SIGNATURE HEALTHCARE CORPORATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE CORPORATION (EIN 04-2103554)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-11
- IRS object ID
- 201512239349300511
- Schema version
- 2013v4.0
- 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 | 2015-08-11T07:47:26-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 042684828 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FEELEY & DRISCOLL PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 PORTLAND STREET | AddressLine1 |
| City | BOSTON | City |
| State | MA | State |
| ZIP Code | 02114 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 02302 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIM HOLLON | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 5089417000 | PhoneNum |
| Signature | 2015-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFFREY T ROGERS | PreparerPersonNm |
| PTIN | P01074284 | PTIN |
| Phone | 6177427788 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| 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 | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 02302 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,375,980 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | SIGNATURE-HEALTHCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1890 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 125 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $334,102 | PYContributionsGrantsAmt |
| CY Contributions Grants | $211,254 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $52,009 | PYInvestmentIncomeAmt |
| CY Investment Income | $191,216 | CYInvestmentIncomeAmt |
| PY Other Revenue | $970,643 | PYOtherRevenueAmt |
| CY Other Revenue | $948,812 | CYOtherRevenueAmt |
| PY Total Revenue | $1,356,754 | PYTotalRevenueAmt |
| CY Total Revenue | $1,351,282 | 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 | $35,749 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $101,148 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $522,750 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $492,580 | PYOtherExpensesAmt |
| CY Other Expenses | $568,771 | CYOtherExpensesAmt |
| PY Total Expenses | $528,329 | PYTotalExpensesAmt |
| CY Total Expenses | $669,919 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $828,425 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $681,363 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,406,110 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,001,468 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,698,729 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $679,405 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,707,381 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,322,063 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF SIGNATURE HEALTHCARE IS TO BE THE LEADING COMMUNITY BASE 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $110,377 | ExpenseAmt |
| Revenue | $745,490 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $110,377 | 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 | 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 | 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 | 6 | 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 | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM HOLLON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5089417000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 023023395 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| TIMOTHY J CRUZ | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH P DRIER III | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID P FRENETTE | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| WALLACE H PECKHAM III | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PATTI ROLAND | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL J SULLIVAN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT D SULLIVAN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY V WALDRON | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID R WOLOHOJIAN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KIM N HOLLON | ||||||||
| CHIEF EXECUTIVE OFFICER | 1.00 | Yes (X) | $0 | $657,424 | $34,399 | 40.00 | Yes (X) | |
| ROBERT S GREENBERG MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $271,061 | $20,781 | 40.00 | ||
| DAVID A DRINKWATER MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $502,163 | $22,549 | 40.00 | ||
| PATRICIA TORTORELLA | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL L DERN MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $589,524 | $19,815 | 40.00 | ||
| JAMES LEARY | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| REV CHERYL HARRIS | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EUGENE MARROW | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KEITH S MERLIN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $472,530 | $54,904 | 40.00 | ||
| JAMES PAPADAKOS | ||||||||
| CHIEF FINANCIAL OFFICER | 1.00 | $0 | $325,452 | $33,715 | 40.00 | Yes (X) | ||
| ROBERT COVETT MD | ||||||||
| FORMER TRUSTEE | 0.00 | $0 | $361,953 | $7,787 | 40.00 | Yes (X) | ||
| TIMOTHY R LYNCH MD | ||||||||
| FORMER TRUSTEE | 0.00 | $0 | $20,629 | $1,735 | 40.00 | Yes (X) | ||
| DALE J ELLENBERG | ||||||||
| FORMER TRUSTEE | 0.00 | $0 | $251,185 | $25,049 | 40.00 | Yes (X) | ||
| KENNETH LAWSON | ||||||||
| FORMER TRUSTEE | 0.00 | $0 | $423,983 | $27,447 | 40.00 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,875,904 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $248,181 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $17,780 | FundraisingAmt |
| All Other Contributions | $193,474 | AllOtherContributionsAmt |
| Noncash Contributions | $34,298 | NoncashContributionsAmt |
| Total Contributions | $211,254 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,101 | TotalRevenueColumnAmt |
| Exclusion | $36,101 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,598,390 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,852,900 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $745,490 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $745,490 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $745,490 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $155,115 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $155,115 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $155,115 | TotalRevenueColumnAmt |
| Exclusion | $155,115 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $375,120 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $17,780 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $171,798 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $203,322 | TotalRevenueColumnAmt |
| Exclusion | $203,322 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,351,282 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $745,490 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $394,538 | ExclusionAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,148 | TotalAmt |
| Fundraising | $101,148 | FundraisingAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| FUNDRAISING EXPENSES | $421,602 | $421,602 | ||
| ADMINISTRATIVE EXPENSES | $147,169 | $110,377 | $36,792 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $669,919 | TotalAmt |
| Program Services | $110,377 | ProgramServicesAmt |
| Management And General | $36,792 | ManagementAndGeneralAmt |
| Fundraising | $522,750 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,282 | BOYAmt |
| EOY | $37,987 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $270,000 | BOYAmt |
| EOY | $221,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,500 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,057,305 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,752,405 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,718,722 | BOYAmt |
| EOY | $5,304,900 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,018,896 | BOYAmt |
| EOY | $3,340,081 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,281,210 | BOYAmt |
| EOY | $3,096,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,406,110 | BOYAmt |
| EOY | $12,001,468 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,143 | BOYAmt |
| EOY | $22,585 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,017,896 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $637,690 | BOYAmt |
| EOY | $656,820 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,698,729 | BOYAmt |
| EOY | $679,405 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,424,131 | BOYAmt |
| EOY | $7,801,038 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,828,169 | BOYAmt |
| EOY | $1,983,944 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,455,081 | BOYAmt |
| EOY | $1,537,081 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,707,381 | BOYAmt |
| EOY | $11,322,063 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,406,110 | BOYAmt |
| EOY | $12,001,468 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $681,363 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $47,969 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$30,114,650 | 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 Type1 | Yes (X) | SupportingOrgType1Ind |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeDesc | Governing Document ListedGoverningDocumentListedInd | Supported Org NotifiedSupportedOrgNotifiedInd | US OrganizedUSOrganizedInd | SupportSupportAmt |
|---|---|---|---|---|---|
| BROCKTON HOSPITAL INC | |||||
| 222472297 | 3 | Yes (1) | Yes (1) | Yes (1) | $0 |
| SIGNATURE MEDICAL GROUP INC | |||||
| 043306782 | 9 | Yes (1) | Yes (1) | Yes (1) | $30,608,025 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $30,608,025 | SupportSumAmt |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,742,703 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $274,466 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,017,169 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,335,390 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$168,892 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,166,498 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,187,674 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $147,716 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,335,390 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.84000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.16000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $957,454 | OtherCostOrOtherBasisAmt |
| Book Value | $957,454 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,528,276 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,198,880 | DepreciationAmt |
| Book Value | $2,329,396 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,667,434 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,083,323 | DepreciationAmt |
| Book Value | $1,584,111 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $387,939 | OtherCostOrOtherBasisAmt |
| Depreciation | $366,363 | DepreciationAmt |
| Book Value | $21,576 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $516,202 | OtherCostOrOtherBasisAmt |
| Depreciation | $103,839 | DepreciationAmt |
| Book Value | $412,363 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,304,900 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| BOARD-DESIGNATED INVESTMENTS | $40,056 | F |
| DONOR-RESTRICTED INVESTMENTS | $3,300,025 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,340,081 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SPLIT DOLLAR LIFE INSURANCE POLICY | Desc |
| Book Value | $3,096,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,096,000 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED ASSET RETIREMENT OBLIGATION | Desc |
| Amt | $656,820 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $656,820 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $2,985,556 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,634,274 | OtherRevenueAmt |
| Revenue Not Reported | $1,634,274 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,351,282 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,351,282 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,694,617 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $2,024,698 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $2,024,698 | ExpensesNotReportedAmt |
| Expenses Subtotal | $669,919 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $669,919 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 1,852,900. FUNDRAISING EVENT EXPENSES 171,798. NON-OPERATING ACTIVITIES -282,618. RESTRICTED NET ASSET ACTIVITY -107,806. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 1,852,900. FUNDRAISING EVENT EXPENSES 171,798. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | ActivityActivityTxt | Fundraiser Control Of FundsFundraiserControlOfFundsInd | Gross ReceiptsGrossReceiptsAmt | Retained By ContractorRetainedByContractorAmt | Net To OrganizationNetToOrganizationAmt |
|---|---|---|---|---|---|---|---|---|
| RIGHTTRACK SOLUTIONS LLC | ||||||||
| 340 ANAWAN STREET | REHOBOTH | MA | 02769 | TRAINING-DATA ENTRY | 0 | $0 | $0 | $7,500 |
| BLACKBAUD SYSTEMS | ||||||||
| PO BOX 930256 | ATLANTA | GA | 31193 | ANALYSIS OF CONTRIBUTIONS | 0 | $0 | $0 | $29,332 |
| DJP CONSULTING | ||||||||
| 10 FAXON STREET | NEWPORT | RI | 02840 | GRANT WRITING | 0 | $0 | $0 | $12,700 |
| FREEDMAN HEALTHCARE LLC | ||||||||
| 29 CRAFTS STREET | NEWTON | MA | 02458 | GRANT CONSULTING | 0 | $0 | $0 | $33,500 |
| RAFFERTY COMMUNICATIONS | ||||||||
| 36 COUNTRY ROAD | CHESTNUT HILL | MA | 02458 | GRANT WRITING | 0 | $0 | $0 | $18,116 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net To Organization | $101,148 | TotalNetToOrganizationAmt |
| Licensed States | MA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | RING OF CHAMPIONS | NameOfEvent1Amt |
| Gross Receipts Event1 | $83,722 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $392 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $83,330 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $65 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $392 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $13,812 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $400 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $3,857 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | CANCER WALK | NameOfEvent2Amt |
| Gross Receipts Event2 | $189,713 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $6,190 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $183,523 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $244 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $5,506 | NonCashPrizesEvent2Amt |
| Food And Beverage Event2 | $3,656 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $111,983 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $119,465 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $11,198 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $108,267 | GrossRevenueOtherEventsAmt |
| Non Cash Prizes Other Events | $8,608 | NonCashPrizesOtherEventsAmt |
| Food And Beverage Other Events | $14,850 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $8,425 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $392,900 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $17,780 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $375,120 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $309 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $14,506 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $32,318 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $400 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $124,265 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $171,798 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $203,322 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIM N HOLLON | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $0 | $657,424 | $0 | $0 | $0 | $0 | $0 | $11,475 | $0 | $22,924 | $0 | $691,823 | $0 | $0 |
| ROBERT S GREENBERG MD | ||||||||||||||
| TRUSTEE | $0 | $271,061 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $15,681 | $0 | $291,842 | $0 | $0 |
| DAVID A DRINKWATER MD | ||||||||||||||
| TRUSTEE | $0 | $502,163 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,549 | $0 | $524,712 | $0 | $0 |
| MICHAEL L DERN MD | ||||||||||||||
| TRUSTEE | $0 | $589,524 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $14,715 | $0 | $609,339 | $0 | $0 |
| KEITH S MERLIN | ||||||||||||||
| TRUSTEE | $0 | $472,530 | $0 | $0 | $0 | $0 | $0 | $32,355 | $0 | $22,549 | $0 | $527,434 | $0 | $0 |
| JAMES PAPADAKOS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $325,452 | $0 | $0 | $0 | $0 | $0 | $8,751 | $0 | $24,964 | $0 | $359,167 | $0 | $0 |
| ROBERT COVETT MD | ||||||||||||||
| FORMER TRUSTEE | $0 | $361,953 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,787 | $0 | $369,740 | $0 | $0 |
| TIMOTHY R LYNCH MD | ||||||||||||||
| FORMER TRUSTEE | $0 | $20,629 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,735 | $0 | $22,364 | $0 | $0 |
| DALE J ELLENBERG | ||||||||||||||
| FORMER TRUSTEE | $0 | $251,185 | $0 | $0 | $0 | $0 | $0 | $2,500 | $0 | $22,549 | $0 | $276,234 | $0 | $0 |
| KENNETH LAWSON | ||||||||||||||
| FORMER TRUSTEE | $0 | $423,983 | $0 | $0 | $0 | $0 | $0 | $4,898 | $0 | $22,549 | $0 | $451,430 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | DURING THE YEAR ENDED 9/30/14 BROCKTON HOSPITAL (A RELATED ORGANIZATION) MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTION FOR TWO EMPLOYEES. 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 9/30/14: JAMES PAPADAKOS - $1,326 KEITH MERLIN - $27,255 | ExplanationTxt |
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 | LOAN RECEIVABLE (SPLIT DOLLAR LIFE INSURANCE POLICY) | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $2,535,000 | OriginalPrincipalAmt |
| Balance Due | $2,535,000 | 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 | $2,535,000 | 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 | 111 | $32,283 | FMV |
| Yes (X) | GIFT CARDS | 24 | $2,015 | 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 (UNRESTRICTED) 561,000. TRANSFERS TO AFFILIATE -30,608,025. LOSS ON EARLY EXTINQUISHMENT OF DEBT -149,625. PERMANENTLY RESTRICTED GIFTS AND BEQUESTS 82,000. |
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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 02302 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320048951 | EIN |
| Primary Activities | REALTY COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Total Income | $1,719,120 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | BusinessNameLine1 |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043306782 | MEDICAL CARE | MA | 501C(3) | 9 | SIGNATURE HEALTHCARE CORPORATION | Yes (1) |
| BROCKTON HOSPITAL INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 222472297 | MEDICAL CARE | MA | 501C(3) | 3 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 680 CENTRE STREET | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 02302 | ZIPCode |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $6,816,779 | ShareOfTotalIncomeAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 (20 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BROCKTON HOSPITAL INC | ||
| O | $354,973 | FMV |
| BROCKTON HOSPITAL INC | ||
| P | $198,086 | FMV |
| BROCKTON HOSPITAL INC | ||
| Q | $44,722 | FMV |
| BROCKTON HOSPITAL INC | ||
| R | $150,050 | FMV |
| BROCKTON HOSPITAL INC | ||
| I | $14,751,784 | FMV |
| BROCKTON HOSPITAL INC | ||
| J | $645,000 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| R | $3,275,875 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| S | $1,153,671 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| Q | $1,342,456 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| I | $42,412,598 | FMV |
| 110 LIBERTY STREET COMPANY LLC | ||
| S | $2,578 | FMV |
| 110 LIBERTY STREET COMPANY LLC | ||
| I | $11,833,422 | FMV |
| 110 LIBERTY STREET COMPANY LLC | ||
| Q | $2,758,227 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| I | $12,607,836 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| B | $73,097 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| Q | $10,147 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| R | $457,003 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| J | $234,270 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| S | $895,875 | FMV |
| BROCKTON HOSPITAL INC | ||
| S | $5,481,875 | FMV |