2017-08-03T11:38:28-05:00 2016-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2015-10-01 043306782 SIGNATURE HEALTHCARE MEDICAL GROUP INC SIGN 5089417000 680 CENTRE STREET BROCKTON MA 02302 JAMES PAPADAKOS TREASURER 5089417000 2017-07-31 1 CHRISTINE KAWECKI P00743140 5169187000 2017-07-17 2015 2021-01-29 14:40:06Z SIGNATURE MEDICAL GROUP DAVID DRINKWATER MD 680 CENTRE STREET BROCKTON MA 02302 96323608 0 X WWW.SIGNATURE-HEALTHCARE.ORG X 1996 MA TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL. 10 0 743 0 0 0 75000 0 88059309 95516690 0 9398 1530692 797520 89665001 96323608 0 0 0 0 75808747 82244693 0 0 0 22985761 26699782 98794508 108944475 -9129507 -12620867 24500520 31328742 15693191 18619748 8807329 12708994 TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL BY IMPROVING ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL. 0 0 100598076 96297010 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. 100598076 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 60 0 1 743 1 0 0 0 0 0 0 0 0 0 0 X 10 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X X KIM HOLLON 5089417000 680 CENTRE STREET BROCKTON MA 023023395 DAVID DRINKWATER MD PRESIDENT 40.00 2.00 X X 525812 0 25886 MITCHELL SELINGER MD VP 1.00 40.00 X X 0 487093 18007 SYED M IMAM MD DIRECTOR 40.00 0.00 X 1150136 0 49199 SONJAY SHRINIVAS DO DIRECTOR 40.00 0.00 X 334783 0 25459 VIKAS TEWARI MD DIRECTOR 40.00 0.00 X 500984 0 43022 AMIN SABET MD DIRECTOR 40.00 0.00 X 213556 0 33849 ALEXANDER GEORGAKIS MD DIRECTOR 40.00 0.00 X 537213 0 45222 ROBERT WEINSTEIN MD CHIEF-FAMILY PRACTICE/EX-OFFICIO 40.00 0.00 X 650701 0 49120 DAVID KASHMER MD CHIEF-SURGERY/EX-OFFICIO 40.00 0.00 X 449050 0 7265 AMIT PRASAD MD 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725470 0 0 0 5800 0 23796 0 23473 0 778539 0 0 0 PAUL J PETTINATO MD PHYSICIAN 895279 0 0 0 5138 0 23796 0 81 0 924294 0 0 0 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. 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. 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 N/A 0 BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES INC 680 CENTRE STREET BROCKTON MA 02302 042530255 PHYSICIAN GROUP MA N/A C 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1