SIGNATURE HEALTHCARE MEDICAL GROUP INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE MEDICAL GROUP INC (EIN 04-3306782)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-10
- IRS object ID
- 201542229349301344
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-10T13:40:31-05:00 | 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 | 043306782 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE MEDICAL GROUP INC | 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 | JAMES N PAPADAKOS | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 5089417000 | PhoneNum |
| Signature | 2015-07-30 | 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 | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE MEDICAL GROUP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID DRINKWATER | 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 | $84,775,367 | 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 BY IMPROVING ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 412 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $43,363,128 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $84,775,367 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $43,363,128 | PYTotalRevenueAmt |
| CY Total Revenue | $84,775,367 | 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 | $40,265,485 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $63,694,843 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,152,201 | PYOtherExpensesAmt |
| CY Other Expenses | $27,129,163 | CYOtherExpensesAmt |
| PY Total Expenses | $47,417,686 | PYTotalExpensesAmt |
| CY Total Expenses | $90,824,006 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,054,558 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$6,048,639 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,835,993 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,021,436 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,064,403 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,705,923 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$14,228,410 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,315,513 | 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 | $82,911,558 | ExpenseAmt |
| Revenue | $84,775,367 | RevenueAmt |
| Desc | TO IMPROVE ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL TO THE RESIDENTS OF THE HOSPITAL SERVICE AREA. 391,000 PHYSICIAN ENCOUNTERS WERE PROVIDED FOR THE YEAR ENDED SEPTEMBER 30, 2014. | Desc |
| Total Program Service Expenses | $82,911,558 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 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 | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 412 | 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 | 21 | 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 | 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 | 02302 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| DAVID C LEIMAN MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $289,144 | $0 | $26,561 | ||||
| JEAN-PIERRE M GEAGEA MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $633,081 | $0 | $3,757 | ||||
| KEITH S MERLIN MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $472,530 | $0 | $54,904 | ||||
| KENNETH S LAWSON MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $423,983 | $0 | $27,447 | ||||
| KERRY M GIRARD MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $710,867 | $0 | $27,649 | ||||
| KIM HOLLON | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $657,424 | $34,399 | 40.00 | |||
| MICHAEL L DERN MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $589,524 | $19,815 | 40.00 | |||
| MITCHELL J SELINGER MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $478,324 | $23,838 | 40.00 | Yes (X) | ||
| PAUL J PETTINATO MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $726,685 | $0 | $2,786 | ||||
| ROBERT E WEINSTEIN MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $677,212 | $28,183 | 40.00 | |||
| ROBERT G COVETT MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $361,953 | $0 | $7,787 | ||||
| ROBERT S GREENBERG MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $271,061 | $20,781 | 40.00 | |||
| SONJAY SHRINIVAS MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $266,233 | $0 | $11,762 | ||||
| SYED M IMAM MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $1,075,768 | $27,649 | 40.00 | |||
| TUTASI K WATERS MD | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $371,152 | $0 | $31,626 | ||||
| VICKI A SCHWARTZ MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $190,748 | $25,717 | 40.00 | |||
| VIKAS TEWARI MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $427,289 | $27,664 | 40.00 | |||
| VERA DEPALO MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $129,304 | $3,418 | 40.00 | |||
| DAVID A DRINKWATER MD | |||||||||
| PRESIDENT | 40.00 | Yes (X) | $502,163 | $0 | $22,549 | Yes (X) | |||
| ZULFIQAR A MIR MD | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $293,754 | $0 | $22,549 | ||||
| WEI-CHIN SUNG MD | |||||||||
| PHYSICIAN | 1.00 | Yes (X) | $0 | $520,406 | $28,049 | 40.00 | |||
| JAMES PAPADAKOS | |||||||||
| TREASURER | 1.00 | $0 | $325,452 | $33,715 | 40.00 | Yes (X) | |||
| ANN-MARIE HATCH | |||||||||
| CLERK | 40.00 | $41,942 | $0 | $8,150 | Yes (X) | ||||
| SCOTT MANDEL MD | |||||||||
| PHYSICIAN | 40.00 | $765,823 | $0 | $28,759 | Yes (X) | ||||
| KYUNG HEE CHANG MD | |||||||||
| PHYSICIAN | 40.00 | $849,923 | $0 | $31,268 | Yes (X) | ||||
| MARSHALL ARMITAGE MD | |||||||||
| PHYSICIAN | 40.00 | $681,937 | $0 | $20,678 | Yes (X) | ||||
| ABDEL-HAI H HAMMO MD | |||||||||
| FORMER DIRECTOR | 40.00 | $197,789 | $0 | $8,669 | Yes (X) | ||||
| CRAIG A WARNICK MD | |||||||||
| FORMER DIRECTOR | 0.00 | $0 | $677,450 | $20,913 | 40.00 | Yes (X) | |||
| GREGORY R SEILER MD | |||||||||
| FORMER DIRECTOR | 0.00 | $0 | $49,515 | $1,809 | 40.00 | Yes (X) | |||
| KIM WALSH | |||||||||
| FORMER DIRECTOR | 0.00 | $0 | $227,492 | $18,829 | 40.00 | Yes (X) | |||
| MARC A GREENWALD MD | |||||||||
| FORMER DIRECTOR | 40.00 | $341,552 | $0 | $11,830 | Yes (X) | ||||
| VALENTINE K ATANASSOV MD | |||||||||
| FORMER DIRECTOR | 0.00 | $0 | $596,630 | $27,649 | 40.00 | Yes (X) | |||
| SYLVIA MCPHAIL | |||||||||
| FORMER CLERK | 1.00 | $0 | $51,137 | $1,598 | 40.00 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $7,930,511 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,944,736 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $692,757 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LOCUMTENENSCOM | |||||
| 2655 NORTHWINDS PARKWAY | ALPHARETTA | GA | 30009 | PHYSICIAN SERVICE | $164,625 |
| GASTROINTESTINAL SPECIALISTS | |||||
| 189 QUINCY STREET | BROCKTON | MA | 03202 | PHYSICIAN SERVICE | $100,302 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OUTPATIENT NET REVENUE | 900099 | $64,065,700 | $64,065,700 |
| QUALITY INCENTIVES | 900099 | $8,622,795 | $8,622,795 |
| INTERCOMPANY REVENUES | 900099 | $7,345,257 | $7,345,257 |
| DSTI REVENUES | 900099 | $4,053,365 | $4,053,365 |
| MEANINGFUL USE | 900099 | $688,250 | $688,250 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $84,775,367 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,775,367 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $84,775,367 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,632,829 | TotalAmt |
| Program Services | $5,463,844 | ProgramServicesAmt |
| Management And General | $168,985 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,486,589 | TotalAmt |
| Program Services | $48,269,317 | ProgramServicesAmt |
| Management And General | $2,217,272 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $504,744 | TotalAmt |
| Program Services | $483,187 | ProgramServicesAmt |
| Management And General | $21,557 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,254,171 | TotalAmt |
| Program Services | $3,818,321 | ProgramServicesAmt |
| Management And General | $435,850 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,816,510 | TotalAmt |
| Program Services | $2,650,512 | ProgramServicesAmt |
| Management And General | $165,998 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200 | TotalAmt |
| Program Services | $150 | ProgramServicesAmt |
| Management And General | $50 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,000 | TotalAmt |
| Program Services | $67,500 | ProgramServicesAmt |
| Management And General | $22,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,185,727 | TotalAmt |
| Program Services | $7,858,269 | ProgramServicesAmt |
| Management And General | $2,327,458 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $638 | TotalAmt |
| Program Services | $478 | ProgramServicesAmt |
| Management And General | $160 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,378,165 | TotalAmt |
| Program Services | $1,063,494 | ProgramServicesAmt |
| Management And General | $314,671 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,603,690 | TotalAmt |
| Program Services | $2,702,767 | ProgramServicesAmt |
| Management And General | $900,923 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,130 | TotalAmt |
| Program Services | $56,018 | ProgramServicesAmt |
| Management And General | $13,112 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,820,972 | TotalAmt |
| Program Services | $1,365,729 | ProgramServicesAmt |
| Management And General | $455,243 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,311,609 | TotalAmt |
| Program Services | $3,101,194 | ProgramServicesAmt |
| Management And General | $210,415 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MD CONTRACTED EXPENSES | $1,983,817 | $1,945,313 | $38,504 |
| PURCHASED SERVICES | $1,695,142 | $1,296,735 | $398,407 |
| DRUGS & MEDICATIONS | $1,438,310 | $1,212,179 | $226,131 |
| MEDICAL & SURGICAL SUPP | $1,374,706 | $1,085,395 | $289,311 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,057 | TotalAmt |
| Program Services | $471,156 | ProgramServicesAmt |
| Management And General | -$294,099 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,824,006 | TotalAmt |
| Program Services | $82,911,558 | ProgramServicesAmt |
| Management And General | $7,912,448 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,953,750 | BOYAmt |
| EOY | $1,324,817 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,303,802 | BOYAmt |
| EOY | $4,748,882 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,794 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $583,465 | BOYAmt |
| EOY | $1,150,679 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,452,656 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,667,905 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,184,042 | BOYAmt |
| EOY | $7,784,751 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,579,920 | BOYAmt |
| EOY | $3,340,116 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,000 | BOYAmt |
| EOY | $4,400,971 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,220 | BOYAmt |
| EOY | $271,220 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,835,993 | BOYAmt |
| EOY | $23,021,436 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,136,764 | BOYAmt |
| EOY | $5,897,400 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,927,639 | BOYAmt |
| EOY | $5,808,523 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,064,403 | BOYAmt |
| EOY | $11,705,923 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,228,410 | BOYAmt |
| EOY | $11,315,513 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,228,410 | BOYAmt |
| EOY | $11,315,513 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,835,993 | BOYAmt |
| EOY | $23,021,436 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$6,048,639 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $31,592,562 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,321,204 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,115,817 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $38,797,419 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $43,363,128 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $84,775,367 | CurrentTaxYearAmt |
| Total | $209,372,935 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,321,204 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,115,817 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $38,797,419 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $43,363,128 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $84,775,367 | CurrentTaxYearAmt |
| Total | $209,372,935 | 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 | $209,372,935 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,321,204 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,115,817 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $38,797,419 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $43,363,128 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $84,775,367 | CurrentTaxYearAmt |
| Total | $209,372,935 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00000 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| 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 | $9,034,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,793,496 | DepreciationAmt |
| Book Value | $5,241,312 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,947,600 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,860,764 | DepreciationAmt |
| Book Value | $2,086,836 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $470,248 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,645 | DepreciationAmt |
| Book Value | $456,603 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,784,751 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 457(B) RETIREMENT INVESTMENT | Desc |
| Book Value | $3,340,116 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,340,116 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| 457(B) PLAN INVESTMENT LIABILITY | $3,340,116 |
| LEASEHOLD INCENTIVES | $2,269,518 |
| DEFERRED RENT | $198,889 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,808,523 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| 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 (31 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 C LEIMAN MD | ||||||||||||||
| DIRECTOR | $289,144 | $0 | $0 | $0 | $0 | $0 | $4,012 | $0 | $22,549 | $0 | $315,705 | $0 | $0 | $0 |
| JEAN-PIERRE M GEAGEA MD | ||||||||||||||
| DIRECTOR | $633,081 | $0 | $0 | $0 | $0 | $0 | $3,676 | $0 | $81 | $0 | $636,838 | $0 | $0 | $0 |
| KEITH S MERLIN MD | ||||||||||||||
| DIRECTOR | $472,530 | $0 | $0 | $0 | $0 | $0 | $32,355 | $0 | $22,549 | $0 | $527,434 | $0 | $0 | $0 |
| KENNETH S LAWSON MD | ||||||||||||||
| DIRECTOR | $423,983 | $0 | $0 | $0 | $0 | $0 | $4,898 | $0 | $22,549 | $0 | $451,430 | $0 | $0 | $0 |
| KERRY M GIRARD MD | ||||||||||||||
| DIRECTOR | $710,867 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $22,549 | $0 | $738,516 | $0 | $0 | $0 |
| KIM HOLLON | ||||||||||||||
| DIRECTOR | $0 | $657,424 | $0 | $0 | $0 | $0 | $0 | $11,475 | $0 | $22,924 | $0 | $691,823 | $0 | $0 |
| MICHAEL L DERN MD | ||||||||||||||
| DIRECTOR | $0 | $589,524 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $14,715 | $0 | $609,339 | $0 | $0 |
| MITCHELL J SELINGER MD | ||||||||||||||
| DIRECTOR | $0 | $478,324 | $0 | $0 | $0 | $0 | $0 | $7,650 | $0 | $16,188 | $0 | $502,162 | $0 | $0 |
| PAUL J PETTINATO MD | ||||||||||||||
| DIRECTOR | $726,685 | $0 | $0 | $0 | $0 | $0 | $2,705 | $0 | $81 | $0 | $729,471 | $0 | $0 | $0 |
| ROBERT E WEINSTEIN MD | ||||||||||||||
| DIRECTOR | $0 | $677,212 | $0 | $0 | $0 | $0 | $0 | $5,634 | $0 | $22,549 | $0 | $705,395 | $0 | $0 |
| ROBERT G COVETT MD | ||||||||||||||
| DIRECTOR | $361,953 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,787 | $0 | $369,740 | $0 | $0 | $0 |
| ROBERT S GREENBERG MD | ||||||||||||||
| DIRECTOR | $0 | $271,061 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $15,681 | $0 | $291,842 | $0 | $0 |
| SONJAY SHRINIVAS MD | ||||||||||||||
| DIRECTOR | $266,233 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,762 | $0 | $277,995 | $0 | $0 | $0 |
| SYED M IMAM MD | ||||||||||||||
| DIRECTOR | $0 | $1,075,768 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $22,549 | $0 | $1,103,417 | $0 | $0 |
| TUTASI K WATERS MD | ||||||||||||||
| DIRECTOR | $371,152 | $0 | $0 | $0 | $0 | $0 | $23,839 | $0 | $7,787 | $0 | $402,778 | $0 | $0 | $0 |
| VICKI A SCHWARTZ MD | ||||||||||||||
| DIRECTOR | $0 | $190,748 | $0 | $0 | $0 | $0 | $0 | $3,392 | $0 | $22,325 | $0 | $216,465 | $0 | $0 |
| VIKAS TEWARI MD | ||||||||||||||
| DIRECTOR | $0 | $427,289 | $0 | $0 | $0 | $0 | $0 | $5,115 | $0 | $22,549 | $0 | $454,953 | $0 | $0 |
| DAVID A DRINKWATER MD | ||||||||||||||
| PRESIDENT | $502,163 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,549 | $0 | $524,712 | $0 | $0 | $0 |
| ZULFIQAR A MIR MD | ||||||||||||||
| PHYSICIAN | $293,754 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,549 | $0 | $316,303 | $0 | $0 | $0 |
| WEI-CHIN SUNG MD | ||||||||||||||
| PHYSICIAN | $0 | $520,406 | $0 | $0 | $0 | $0 | $0 | $5,500 | $0 | $22,549 | $0 | $548,455 | $0 | $0 |
| JAMES PAPADAKOS | ||||||||||||||
| TREASURER | $0 | $325,452 | $0 | $0 | $0 | $0 | $0 | $8,751 | $0 | $24,964 | $0 | $359,167 | $0 | $0 |
| SCOTT MANDEL MD | ||||||||||||||
| PHYSICIAN | $765,823 | $0 | $0 | $0 | $0 | $0 | $6,210 | $0 | $22,549 | $0 | $794,582 | $0 | $0 | $0 |
| KYUNG HEE CHANG MD | ||||||||||||||
| PHYSICIAN | $849,923 | $0 | $0 | $0 | $0 | $0 | $8,719 | $0 | $22,549 | $0 | $881,191 | $0 | $0 | $0 |
| MARSHALL ARMITAGE MD | ||||||||||||||
| PHYSICIAN | $681,937 | $0 | $0 | $0 | $0 | $0 | $12,891 | $0 | $7,787 | $0 | $702,615 | $0 | $0 | $0 |
| ABDEL-HAI H HAMMO MD | ||||||||||||||
| FORMER DIRECTOR | $197,789 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,669 | $0 | $206,458 | $0 | $0 | $0 |
| CRAIG A WARNICK MD | ||||||||||||||
| FORMER DIRECTOR | $0 | $677,450 | $0 | $0 | $0 | $0 | $0 | $5,232 | $0 | $15,681 | $0 | $698,363 | $0 | $0 |
| GREGORY R SEILER MD | ||||||||||||||
| FORMER DIRECTOR | $0 | $49,515 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,809 | $0 | $51,324 | $0 | $0 |
| KIM WALSH | ||||||||||||||
| FORMER DIRECTOR | $0 | $227,492 | $0 | $0 | $0 | $0 | $0 | $9,232 | $0 | $9,597 | $0 | $246,321 | $0 | $0 |
| MARC A GREENWALD MD | ||||||||||||||
| FORMER DIRECTOR | $341,552 | $0 | $0 | $0 | $0 | $0 | $3,446 | $0 | $8,384 | $0 | $353,382 | $0 | $0 | $0 |
| VALENTINE K ATANASSOV MD | ||||||||||||||
| FORMER DIRECTOR | $0 | $596,630 | $0 | $0 | $0 | $0 | $0 | $5,100 | $0 | $22,549 | $0 | $624,279 | $0 | $0 |
| SYLVIA MCPHAIL | ||||||||||||||
| FORMER CLERK | $0 | $51,137 | $0 | $0 | $0 | $0 | $0 | $1,048 | $0 | $550 | $0 | $52,735 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE BOARD ESTABLISHED A COMPENSATION COMMITTEE, MADE UP OF DISINTERESTED TRUSTEES, WHO ARE GIVEN THE AUTHORITY TO ESTABLISH COMPENSATION FOR ALL SENIOR EXECUTIVES. THE COMPENSATION COMMITTEE PERFORMS ANNUAL REVIEWS AND APPROVES EXECUTIVE COMPENSATION. THE COMMITTEE IS DESIGNED TO ENSURE THAT ALL COMPENSATION IS REASONABLE, MEETS ALL REGULATORY REQUIREMENTS AND IS COMPETITIVE WITHIN THE RELEVANT MARKET. |
| PART I, LINE 1B | THE COMPENSATION ELEMENTS INDICATED ON SCHEDULE J, PART I (TAX INDEMNIFICATION/GROSS-UP PAYMENTS) WERE PROVIDED PURSUANT TO THE EMPLOYMENT AGREEMENT MAINTAINED BETWEEN THE ORGANIZATION AND THE INDIVIDUAL. |
| PART I, LINE 4B | DURING THE YEAR ENDED 9/30/2014 THE SIGNATURE HEALTHCARE MEDICAL GROUP MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS FOR NINE EMPLOYEES. CONSISTENT WITH REPORTING REQUIREMENTS FOR IRS FORM 990, SIGNATURE HEALTHCARE MEDICAL GROUP 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 9/30/2014: KEITH MERLIN - $27,255 TUTASI WATERS - $20,859 SCOTT MANDEL - $2,268 MARSHALL ARMITAGE - $9,163 ROBERT WEINSTEIN - $534 KYUNG HEE CHANG - $3,619 VIKAS TEWARI - $15 WEI-CHIN SUNG - $400 CRAIG WARNICK - $132 DURING THE YEAR ENDED 9/30/2014 THE HOSPITAL MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS 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 9/30/2014: JAMES PAPADAKOS - $1,326 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 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 COMMITTEE REVIEWS AND APPROVES THE COMPENSATION BASED ON WRITTEN EMPLOYMENT CONTRACTS, USE OF INDEPENDENT COMPENSATION CONSULTANTS, AND COMPENSATION SURVEYS. |
| 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 IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 7,858,269. MANAGEMENT AND GENERAL EXPENSES 2,327,458. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,185,727. |
| FORM 990, PART XI, LINE 9: | TRANSFERS FROM AFFILIATES 31,519,465. NET ASSET RELEASES FOR PP&E ACQUISITIONS 73,097. |
| FORM 990 PART XI LINE 2 | THE ORGANIZATION'S FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM ON A CONSOLIDATED BASIS. THE ORGANIZATION HAS AN AUDIT COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF AN INDEPENDENT ACCOUNTING FIRM. |
Schedule R IRS990ScheduleR
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| BROCKTON HOSPITAL INC | ||||||||||
| 680 CENTRE ST | BROCKTON | MA | 02302 | 222472297 | HOSPITAL | MA | 501C(3) | 3 | SIGNATURE HEALTHCARE CORPORATION | 0 |
| SIGNATURE HEALTHCARE CORPORATION | ||||||||||
| 680 CENTRE ST | BROCKTON | MA | 02302 | 042103554 | MANAGEMENT | MA | 501C(3) | 11 | SIGNATURE HEALTHCARE CORPORATION | 0 |
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 | 042350255 | EIN |
| Primary Activities | PHYSICIAN GROUP | 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 |
| 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 | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (18 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| SIGNATURE HEALTH CORPORATION | |
| C | $73,097 |
| SIGNATURE HEALTH CORPORATION | |
| I | -$12,607,836 |
| SIGNATURE HEALTH CORPORATION | |
| K | $234,270 |
| SIGNATURE HEALTH CORPORATION | |
| P | $10,147 |
| SIGNATURE HEALTH CORPORATION | |
| R | $895,875 |
| SIGNATURE HEALTH CORPORATION | |
| S | $457,003 |
| BRIDGEWATER GODDARD PARK MEDICAL | |
| I | -$1,091,106 |
| BRIDGEWATER GODDARD PARK MEDICAL | |
| R | $436,052 |
| BRIDGEWATER GODDARD PARK MEDICAL | |
| S | $240,189 |
| BROCKTON HOSPITAL | |
| J | $177,776 |
| BROCKTON HOSPITAL | |
| K | $70,041 |
| BROCKTON HOSPITAL | |
| O | $16,195,549 |
| BROCKTON HOSPITAL | |
| P | $9,396,023 |
| BROCKTON HOSPITAL | |
| Q | $445,129 |
| BROCKTON HOSPITAL | |
| R | $6,958,009 |
| BROCKTON HOSPITAL | |
| S | $14,237,068 |
| LIBERTY STREET | |
| I | $1,719,120 |
| LIBERTY STREET | |
| K | $1,719,120 |
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