2016-08-12T09:24:03-05:00 2015-09-30 135381590 BDO USA LLP 200 PORTLAND STREET BOSTON MA 02114 990 2014-10-01 042103554 SIGNATURE HEALTHCARE CORPORATION SIGN 5089417000 680 CENTRE STREET BROCKTON MA 02302 KIM HOLLON PRESIDENT/CEO 5089417000 2016-08-01 1 JEFFREY T ROGERS P01074284 6177427788 2014 2016-09-27 15:27:22Z KIM HOLLON 680 CENTRE STREET BROCKTON MA 02302 1801857 0 X SIGNATURE-HEALTHCARE.ORG X 1890 MA THE MAINTENANCE OF DONOR RESTRICTED FUNDS FOR BROCKTON HOSPITAL AS WELL AS SOLICITATION OF CONTRIBUTIONS ON BEHALF OF THE HOSPITAL, INCLUDING THE CANCER WALK AND GOLF TOURNAMENT. 18 13 0 130 0 0 211254 545709 0 0 191216 30818 948812 76687 1351282 653214 0 0 0 0 0 0 101148 82684 506721 568771 542978 669919 625662 681363 27552 12001468 10646413 679405 438930 11322063 10207483 X THE MISSION OF SIGNATURE HEALTHCARE IS 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. 0 0 88016 4339 THE MAINTENANCE OF DONOR RESTRICTED FUNDS FOR BROCKTON HOSPITAL AS WELL AS SOLICITATION OF CONTRIBUTIONS ON BEHALF OF THE HOSPITAL, INCLUDING THE CANCER WALK AND THE GOLF TOURNAMENT. 88016 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 1 10 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 18 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X KIM HOLLON 5089417000 680 CENTRE STREET BROCKTON MA 023023395 TIMOTHY J CRUZ TRUSTEE 1.00 X 0 0 0 JOSEPH P DRIER III TRUSTEE 1.00 X 0 0 0 DAVID P FRENETTE TRUSTEE 1.00 X 0 0 0 WALLACE H PECKHAM III TRUSTEE 1.00 X 0 0 0 PATTI ROLAND TRUSTEE 1.00 X 0 0 0 MICHAEL J SULLIVAN TRUSTEE 1.00 X 0 0 0 ROBERT D SULLIVAN TRUSTEE 1.00 X 0 0 0 MARY V WALDRON TRUSTEE 1.00 X 0 0 0 DAVID R WOLOHOJIAN TRUSTEE 1.00 X 0 0 0 KIM N HOLLON CHIEF EXECUTIVE OFFICER 1.00 40.00 X X 0 719808 35541 ROBERT S GREENBERG MD TRUSTEE 1.00 40.00 X 0 273343 21812 DAVID A DRINKWATER MD TRUSTEE 1.00 40.00 X 0 528762 23876 FRED NICCOLI TRUSTEE 1.00 X 0 0 0 PATRICIA TORTORELLA TRUSTEE 1.00 X 0 0 0 MICHAEL L DERN MD TRUSTEE 1.00 40.00 X 0 612864 20761 JAMES LEARY TRUSTEE 1.00 X 0 0 0 REV CHERYL HARRIS TRUSTEE 1.00 X 0 0 0 EUGENE MARROW TRUSTEE 1.00 X 0 0 0 KEITH S MERLIN MD TRUSTEE 1.00 40.00 X 0 423963 55240 JAMES PAPADAKOS CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 378852 39100 DALE J ELLENBERG MD FORMER TRUSTEE 0.00 40.00 X 0 246433 26377 0 3184025 222707 0 1 1 0 0 27453 518256 29538 545709 21107 21107 909284 904945 4339 4339 4339 9711 0 9711 9711 9711 316046 27453 243698 72348 72348 653214 4339 0 103166 82684 82684 FUNDRAISING EXPENSES 424037 424037 ADMINISTRATIVE EXPENSES 118941 88016 30925 625662 88016 30925 506721 37987 32443 221000 146000 1500 1500 8060303 3637644 5304900 4422659 3340081 3241411 3096000 2802400 12001468 10646413 22585 17401 656820 421529 679405 438930 X 7801038 6560199 1983944 2053881 1537081 1593403 11322063 10207483 12001468 10646413 X 27552 -212027 -930105 X 0 1 X 1 0 X X 2 BROCKTON HOSPITAL INC 222472297 3 1 0 0 SIGNATURE HEALTHCARE MEDICAL GROUP INC 043306782 9 1 718969 0 2 718969 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 4017169 82461 -288537 47603 3763490 3742703 274466 4017169 3507330 235373 3742703 3166498 340832 3507330 3335390 -168892 3166498 0.01000 0.86000 0.13000 0 0 957454 957454 3528276 1769436 1758840 2684534 1169295 1515239 387939 371680 16259 502100 327233 174867 4422659 BOARD-DESIGNATED INVESTMENTS -259873 F DONOR-RESTRICTED INVESTMENTS 3501284 F 3241411 SPLIT DOLLAR LIFE INSURANCE POLICY 2802400 2802400 DEFERRED ASSET RETIREMENT OBLIGATION 421529 421529 1397752 744538 744538 653214 0 653214 1023882 398220 398220 625662 0 625662 PART V, LINE 4: THE ORGANIZATION INTENDS TO USE THE FUNDS IN SUPPORT OF BROCKTON HOSPITAL, INC. IN ADDITION, FUNDS ARE SET ASIDE FOR PROGRAMS THAT INCLUDE FREE CARE, MEDICAL EDUCATION, AND THE SCHOOL OF NURSING. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL INCOME FROM AFFILIATES 895,740. FUNDRAISING EVENT EXPENSES -506,721. RESTRICTED NET ASSET ACTIVITY -255,825. NON-OPERATING ACTIVITIES 611,344. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 904,941. FUNDRAISING EVENT EXPENSES -506,721. X X X X X 1 RIGHTTRACK SOLUTIONS LLC 340 ANAWAN STREET REHOBOTH MA 02769 TRAINING-DATA ENTRY 0 0 0 5000 BLACKBAUD SYSTEMS PO BOX 930256 ATLANTA GA 31193 ANALYSIS OF CONTRIBUTIONS 0 0 0 7744 CRESCENDO 300 UNICORN PARK PARK DRIVE WOBURN MA 01801 PLANNED GIVING SERVICES 0 0 0 5500 GRAHAM-PELTON CONSULTING 101 FEDERAL STREET 1900 BOSTON MA 02110 FUNDRAISING CONSULTING 0 0 0 64440 82684 MA RING OF CHAMPIONS 13479 1337 12142 1337 12941 900 6902 CANCER WALK 282714 18739 263975 194 18729 170135 1 47306 7377 39929 103 5437 14225 12795 343499 27453 316046 297 25503 27166 900 189832 243698 72348 1 X X X X X 0 1 0 0 0 0 0 0 0 KIM N HOLLON CHIEF EXECUTIVE OFFICER 0 719808 0 0 0 0 0 11825 0 23716 0 755349 0 0 ROBERT S GREENBERG MD TRUSTEE 0 273343 0 0 0 0 0 5200 0 16612 0 295155 0 0 DAVID A DRINKWATER MD TRUSTEE 0 528762 0 0 0 0 0 0 0 23876 0 552638 0 0 MICHAEL L DERN MD TRUSTEE 0 612864 0 0 0 0 0 5200 0 15561 0 633625 0 0 KEITH S MERLIN MD TRUSTEE 0 423963 0 0 0 0 0 31363 0 23877 0 479203 0 0 JAMES PAPADAKOS CHIEF FINANCIAL OFFICER 0 378852 0 0 0 0 0 13015 0 26085 0 417952 0 0 DALE J ELLENBERG MD FORMER TRUSTEE 0 246433 0 0 0 0 0 2500 0 23877 0 272810 0 0 PART I, LINE 4B DURING THE YEAR ENDED 12/31/14 BROCKTON HOSPITAL (A RELATED ORGANIZATION) MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTION FOR ONE EMPLOYEE. CONSISTENT WITH REPORTING REQUIREMENTS FOR IRS FORM 990, THE HOSPITAL REPORTS COMPENSATION AND OTHER PAYMENTS TO EMPLOYEES AND FORMER EMPLOYEES ON A CALENDAR YEAR (FORM W-2) BASIS. CONSEQUENTLY, THE FOLLOWING AMOUNTS ARE REPORTED FOR THE FISCAL YEAR ENDING 9/30/15: KEITH MERLIN, MD - $4,012 NORMAN GOODMAN FMR CEO LOAN RECEIVABLE (SPLIT DOLLAR LIFE INSURANCE POLICY) X 2802400 2802400 0 1 1 2802400 X SUPPLIES 133 28172 FMV X GIFT CARDS 15 1366 FACE VALUE 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990 WAS PROVIDED TO EACH BOARD MEMBER ELECTRONICALLY. IN ADDITION, A BOARD MEETING WAS CONVENED TO REVIEW THE 990 IN ADVANCE OF THE FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C QUESTIONNAIRES ARE CIRCULATED ON AN ANNUAL BASIS AND ARE SUMMARIZED AND PRESENTED TO THE BOARD FOR REVIEW AND ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS AND ADJUSTMENTS TO COMPENSATION ARE BASED ON PERFORMANCE STANDARDS AND COMPARISON OF COMPENSATION LEVELS TO SIMILAR PROVIDER ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF SPLIT DOLLAR LIFE POLICY -293,600. TRANSFERS TO AFFILIATE -718,969. PERMANENTLY RESTRICTED GIFTS AND BEQUESTS 82,464. 110 LIBERTY STREET REALTY COMPANY LLC 680 CENTRE STREET BROCKTON MA 02302 320048951 REALTY COMPANY MA SIGNATURE HEALTHCARE CORPORATION SIGNATURE HEALTHCARE MEDICAL GROUP INC 680 CENTRE STREET BROCKTON MA 02302 043306782 MEDICAL CARE MA 501C(3) 9 SIGNATURE HEALTHCARE CORPORATION 1 BROCKTON HOSPITAL INC 680 CENTRE STREET BROCKTON MA 02302 222472297 MEDICAL CARE MA 501C(3) 3 SIGNATURE HEALTHCARE CORPORATION 1 BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES 680 CENTRE STREET BROCKTON MA 02302 042530255 PHYSICIAN PRACTICE MA SIGNATURE HEALTHCARE CORPORATION C 1.00000 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 1 BROCKTON HOSPITAL INC O 383621 FMV BROCKTON HOSPITAL INC P 168051 FMV BROCKTON HOSPITAL INC Q 37881 FMV BROCKTON HOSPITAL INC S 124122 FMV BROCKTON HOSPITAL INC R 668863 FMV BROCKTON HOSPITAL INC I 450950 FMV BROCKTON HOSPITAL INC J 420000 FMV SIGNATURE MEDICAL GROUP INC J 234288 FMV SIGNATURE MEDICAL GROUP INC Q 33774 FMV SIGNATURE MEDICAL GROUP INC P 43 FMV SIGNATURE MEDICAL GROUP INC I 268019 FMV