | $275,290 | $275,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $95,516,690 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,398 | TotalRevenueColumnAmt |
| Exclusion | $9,398 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,200 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,200 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,200 | TotalRevenueColumnAmt |
| Exclusion | $17,200 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $780,320 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $780,320 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $780,320 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96,323,608 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $96,297,010 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $26,598 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,457,242 | TotalAmt |
| Program Services | $10,884,380 | ProgramServicesAmt |
| Management And General | $572,862 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,520,015 | TotalAmt |
| Program Services | $57,119,934 | ProgramServicesAmt |
| Management And General | $3,400,081 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,032,902 | TotalAmt |
| Program Services | $994,556 | ProgramServicesAmt |
| Management And General | $38,346 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,746,564 | TotalAmt |
| Program Services | $5,175,723 | ProgramServicesAmt |
| Management And General | $570,841 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,487,970 | TotalAmt |
| Program Services | $3,238,094 | ProgramServicesAmt |
| Management And General | $249,876 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,000 | TotalAmt |
| Program Services | $72,000 | ProgramServicesAmt |
| Management And General | $24,000 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720 | TotalAmt |
| Program Services | $540 | ProgramServicesAmt |
| Management And General | $180 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,439,465 | TotalAmt |
| Program Services | $1,101,090 | ProgramServicesAmt |
| Management And General | $338,375 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,005 | TotalAmt |
| Program Services | $27,027 | ProgramServicesAmt |
| Management And General | $4,978 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,321,484 | TotalAmt |
| Program Services | $2,493,272 | ProgramServicesAmt |
| Management And General | $828,212 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,120 | TotalAmt |
| Program Services | $59,929 | ProgramServicesAmt |
| Management And General | $14,191 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,811,676 | TotalAmt |
| Program Services | $1,358,757 | ProgramServicesAmt |
| Management And General | $452,919 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,941,189 | TotalAmt |
| Program Services | $2,785,645 | ProgramServicesAmt |
| Management And General | $155,544 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MD CONTRACTED | $7,619,760 | $7,545,604 | $74,156 |
| INTERCOMPANY RENT | $2,347,432 | $1,760,574 | $586,858 |
| PURCHASED SERVICES | $1,767,959 | $1,338,966 | $428,993 |
| MEDICAL & SURGICAL SUPP | $1,709,462 | $1,349,137 | $360,325 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,538,510 | TotalAmt |
| Program Services | $3,292,848 | ProgramServicesAmt |
| Management And General | $245,662 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,944,475 | TotalAmt |
| Program Services | $100,598,076 | ProgramServicesAmt |
| Management And General | $8,346,399 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $616,530 | BOYAmt |
| EOY | $148,249 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,626,240 | BOYAmt |
| EOY | $5,264,100 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,773,996 | BOYAmt |
| EOY | $1,426,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $21,912,003 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,506,659 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,533,423 | BOYAmt |
| EOY | $11,405,344 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,820,814 | BOYAmt |
| EOY | $6,414,286 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,985,972 | BOYAmt |
| EOY | $3,892,916 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,545 | BOYAmt |
| EOY | $2,777,010 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,500,520 | BOYAmt |
| EOY | $31,328,742 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,032,478 | BOYAmt |
| EOY | $8,627,984 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $216,667 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,660,713 | BOYAmt |
| EOY | $9,775,097 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,693,191 | BOYAmt |
| EOY | $18,619,748 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,807,329 | BOYAmt |
| EOY | $12,708,994 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,807,329 | BOYAmt |
| EOY | $12,708,994 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,500,520 | BOYAmt |
| EOY | $31,328,742 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$12,620,867 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $16,522,532 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $75,000 | CurrentTaxYearMinus1YearAmt |
| Total | $75,000 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38,797,419 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $43,363,128 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $84,775,367 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $88,858,039 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $95,533,890 | CurrentTaxYearAmt |
| Total | $351,327,843 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38,797,419 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $43,363,128 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $84,775,367 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $88,933,039 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $95,533,890 | CurrentTaxYearAmt |
| Total | $351,402,843 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $351,402,843 | PublicSupportTotal509Amt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $731,962 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $789,718 | CurrentTaxYearAmt |
| Total | $1,521,680 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38,797,419 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $43,363,128 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $84,775,367 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $89,665,001 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $96,323,608 | CurrentTaxYearAmt |
| Total | $352,924,523 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99570 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99740 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,482,642 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,389,871 | DepreciationAmt |
| Book Value | $9,092,771 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,429,361 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,116,788 | DepreciationAmt |
| Book Value | $2,312,573 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,405,344 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| 457B RETIREMENT PLAN | $5,003,436 | F |
| 457F MD RETIREMENT PLAN | $1,410,850 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $6,414,286 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM THIRD PARTY PAYORS | $2,633,465 |
| SECURITY DEPOSIT | $143,545 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,777,010 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| 457(B) PLAN INVESTMENT LIABILITY | $5,003,436 |
| 457(F) MD PLAN NONVESTED | $402,735 |
| DEFERRED RENT | $452,563 |
| LEASEHOLD INCENTIVES | $3,863,244 |
| 457(F) MD PLAN UNVESTED | $53,119 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,775,097 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID DRINKWATER MD | ||||||||||||||
| PRESIDENT | $515,612 | $0 | $10,200 | $0 | $0 | $0 | $0 | $0 | $25,886 | $0 | $551,698 | $0 | $0 | $0 |
| MITCHELL SELINGER MD | ||||||||||||||
| VP | $0 | $437,910 | $0 | $32,300 | $0 | $16,883 | $0 | $0 | $0 | $18,007 | $0 | $505,100 | $0 | $0 |
| SYED M IMAM MD | ||||||||||||||
| DIRECTOR | $1,144,836 | $0 | $0 | $0 | $5,300 | $0 | $23,740 | $0 | $25,459 | $0 | $1,199,335 | $0 | $0 | $0 |
| SONJAY SHRINIVAS DO | ||||||||||||||
| DIRECTOR | $334,783 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $25,459 | $0 | $360,242 | $0 | $0 | $0 |
| VIKAS TEWARI MD | ||||||||||||||
| DIRECTOR | $495,189 | $0 | $0 | $0 | $5,795 | $0 | $19,548 | $0 | $23,474 | $0 | $544,006 | $0 | $0 | $0 |
| AMIN SABET MD | ||||||||||||||
| DIRECTOR | $209,156 | $0 | $0 | $0 | $4,400 | $0 | $8,616 | $0 | $25,233 | $0 | $247,405 | $0 | $0 | $0 |
| ALEXANDER GEORGAKIS MD | ||||||||||||||
| DIRECTOR | $531,913 | $0 | $0 | $0 | $5,300 | $0 | $19,763 | $0 | $25,459 | $0 | $582,435 | $0 | $0 | $0 |
| ROBERT WEINSTEIN MD | ||||||||||||||
| CHIEF-FAMILY PRACTICE/EX-OFFICIO | $646,651 | $0 | $0 | $0 | $4,050 | $0 | $23,887 | $0 | $25,233 | $0 | $699,821 | $0 | $0 | $0 |
| DAVID KASHMER MD | ||||||||||||||
| CHIEF-SURGERY/EX-OFFICIO | $419,050 | $0 | $30,000 | $0 | $0 | $0 | $0 | $0 | $7,265 | $0 | $456,315 | $0 | $0 | $0 |
| AMIT PRASAD MD | ||||||||||||||
| CHIEF-QUALITY OFFICER/EX-OFFICIO | $106,270 | $0 | $40,000 | $0 | $0 | $0 | $0 | $0 | $5,231 | $0 | $151,501 | $0 | $0 | $0 |
| WEI-CHIN SUNG MD | ||||||||||||||
| DIRECTOR THROUGH 9/1/16 | $496,608 | $0 | $0 | $0 | $6,142 | $0 | $23,566 | $0 | $25,886 | $0 | $552,202 | $0 | $0 | $0 |
| JAMES PAPADAKOS | ||||||||||||||
| TREASURER/EX-OFFICIO | $0 | $328,282 | $0 | $6,900 | $0 | $13,685 | $0 | $0 | $0 | $26,522 | $0 | $375,389 | $0 | $0 |
| KYUNG HEE CHANG MD | ||||||||||||||
| PHYSICIAN | $1,007,455 | $0 | $0 | $0 | $5,407 | $0 | $23,796 | $0 | $25,886 | $0 | $1,062,544 | $0 | $0 | $0 |
| CRAIG WARNICK MD | ||||||||||||||
| PHYSICIAN | $656,365 | $0 | $0 | $0 | $5,579 | $0 | $23,948 | $0 | $17,749 | $0 | $703,641 | $0 | $0 | $0 |
| JEAN-PIERRE GEAGEA MD | ||||||||||||||
| PHYSICIAN | $682,182 | $0 | $0 | $0 | $5,300 | $0 | $23,796 | $0 | $81 | $0 | $711,359 | $0 | $0 | $0 |
| KERRY GIRARD MD | ||||||||||||||
| PHYSICIAN | $725,470 | $0 | $0 | $0 | $5,800 | $0 | $23,796 | $0 | $23,473 | $0 | $778,539 | $0 | $0 | $0 |
| PAUL J PETTINATO MD | ||||||||||||||
| PHYSICIAN | $895,279 | $0 | $0 | $0 | $5,138 | $0 | $23,796 | $0 | $81 | $0 | $924,294 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE STANDING COMPENSATION 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 | 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. |
| PART I, LINE 7 | PHYSICIANS ARE ELIGIBLE TO ENTER A PRODUCTIVITY BASED COMPENSATION PLAN ("PLAN") AND BE COMPENSATED BASED ON THE GREATER OF BASE SALARY OR THE PLAN BASED ON PRODUCTIVITY. AN ADDITIONAL INCENTIVE PLAN FOR PHYSICIANS ON PRODUCTIVITY WILL COMPENSATE FOR POSITIVE PERFORMANCE UNDER PATIENT SATISFACTION, QUALITY, AND CITIZENSHIP CRITERIA. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SIGNATURE HEALTHCARE CORPORATION ("SHC"), 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 A, LINE 7A | SHC, AS SOLE CORPORATE MEMBER, AND ACTING THROUGH ITS BOARD OF TRUSTEES HAS THE POWER TO APPOINT THE ORGANIZATION'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE AUTHORITY OF THE ORGANIZATION'S BOARD OF DIRECTORS TO EXERCISE THE FOLLOWING POWERS IS CONDITIONED ON THE PRIOR APPROVAL OF SHC'S BOARD OF TRUSTEES: APPROVE ANY ACTION IMPACTING THE TAX-EXEMPT STATUS OF SHC OR ITS TAX-EXEMPT AFFILIATES, SHC'S CONFORMANCE WITH LAW OR SHC'S POLICIES; APPROVE PROPOSED OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS; APPROVE CHANGES IN METHODOLOGY, STRUCTURE OR PHILOSOPHY OF COMPENSATION PAID AND BENEFITS PROVIDED TO PHYSICIANS; APPROVE THE EXECUTION OF, OR AMENDMENTS TO ANY MATERIAL CONTRACTS; APPROVE THE SALE OR CHANGE OF OWNERSHIP OF THE ORGANIZATION; APPROVE SIGNIFICANT ACQUISITIONS OR DISPOSITIONS OF PROPERTY AND APPROVE INCURRING DEBT ON THE PART OF THE ORGANIZATION FOR MONEY BORROWED OR FOR GUARANTYING THE DEBT OF ANOTHER PARTY. |
| 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 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: | TRANSFERS (TO) FROM AFFILIATES 16,522,532. |
Schedule R IRS990ScheduleR
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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BROCKTON HOSPITAL INC | |||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 222472997 | HOSPITAL | MA | 501(C)(3) | 3 | SIGNATURE HEALTHCARE CORPORATION | 0 | |
| SIGNATURE HEALTHCARE CORPORATION INC | |||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 042103554 | MANAGEMENT AND FUNDRAISING | MA | 501(C)(3) | 11 | 0 | N/A | |
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 INC | 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 GROUP | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | 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 | Yes (1) | 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 |
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