2015-08-10T13:40:31-05:00 2014-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2013-10-01 043306782 SIGNATURE HEALTHCARE MEDICAL GROUP INC SIGN 5089417000 680 CENTRE STREET BROCKTON MA 02302 JAMES N PAPADAKOS TREASURER 5089417000 2015-07-30 1 JEFFREY T ROGERS P01074284 6177427788 2013 2016-04-25 22:37:26Z SIGNATURE MEDICAL GROUP DAVID DRINKWATER 680 CENTRE STREET BROCKTON MA 02302 84775367 0 X WWW.SIGNATURE-HEALTHCARE.ORG X 1996 MA TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL BY IMPROVING ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL. 21 0 412 0 0 0 0 0 43363128 84775367 0 0 0 0 43363128 84775367 0 0 0 0 40265485 63694843 0 0 0 7152201 27129163 47417686 90824006 -4054558 -6048639 12835993 23021436 27064403 11705923 -14228410 11315513 TO SUPPORT THE MEDICAL, EDUCATIONAL, SCIENTIFIC AND CHARITABLE PURPOSE OF BROCKTON HOSPITAL BY IMPROVING ACCESS TO MEDICAL CARE PROVIDED BY THE HOSPITAL. 0 0 82911558 84775367 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. 82911558 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 1 412 1 0 0 0 0 0 0 0 0 0 0 X 21 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X KIM HOLLON 5089417000 680 CENTRE STREET BROCKTON MA 02302 DAVID C LEIMAN MD DIRECTOR 40.00 X 289144 0 26561 JEAN-PIERRE M GEAGEA MD DIRECTOR 40.00 X 633081 0 3757 KEITH S MERLIN MD DIRECTOR 40.00 X 472530 0 54904 KENNETH S LAWSON MD DIRECTOR 40.00 X 423983 0 27447 KERRY M GIRARD MD DIRECTOR 40.00 X 710867 0 27649 KIM HOLLON DIRECTOR 1.00 40.00 X 0 657424 34399 MICHAEL L DERN MD DIRECTOR 1.00 40.00 X 0 589524 19815 MITCHELL J SELINGER MD DIRECTOR 1.00 40.00 X X 0 478324 23838 PAUL J PETTINATO MD DIRECTOR 40.00 X 726685 0 2786 ROBERT E WEINSTEIN MD DIRECTOR 1.00 40.00 X 0 677212 28183 ROBERT G COVETT MD DIRECTOR 40.00 X 361953 0 7787 ROBERT S GREENBERG MD DIRECTOR 1.00 40.00 X 0 271061 20781 SONJAY SHRINIVAS MD DIRECTOR 40.00 X 266233 0 11762 SYED M IMAM MD DIRECTOR 1.00 40.00 X 0 1075768 27649 TUTASI K WATERS MD DIRECTOR 40.00 X 371152 0 31626 VICKI A SCHWARTZ MD DIRECTOR 1.00 40.00 X 0 190748 25717 VIKAS TEWARI MD DIRECTOR 1.00 40.00 X 0 427289 27664 VERA DEPALO MD DIRECTOR 1.00 40.00 X 0 129304 3418 DAVID A DRINKWATER MD PRESIDENT 40.00 X X 502163 0 22549 ZULFIQAR A MIR MD PHYSICIAN 40.00 X 293754 0 22549 WEI-CHIN SUNG MD PHYSICIAN 1.00 40.00 X 0 520406 28049 JAMES PAPADAKOS TREASURER 1.00 40.00 X 0 325452 33715 ANN-MARIE HATCH CLERK 40.00 X 41942 0 8150 SCOTT MANDEL MD PHYSICIAN 40.00 X 765823 0 28759 KYUNG HEE CHANG MD PHYSICIAN 40.00 X 849923 0 31268 MARSHALL ARMITAGE MD PHYSICIAN 40.00 X 681937 0 20678 ABDEL-HAI H HAMMO MD FORMER DIRECTOR 40.00 X 197789 0 8669 CRAIG A WARNICK MD FORMER DIRECTOR 0.00 40.00 X 0 677450 20913 GREGORY R SEILER MD FORMER DIRECTOR 0.00 40.00 X 0 49515 1809 KIM WALSH FORMER DIRECTOR 0.00 40.00 X 0 227492 18829 MARC A GREENWALD MD FORMER DIRECTOR 40.00 X 341552 0 11830 VALENTINE K ATANASSOV MD FORMER DIRECTOR 0.00 40.00 X 0 596630 27649 SYLVIA MCPHAIL FORMER CLERK 1.00 40.00 X 0 51137 1598 7930511 6944736 692757 16 1 1 0 LOCUMTENENSCOM 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PHYSICIAN SERVICE 164625 GASTROINTESTINAL SPECIALISTS 189 QUINCY STREET BROCKTON MA 03202 PHYSICIAN SERVICE 100302 2 OUTPATIENT NET REVENUE 900099 64065700 64065700 QUALITY INCENTIVES 900099 8622795 8622795 INTERCOMPANY REVENUES 900099 7345257 7345257 DSTI REVENUES 900099 4053365 4053365 MEANINGFUL USE 900099 688250 688250 84775367 84775367 84775367 0 0 X 5632829 5463844 168985 50486589 48269317 2217272 504744 483187 21557 4254171 3818321 435850 2816510 2650512 165998 200 150 50 90000 67500 22500 10185727 7858269 2327458 638 478 160 1378165 1063494 314671 3603690 2702767 900923 69130 56018 13112 1820972 1365729 455243 3311609 3101194 210415 MD CONTRACTED EXPENSES 1983817 1945313 38504 PURCHASED SERVICES 1695142 1296735 398407 DRUGS & MEDICATIONS 1438310 1212179 226131 MEDICAL & SURGICAL SUPP 1374706 1085395 289311 177057 471156 -294099 90824006 82911558 7912448 0 1953750 1324817 2303802 4748882 150794 583465 1150679 16452656 8667905 5184042 7784751 2579920 3340116 65000 4400971 15220 271220 12835993 23021436 22136764 5897400 4927639 5808523 27064403 11705923 X -14228410 11315513 -14228410 11315513 12835993 23021436 X -6048639 31592562 X X 0 1 X 1 0 X 14321204 28115817 38797419 43363128 84775367 209372935 14321204 28115817 38797419 43363128 84775367 209372935 0 0 0 209372935 14321204 28115817 38797419 43363128 84775367 209372935 1.00000 1.00000 0.00000 X 9034808 3793496 5241312 6947600 4860764 2086836 470248 13645 456603 7784751 457(B) RETIREMENT INVESTMENT 3340116 F 3340116 457(B) PLAN INVESTMENT LIABILITY 3340116 LEASEHOLD INCENTIVES 2269518 DEFERRED RENT 198889 5808523 X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 DAVID C LEIMAN MD DIRECTOR 289144 0 0 0 0 0 4012 0 22549 0 315705 0 0 0 JEAN-PIERRE M GEAGEA MD DIRECTOR 633081 0 0 0 0 0 3676 0 81 0 636838 0 0 0 KEITH S MERLIN MD DIRECTOR 472530 0 0 0 0 0 32355 0 22549 0 527434 0 0 0 KENNETH S LAWSON MD DIRECTOR 423983 0 0 0 0 0 4898 0 22549 0 451430 0 0 0 KERRY M GIRARD MD DIRECTOR 710867 0 0 0 0 0 5100 0 22549 0 738516 0 0 0 KIM HOLLON DIRECTOR 0 657424 0 0 0 0 0 11475 0 22924 0 691823 0 0 MICHAEL L DERN MD DIRECTOR 0 589524 0 0 0 0 0 5100 0 14715 0 609339 0 0 MITCHELL J SELINGER MD DIRECTOR 0 478324 0 0 0 0 0 7650 0 16188 0 502162 0 0 PAUL J PETTINATO MD DIRECTOR 726685 0 0 0 0 0 2705 0 81 0 729471 0 0 0 ROBERT E WEINSTEIN MD DIRECTOR 0 677212 0 0 0 0 0 5634 0 22549 0 705395 0 0 ROBERT G COVETT MD DIRECTOR 361953 0 0 0 0 0 0 0 7787 0 369740 0 0 0 ROBERT S GREENBERG MD DIRECTOR 0 271061 0 0 0 0 0 5100 0 15681 0 291842 0 0 SONJAY SHRINIVAS MD DIRECTOR 266233 0 0 0 0 0 0 0 11762 0 277995 0 0 0 SYED M IMAM MD DIRECTOR 0 1075768 0 0 0 0 0 5100 0 22549 0 1103417 0 0 TUTASI K WATERS MD DIRECTOR 371152 0 0 0 0 0 23839 0 7787 0 402778 0 0 0 VICKI A SCHWARTZ MD DIRECTOR 0 190748 0 0 0 0 0 3392 0 22325 0 216465 0 0 VIKAS TEWARI MD DIRECTOR 0 427289 0 0 0 0 0 5115 0 22549 0 454953 0 0 DAVID A DRINKWATER MD PRESIDENT 502163 0 0 0 0 0 0 0 22549 0 524712 0 0 0 ZULFIQAR A MIR MD PHYSICIAN 293754 0 0 0 0 0 0 0 22549 0 316303 0 0 0 WEI-CHIN SUNG MD PHYSICIAN 0 520406 0 0 0 0 0 5500 0 22549 0 548455 0 0 JAMES PAPADAKOS TREASURER 0 325452 0 0 0 0 0 8751 0 24964 0 359167 0 0 SCOTT MANDEL MD PHYSICIAN 765823 0 0 0 0 0 6210 0 22549 0 794582 0 0 0 KYUNG HEE CHANG MD PHYSICIAN 849923 0 0 0 0 0 8719 0 22549 0 881191 0 0 0 MARSHALL ARMITAGE MD PHYSICIAN 681937 0 0 0 0 0 12891 0 7787 0 702615 0 0 0 ABDEL-HAI H HAMMO MD FORMER DIRECTOR 197789 0 0 0 0 0 0 0 8669 0 206458 0 0 0 CRAIG A WARNICK MD FORMER DIRECTOR 0 677450 0 0 0 0 0 5232 0 15681 0 698363 0 0 GREGORY R SEILER MD FORMER DIRECTOR 0 49515 0 0 0 0 0 0 0 1809 0 51324 0 0 KIM WALSH FORMER DIRECTOR 0 227492 0 0 0 0 0 9232 0 9597 0 246321 0 0 MARC A GREENWALD MD FORMER DIRECTOR 341552 0 0 0 0 0 3446 0 8384 0 353382 0 0 0 VALENTINE K ATANASSOV MD FORMER DIRECTOR 0 596630 0 0 0 0 0 5100 0 22549 0 624279 0 0 SYLVIA MCPHAIL FORMER CLERK 0 51137 0 0 0 0 0 1048 0 550 0 52735 0 0 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 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. 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 BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES 680 CENTRE STREET BROCKTON MA 02302 042350255 PHYSICIAN GROUP MA SIGNATURE HEALTHCARE CORPORATION C 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 SIGNATURE HEALTH CORPORATION C 73097 SIGNATURE HEALTH CORPORATION I -12607836 SIGNATURE HEALTH CORPORATION K 234270 SIGNATURE HEALTH CORPORATION P 10147 SIGNATURE HEALTH CORPORATION R 895875 SIGNATURE HEALTH CORPORATION S 457003 BRIDGEWATER GODDARD PARK MEDICAL I -1091106 BRIDGEWATER GODDARD PARK MEDICAL R 436052 BRIDGEWATER GODDARD PARK MEDICAL S 240189 BROCKTON HOSPITAL J 177776 BROCKTON HOSPITAL K 70041 BROCKTON HOSPITAL O 16195549 BROCKTON HOSPITAL P 9396023 BROCKTON HOSPITAL Q 445129 BROCKTON HOSPITAL R 6958009 BROCKTON HOSPITAL S 14237068 LIBERTY STREET I 1719120 LIBERTY STREET K 1719120