2014-08-14T14:27:25-05:00 2013-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2012-10-01 222472997 BROCKTON HOSPITAL INC BROC 5089417000 680 CENTRE STREET BROCKTON MA 02302 KIM HOLLON 5089417000 2014-08-13 1 ALAN GAROFALO P00744592 6177427788 2012 2015-11-30 17:44:51Z SIGNATURE HEALTHCARE BROCKTON HOSPITAL KIM HOLLON 680 CENTRE STREET BROCKTON MA 02302 224753563 0 X WWW.SIGNATURE-HEALTHCARE.ORG X 1890 MA THE HOSPITAL OPERATES A 245 BED ACUTE CARE FACILITY THAT PROVIDES HEALTH CARE SERVICES TO 20 COMMUNITIES IN SOUTHEASTERN MASSACHUSETTS. IN FISCAL YEAR 2013 THE HOSPITAL PROVIDED $22,397,360 OF UNREIMBURSED CHARITY CARE. THIS EQUATES TO THOUSANDS OF VISITS TO PRIMARY CARE AND SPECIALTY CLINICS. THE HOSPITAL'S CHILDREN AND YOUTH PROGRAM, A HOSPITAL-BASED PRIMARY CARE PRACTICE THAT TREATS UNDER-PRIVILEGED CHILDREN, ACCOMMODATED APPROXIMATELY 10,000 PATIENT VISITS. THOUSANDS OF UNDERINSURED PEOPLE TOOK ADVANTAGE OF ONGOING COMMUNITY HEALTH LECTURES, SCREENINGS, CLASSES AND SUPPORT GROUPS BOTH AT THE HOSPITAL AND IN THE COMMUNITY. 16 11 1941 160 367689 -287956 61926 53320 215014749 214142831 1329410 2288782 7077171 8268630 223483256 224753563 0 0 0 0 110239873 117168847 0 0 0 88279956 88440305 198519829 205609152 24963427 19144411 152503977 175530671 126398676 106838500 26105301 68692171 BROCKTON HOSPITAL'S MISSION IS TO BE A PRIVATE NOT-FOR-PROFIT COMMUNITY BASED HOSPITAL THAT IS RECOGNIZED AS THE "HOSPITAL OF CHOICE" BY STAFF, PATIENTS, AND THE COMMUNITY IT SERVES. 0 0 178429816 220320159 THE HOSPITAL OPERATES A 245 BED ACUTE CARE FACILITY THAT PROVIDES HEALTH CARE SERVICES TO 20 COMMUNITIES IN SOUTHEASTERN MASSACHUSETTS. IN FISCAL YEAR 2013 THE HOSPITAL PROVIDED $22,397,360 OF UNREIMBURSED CHARITY CARE. THIS EQUATES TO THOUSANDS OF VISITS TO PRIMARY CARE AND SPECIALTY CLINICS. THE HOSPITAL'S CHILDREN AND YOUTH PROGRAM, A HOSPITAL-BASED PRIMARY CARE PRACTICE THAT TREATS UNDER-PRIVILEGED CHILDREN, ACCOMMODATED APPROXIMATELY 10,000 PATIENT VISITS. THOUSANDS OF UNDERINSURED PEOPLE TOOK ADVANTAGE OF ONGOING COMMUNITY HEALTH LECTURES, SCREENINGS, CLASSES AND SUPPORT GROUPS BOTH AT THE HOSPITAL AND IN THE COMMUNITY. 178429816 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 235 0 1 1941 1 1 1 0 0 0 0 0 0 0 0 0 X 16 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MA X X KIM HOLLON 5089417000 680 CENTRE STREET BROCKTON MA 023023395 TIMOTHY J CRUZ 1.00 X 0 0 0 JOSEPH P DRIER III 1.00 X 0 0 0 DAVID P FRENETTE 1.00 X 0 0 0 WALLACE H PECKHAM III 1.00 X 0 0 0 PATTI ROLAND 1.00 X 0 0 0 MICHAEL J SULLIVAN 1.00 X 0 0 0 ROBERT D SULLIVAN 1.00 X 0 0 0 MARY V WALDRON 1.00 X 0 0 0 DAVID R WOLOHOJIAN 1.00 X 0 0 0 KIM HOLLON 40.00 X X 567243 0 33950 DAVID DRINKWATER MD 1.00 40.00 X 0 533077 22325 PATRICIA TORTORELLA 1.00 X 0 0 0 DALE J ELLENBERG MD 1.00 40.00 X 0 235787 24825 MICHAEL L DERN MD 1.00 40.00 X 0 530116 19491 ROBERT S GREENBERG MD 1.00 40.00 X 0 276562 21948 JAMES E LEARY 1.00 X 0 0 0 JAMES PAPADAKOS 40.00 X 178992 0 14695 STEPHEN BORGES 40.00 X 185827 0 28763 DAVID J FISHER 40.00 X 200400 0 27121 KIMBERLY WALSH 40.00 X 239211 0 19560 KAREN MURPHY 40.00 X 283192 0 11453 MARIE F GROSS 40.00 X 263646 0 9080 JEFFREY MILLER 40.00 X 189187 0 27505 DENNIS RENAUD 40.00 X 176740 0 4584 KIM MCCARTHY-WALSH 40.00 X 166227 0 7978 TIMOTHY R LYNCH MD 1.00 40.00 X 0 282195 22325 ROBERT COVETT MD 1.00 40.00 X 0 372242 9369 KEN LAWSON 0.00 40.00 X 0 412260 33531 GEORGE C BROWN 1.00 40.00 X 0 604623 17365 JEAN-PIERRE GEAGEA 1.00 40.00 X 0 681497 3764 MARC GREENWALD 1.00 40.00 X 0 350965 20457 DANIEL MUSE 1.00 40.00 X 0 446685 16710 ABDEL-HAI HAMMO 1.00 40.00 X 0 528012 22325 2450665 5254021 419124 126 1 1 0 MATRIX ANESTHESIA PD 1342 BELMONT STREET STE 205 BROCKTON MA 02302 PHYSICIAN SERVICES 2486950 FTI CONSULTING 5310 MARYLAND WAY SUITE 250 BRENTWOOD TN 37027 CONSULTING SERVICES 946788 SECURAMERICA LLC 3399 PEACHTREE RD SUITE 1000 ATLANTA GA 30326 SECURITY SERVICES 941079 PRATT PEDIATRIC ASSOCIATES 750 WASHINGTON STREET BOSTON MA 02111 PHYSICIAN SERVICES 687988 ROPES & GRAY ONE INTERNATIONAL PLACE BOSTON MA 02110 LEGAL 456261 27 53320 53320 PATIENT SERVICE REVENU 900099 211441007 211441007 MEANINGFUL USE EHR REV 900099 2334135 2334135 OUTREACH LAB SERVICES 541380 367689 367689 214142831 1105318 1105318 1183464 0 1183464 1183464 1183464 SCHOOL OF NURSING 900099 5187658 5187658 MISCELLANEOUS 900099 1958660 235047 1723613 VANTAGE JOINT VENTURE 900099 1122312 1122312 8268630 224753563 220320159 367689 4012395 1495762 1346186 149576 92479700 82802409 9677291 6587593 4413687 2173906 9910431 7998536 1911895 6695361 4485892 2209469 4399372 4399372 1275234 854407 420827 228000 152760 75240 165534 149699 15835 813789 549716 264073 3494998 2854320 640678 1607352 1076926 530426 2685940 1799623 886317 106331 80347 25984 1507343 1009920 497423 5001672 3351120 1650552 1935707 1307905 627802 OTHER PROFESSIONAL SERV 17159884 15961392 1198492 OTHER EXPENSES 12477342 10083576 2393766 MEDICAL & SURGICAL SUPP 10330414 10227110 103304 PURCHASED SERVICES 8862525 7251761 1610764 16388868 16273152 115716 205609152 178429816 27179336 0 5639672 5645427 23209504 23655712 25373910 42015519 1388976 1570524 5462561 5371818 162347623 128789624 33875171 33557999 3494570 3018896 54059613 60694776 152503977 175530671 31309581 33205876 1480235 1453418 35619790 34324287 5960784 5843137 52028286 32011782 126398676 106838500 X 21503571 63496118 1388667 1947289 3213063 3248764 26105301 68692171 152503977 175530671 X 19144411 3464755 19977704 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 165534 165534 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PART II-B, LINE 1 (I) - THE HOSPITAL PAID THE FOLLOWING COMPANIES FOR LOBBYING ON BEHALF OF THE HOSPITAL REGARDING VARIOUS STATE AND FEDERAL LEGISLATION IMPACTING BOTH THE HOSPITAL AND THE HEALTHCARE INDUSTRY AS A WHOLE. THESE ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF THE HOSPITAL'S ACTIVITIES. $130,138 WENT TO ELLEN MURPHY & ASSOCIATES. THE ALLOCATED PORTION OF DUES TO THE FOLLOWING ORGANIZATIONS:$26,326 MASSACHUSETTS HOSPITAL ASSOCIATION; $9,070 AMERICAN HOSPITAL ASSOCIATION. 3507330 235373 3742703 3166498 340832 3507330 3335390 -168892 3166498 3187674 147716 3335390 3404596 250 -217172 3187674 0.87000 0.13000 0 0 30564 30564 59232472 38552918 20679554 102412637 90236706 12175931 671950 671950 33557999 ASSETS WHOSE USE IS LIMITED 52431737 UNAMORTIZED BOND ISSUANCE COSTS 116731 INVESTMENT IN JOINT VENTURE 974063 LOAN RECEIVABLE - SPLIT DOLLAR LIFE INSURANCE 895000 SECURITY DEPOSIT 62245 MALPRACTICE INSURANCE RESERVE 6215000 60694776 AMOUNTS DUE TO 3RD PARTY PAYORS 5930889 PENSION LIABILITY 26080893 32011782 225214809 461246 461246 224753563 0 224753563 205609152 0 205609152 0 205609152 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HOSPITAL'S ENDOWMENT CONSISTS OF INDIVIDUAL DONOR RESTRICTED ENDOWMENT FUNDS FOR A VARIETY OF PURPOSES AS WELL AS SPLIT INTEREST AGREEMENTS, WHICH HAVE BEEN DESIGNATED FOR ENDOWMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 461,246. NONOPERATING INCOME 1 1 1 X 1 X 1 0 1 1 7581526 4710238 2871288 0.01400 43891953 42339439 1552514 0.00760 8208207 5649507 2558700 0.01240 59681686 52699184 6982502 0.03400 132023 132023 0.00060 7479545 5929464 1550081 0.00750 19716140 13969431 5746709 0.02790 41490 41490 0.00020 27369198 19898895 7470303 0.03620 87050884 72598079 14452805 0.07020 22340 22340 0.00010 22340 22340 0.00010 1 3849433 1789239 54414842 51053860 3360982 X 1 1 1 1 BROCKTON HOSPITAL INC

680 CENTRE STREET BROCKTON MA 02302

X X X TCU/PSYCH BROCKTON HOSPITAL 1 1 X X X X X X 12 1 1 1 X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X 1 1 X X X X 1 0 1 X 0 0 PART III, LINE 4: THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO ESTIMATED BAD DEBT LOSSES. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES.THE HOSPITAL USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE AT COST. PART III, LINE 8: THE HOSPITAL USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE ALLOWABLE COSTS RELATED TO MEDICARE REVENUE RECEIVED. BROCKTON HOSPITAL PART V, SECTION B, LINE 3: SIGNATURE HEALTHCARE WORKS COLLABORATIVELY WITH THE BROCKTON DEPARTMENT OF PUBLIC HEALTH, THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER AND NUMEROUS COMMUNITY SOCIAL SERVICE AGENCIES TO COORDINATE PUBLIC HEALTH INITIATIVES AND ADDRESS THE NEEDS OF THE AT-RISK POPULATION. FROM FEBRUARY TO DECEMBER 2013, THE STOUGHTON YOUTH COMMISSION CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE GREATER BROCKTON COMMUNITY HEALTH NETWORK AREA (CHNA 22) WITH THE GOAL OF IDENTIFYING UNMET COMMUNITY HEALTH NEEDS, VULNERABLE POPULATIONS AND GAPS IN EXISTING COMMUNITY HEALTH SERVICES. IN THIS VERSION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE GREATER BROCKTON CHNA 22 FOCUSED ON THE FOLLOWING FOUR PRIORITY AREAS:- ASTHMA- NUTRITION AND FITNESS- ORAL HEALTH, AND- SUBSTANCE ABUSETHIS UPDATE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED A FOUR PRONGED APPROACH TO UNCOVER THE STATE OF THE HEALTH OF THE CITY OF BROCKTON AND ITS SURROUNDING TOWNS: 1. CONDUCTING KEY INFORMANT INTERVIEW WITH PEOPLE WHO WORK WITHIN THE CHNA 22 CITIES AND TOWNS INCLUDING BROCKTON TO DETERMINE HOW THE NEEDS OF THE RESIDENTS ARE MET BOTH INSIDE AND OUTSIDE THE CITY;2. REVIEWING EXISTING PROGRAMS/STRATEGIES AND SERVICES IN THE AREA TO DISCOVER GAPS;3. ANALYZING EXISTING DATA TO DETERMINE HOW HEALTH OUTCOMES IN THE CITY OF BROCKTON AND SURROUNDING TOWNS DIFFER FROM EACH OTHER AND THE STATE OF MASSACHUSETTS OVERALL;4. CONDUCTING FOCUS GROUPS WITHIN AND OUTSIDE OF BROCKTON TO EXAMINE THEIR PERCEPTIONS REGARDING THE FOUR AFOREMENTIONED HEALTH TOPICS AND THEIR IMPACT IN THE SERVICE AREA.AT LEAST ONE KEY INFORMANT WAS INTERVIEWED IN EVERY CHNA 22 TOWN AND A TOTAL OF 23 KEY INFORMANT INTERVIEWS WERE CONDUCTED. ORGANIZATIONS INCLUDED LOCAL SUBSTANCE ABUSE AND VIOLENCE COALITIONS, VNAS, SCHOOL PERSONNEL, BOARD OF HEALTH, YMCA, COA'S AND MORE. THERE WERE A TOTAL OF FOUR (4) FOCUS GROUPS, ONE ON EACH OF THE CHNA 22 FOCUS AREAS. THESE FOCUS GROUPS TOOK PLACE AT THE MENS SOBER HOUSE IN BROCKTON, THE EAST BRIDGEWATER YMCA, SELF HELP, INC. AND TRINITY BAPTIST CHURCH. MOREOVER, SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A DISPROPORTIONATE SHARE HOSPITAL AND IS OFTEN THE PROVIDER OF LAST RESORT. SIGNATURE HEALTHCARE BROCKTON HOSPITAL OFFERS SPECIALTY CARE CLINICS IN TB, ENDOCRINOLOGY, AND GYNECOLOGY TO WHICH THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER (FEDERAL 330 CENTER) REFERS PATIENTS. SIGNATURE HEALTHCARE DEVELOPED HEALTHY BEGINNINGS, A COMMUNITY OUTREACH PROGRAM FOR PREGNANT WOMEN WHO REQUIRE MEDICAL CARE, SOCIAL SUPPORT, FINANCIAL COUNSELING AND TRANSLATOR SERVICES. GIVEN THE DIVERSE NATURE OF THE PATIENT POPULATION, SIGNATURE HEALTHCARE SUPPLIES 24/7 TRANSLATOR SERVICES WITH 15 EMPLOYED TRANSLATORS SPEAKING 36 LANGUAGES.THE PAYER MIX OF SIGNATURE HEALTHCARE'S PATIENT PANEL IS AS EXPECTED GIVEN THE DEMOGRAPHICS OF THE COMMUNITY WITH A 3.4% RESIDUALLY UNINSURED, 22% MEDICAID AND MEDICAID MANAGED CARE, AND 66% PUBLIC PAY IN TOTAL. ADDITIONALLY, THE COMMERCIAL PAYER RATES VARY CONSIDERABLY IN MASSACHUSETTS PER THE ATTORNEY GENERAL'S 2008 REPORT WHICH REVEALED A GREATER THAN 300 PERCENT VARIATION IN RATES PAID TO THE HOSPITALS BY A COMMERCIAL PAYER. SIGNATURE HEALTHCARE BROCKTON HOSPITAL FELL IN THE LOWEST QUARTILE AND HAD THE 14TH LOWEST RATES OF ALL 68 HOSPITALS.SIGNATURE HEALTHCARE HAS BEEN RECOGNIZED AS A LOW COST, HIGH QUALITY PROVIDER OF CARE. IN 2013 SIGNATURE HEALTHCARE EARNED "TOP PERFORMER" ON KEY QUALITY MEASURES FROM THE JOINT COMMISSION, ONE OF ONLY 17 HOSPITALS IN MASSACHUSETTS TO RECEIVE THIS DISTINCTION AND ONE OF 8 ACHIEVING EXCELLENCE IN FOUR MEASURE SETS: HEART ATTACK, HEART FAILURE, SURGERY AND PNEUMONIA.IN 2008, SIGNATURE HEALTHCARE ACQUIRED A GEOGRAPHICALLY DISPERSED MULTI-SPECIALTY GROUP OF EMPLOYED PHYSICIANS COMPRISED OF 17 DIFFERENT SPECIALTIES, NOW CALLED SIGNATURE MEDICAL GROUP. SIGNATURE MEDICAL GROUP HAS LONG EMBRACED PROVIDING CARE FOR THE MEDICALLY COMPLEX, UNDERINSURED PATIENTS WHO ARE UNDERSERVED BY BOTH PRIMARY CARE AND SPECIALISTS IN THE AREA. MANY PHYSICIAN PRACTICES OUTSIDE OF SIGNATURE HEALTHCARE AND THE BROCKTON NEIGHBORHOOD HEALTH CENTER LIMIT THEIR PRACTICES AND ACCEPTANCE OF MEDICAID AND HEALTH SAFETY NET PATIENTS. SIGNATURE MEDICAL GROUP WHICH SERVES A TOTAL OF 60,000 PATIENTS IS COMMITTED TO THE CARE OF THE NEEDY POPULATION WHICH HAS RESULTED IN SIGNIFICANT FINANCIAL LOSSES. BROCKTON HOSPITAL PART V, SECTION B, LINE 4: STEWARD GOOD SAMARITAN HOSPITAL BROCKTON HOSPITAL PART V, SECTION B, LINE 5C: CHNA 22 ORGANIZATION WEBSITE: WWW.CHNA22.ORG. BROCKTON HOSPITAL PART V, SECTION B, LINE 7: SIGNATURE HEALTHCARE, IN COLLABORATION WITH THE CHNA22, DEVELOPED A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT FOR THE GREATER BROCKTON AREA IN DECEMBER, 2010. THE ASSESSMENT REVEALED FOUR KEY AREAS OF NEED: ASTHMA, NUTRITION AND FITNESS, ORAL HEALTH, AND SUBSTANCE ABUSE. IN DECEMBER, 2013 THE CHNA 22 AGAIN CONDUCTED A NEEDS ASSESSMENT WHICH FOCUSED SOLELY IN THESE FOUR AREAS OF NEED. IN 2013 SIGNATURE HEALTHCARE ADDRESSED ALL BUT THE ORAL HEALTH NEEDS AND PRIORITIZED THEIR EFFORTS TO ADDRESS THE NUTRITION AND DIABETES NEEDS. SIGNATURE HEALTHCARE ADDRESSED THE OTHER COMMUNITY NEEDS AS FOLLOWS: 1. SUBSTANCE ABUSE- PARTICIPATED IN BROCKTON MAYOR'S OPIOID OVERDOSE PREVENTION COALITION - PARTICIPATED IN AVON COALITION FOR EVERY STUDENT (K2 SPICE EDUCATION)- PROVIDED EDUCATION TO TEN AREA SCHOOLS AND PARENT TEACHER'S ASSOCIATIONS ON THE USE OF PERFORMANCE ENHANCING SUPPLEMENTS IN ATHLETES AND FINALLY, FISCAL SUPPORT OF THE BAMSI, BROCKTON AREA MULTI SERVICES AREA, INC. HELPLINE. 2. ASTHMA - SIGNATURE HEALTHCARE IS A MEMBER OF THE GREATER BROCKTON ASTHMA COALITION AND AS PART OF OUR MEMBERSHIP, OUR PHYSICIANS CONTRIBUTED ASTHMA EDUCATION TO BROCKTON AREA RESIDENTS.3. ORAL HEALTH - SIGNATURE HEALTHCARE DOES NOT EMPLOY OR PROVIDE GENERAL DENTISTRY CARE. WE WORK COLLABORATIVELY WITH THE BROCKTON NEIGHBORHOOD HEALTH CENTER TO ATTEND TO THE ORAL HEALTH NEEDS OF OUR COMMUNITY.THE SUMMARY OF FINDINGS FOR OUR COMMUNITY HEALTH NEEDS ASSESSMENT CONTINUED TO SHOW CONCERN FOR DIABETES AND NUTRITION THUS THAT IS WHERE SIGNATURE HEALTHCARE PRIMARILY FOCUSED ITS RESOURCES. ACCORDING TO THE DATA COLLECTED AS WELL AS INFORMATION OBTAINED FROM KEY INFORMANTS AND COMMUNITY MEMBERS, CONTINUED EDUCATION AND SUPPORT RELATED TO THESE AREAS WAS NECESSARY. THROUGHOUT THE YEAR OUR NUTRITION AND ENDOCRINOLOGY STAFF AS WELL AS OUR DIABETES EDUCATIONS WORK AT CREATING AND PROVIDING EDUCATIONAL TOOLS AND SEMINARS. DUE TO MANY OF THE FINDINGS IN THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNATURE HEALTHCARE IMPLEMENTED THE "WELLNESS WEDNESDAY" PROGRAM. THERE ARE MANY ELEMENTS TO THIS PROGRAM WHICH INCLUDE FREE EXERCISE CLASSES, FREE HEALTH SCREENINGS, HEALTHY COOKING DEMONSTRATIONS AND FREE HEALTHY RECIPES. SINCE COST AND SAFETY WERE IDENTIFIED AS BARRIERS KEEPING THE COMMUNITY FROM STAYING ACTIVE, SIGNATURE HEALTHCARE OFFERS FREE ZUMBA CLASSES TO THE COMMUNITY AND EMPLOYEES EVERY WEDNESDAY EVENING FROM 5:00PM TO 6:00PM. THESE CLASSES, ATTENDED BY 20 TO 30 PEOPLE WEEKLY, HAVE BEEN EXTREMELY WELL RECEIVED. THE PROGRAM HAS BEEN RUNNING FOR TWO AND ONE-HALF YEARS AND CONTINUES TO THRIVE. SIGNATURE HEALTHCARE STARTED FY 14 BY MOVING THE CLASSES TO MASSASOIT COMMUNITY COLLEGE, A WONDERFUL COMMUNITY PARTNER, TO PROVIDE ADDITIONAL SPACE AS WELL AS THE POTENTIAL FOR NEW PARTICIPANTS FROM THE FACULTY AND STUDENTS OF THE COLLEGE. ON MANY OCCASIONS THROUGHOUT FY 2013 OUR SIGNATURE HEALTHCARE STAFF OFFERED INFORMATION AND HANDS-ON ACTIVITIES TO THE COMMUNITY. ONE MAJOR EVENT IN WHICH SIGNATURE HEALTHCARE EMPLOYEES TOOK PART, ALONG WITH COMMUNITY PARTNERS, WAS OUR SECOND ANNUAL "DIABETES DAY". THIS EVENT INCLUDED MANY COMPONENTS: FREE SCREENINGS INCLUDING VASCULAR, A1C, GLUCOSE AND CHOLESTEROL; A HEALTHY COOKING DEMONSTRATION INCLUDING THE DISTRIBUTION OF RECIPE CARDS FOR THE DISHES PREPARED DURING THE EVENT; AND THERE WAS A VENDOR AREA WHERE COMMUNITY PARTNERS AND SIGNATURE HEALTHCARE DEPARTMENTS HIGHLIGHTED THEIR NUTRITIONAL AND DIABETES RELATED SERVICES. THERE WAS AN EXERCISE AREA WITH ZUMBA FOR ADULTS AND AN OBSTACLE COURSE FOR CHILDREN. LASTLY THERE WAS AN "ASK THE EXPERT" AREA WHERE SIGNATURE HEALTHCARE PROVIDERS WERE AVAILABLE FOR THE ATTENDEES TO ASK A VARIETY OF QUESTIONS ON A ONE-ON-ONE BASIS. THIS EVENT WAS A GREAT SUCCESS WITH OVER 400 PEOPLE IN ATTENDANCE AND 165 OF THOSE SCREENED. SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS PART OF THE BROCKTON'S PROMISE HEALTH START TEAM. THE CITY OF BROCKTON RECEIVED THE MASS IN MOTION GRANT WHICH IS FOCUSED ON POLICY AND ENVIRONMENTAL CHANGES PERTAINING TO EXERCISE AND HEALTHY EATING. THIS GRANT FUNDING IS PROVIDED IN TWO PHASES WITH THE FIRST PHASE FOCUSING ON DATA COLLECTION TO IDENTIFY THE ISSUES PERTAINING TO EXERCISE AND HEALTHY EATING. MUCH OF THE DATA COLLECTED REVEALED SIMILAR FINDINGS TO THE COMMUNITY NEEDS ASSESSMENT FROM 2010. MANY INDIVIDUALS BELIEVE ACCESS AND AFFORDABILITY WERE ISSUES IN PURCHASING HEALTHY FOODS. A SECOND MAJOR COMMENT WAS THAT MEMBERSHIP TO FITNESS FACILITIES IS TOO EXPENSIVE AND RESPONDENTS BELIEVE IT IS UNSAFE TO EXERCISE OUT OF DOORS. ANOTHER PROJECT OF THE HEALTHY START TEAM WAS A CLEANUP OF HILSTROM PARK TO PROVIDE A SAFE AND CLEAN AREA TO WALK OUTDOORS. MANY VOLUNTEERS ASSISTED IN PREPARING THIS BEAUTIFUL WOODED AREA BY CLEANING OUT GARBAGE, REMOVING BRANCHES AND OVERGROWN VEGETATION AND BUILDING WALKWAYS TO CREATE A SAFE AND ENJOYABLE AREA. THE HEALTHY START TEAM WORKS TO PROVIDE LOCATIONS FOR MANY COMMUNITY RAISED BED GARDENS, MANY OF WHICH ARE LOCATED PROXIMATE TO THE TARGETED POPULATIONS; I.E., THE SENIOR CENTER, BROCKTON PUBLIC SCHOOLS, HOUSING AUTHORITY LOCATIONS, BOYS & GIRLS CLUB, ETC. THE GOAL IS TO HAVE INDIVIDUALS LIVING OR VISITING THESE SITES TO TAKE AN ACTIVE ROLE IN GROWING THEIR OWN FRESH FOOD. A COROLLARY INITIATIVE UNDERWAY IS THE ADDITION OF ELECTRONIC BENEFIT TRANSFER (EBT) MACHINES AT THE FARMER'S MARKET WHICH TAKES PLACE AT BROCKTON CITY HALL DURING THE GROWING SEASON. THIS COMMITTEE IS COMPRISED OF MEMBERS FROM THE OLD COLONY PLANNING COUNCIL WHO ARE WORKING WITH THE GROUP TO OFFER SAFER AREAS TO WALK, RUN AND BIKE TO AND FROM SCHOOLS, ETC. THROUGH COMMUNITY OUTREACH WITH LOCAL BUSINESS, COMMUNITY GROUP AND EVENTS, HOSPITAL STAFF MEMBERS WERE ABLE TO EDUCATE THE COMMUNITY ON OBESITY AND DIABETES IN A VARIETY OF WAYS. SIGNATURE HEALTHCARE PROVIDED EDUCATIONAL TOOLS ON DIABETES, HEALTHY RECIPES, FREE EXERCISE CLASESS AND OPPORTUNITIES FOR QUESTIONS AND ANSWERS WITH OUR PROFESSIONAL STAFF. DURING FY 13, HOSPITAL STAFF ALSO PARTICIPATED IN MORE THAN TWENTY FIVE (25) COMMUNITY EVENTS TO PROMOTE EDUCATION ON OF DIABETES, NUTRITION AND OBESITY. - LINCOLN TECHNICAL INSTITUTE, COMMUNITY RESOURCE FAIR- COMMUNITY CARE SERVICES, HEALTH & SAFETY FAIR- MASSASOIT COMMUNITY COLLEGE - CANTON CAMPUS- MASSASOIT COMMUNITY COLLEGE - BROCKTON CAMPUS- STOUGHTON PARENT ENGAGEMENT CENTER- STONEHILL COLLEGE- FULL GOSPEL CHURCH - WOMEN'S MINISTRY- METRO SOUTH CHAMBER OF COMMERCE, TASTE OF METRO SOUTH EVENT- BROCKTON PUBLIC SCHOOLS, PARENT'S ACADEMY RESOURCE FAIR- BROCKTON HIGH SCHOOL ANNUAL WELLNESS FAIR- GREATER BROCKTON HEALTH FAIR SPONSORED BY CHNA 22 AND WALGREENS- NEW LIFE COUNSELING & WELLNESS CENTER INC.- KEYS OF THE KINGDOM TABERNACLE OF PRAYER FOR ALL PEOPLE, INC.- NEIGHBORHOOD HEALTH CENTER "NATIONAL HEALTH CENTER WEEK" HEALTH FAIR NEW LIFE COMMUNITY EMPOWERMENT CENTER- OLD COLONY YMCA YOUTH DIVISION BROCKTON BRANCH, "HEALTHY KIDS DAY"- OLD COLONY YMCA (NUMEROUS KICKOFF AND MIDPOINT EVENTS AS PART OF THE "SMALLEST WINNER" PROGRAM.- BROCKTON PUBLIC SCHOOLS, SUMMER FUN IN THE CITY RESOURCE FAIR- OLD COLONY YMCA EAST BRIDGEWATER BRANCH, SENIOR HEALTH FAIR- CITY OF BROCKTON "NIGHT OUT AGAINST CRIME"- SUMMERFEST- TAUNTON WIC "CELEBRATION OF THE YOUNG PARENT"- ANNUAL RAYNHAM COMMUNITY PRIDE DAYSIGNATURE HEALTHCARE IS A DISPROPORTIONATE SHARE HOSPITAL AND IS OFTEN THE PROVIDER OFLAST RESORT. SIGNATURE HEALTHCARE BROCKTON HOSPITAL OFFERS SPECIALTY CARE CLINICS IN TB, ENDOCRINOLOGY AND GYNECOLOGY TO WHICH THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER (FEDERAL 330 CENTER) REFERS PATIENTS. SIGNATURE HEALTHCARE DEVELOPED HEALTHY BEGINNINGS: A COMMUNITY OUTREACH PROGRAM FOR PREGNANT WOMEN WHO REQUIRE MEDICAL CARE, SOCIAL SUPPORT, FINANCIAL COUNSELING AND TRANSLATOR SERVICES. GIVEN THE DIVERSE NATURE OF THE PATIENT POPULATION, SIGNATURE HEATLHCARE SUPPLIES 24/7 TRANSLATOR SERVICES WITH FIFTEEN (15) EMPLOYED TRANSLATORS SPEAKING THIRTY-SIX (36) LANGUAGES. BROCKTON HOSPITAL PART V, SECTION B, LINE 7: THE PAYER MIX OF SIGNATURE HEALTHCARE'S PATIENT PANEL IS AS EXPECTED GIVEN THE DEMOGRAPHICS OF THE COMMUNITY WITH 3.4% RESIDUALLY UNINSURED, 22% MEDICAID AND MEDICAID MANAGED CARE, AND 66% OF THE TOTAL ON PUBLIC PAY. ADDITIONALLY THE COMMERCIAL PAYER RATES VARY CONSIDERABLY IN MASSACHUSETTS PER THE ATTORNEY GENERAL'S 2008 REPORT WHICH REVEALED A GREATER THAN 300% VARIATION IN RATES PAID TO THE HOSPITALS BY A COMMERCIAL PAYER. SIGNATURE HEALTHCARE BROCKTON HOSPITAL FELL IN THE LOWEST QUARTILE AND HAD THE 14TH LOWEST RATES OF ALL SIXTY-EIGHT (68) HOSPITALS. SIGNATURE HEALTH HAS BEEN RECOGNIZED AS A LOW COST, HIGH QUALITY PROVIDER OF CARE. IN 2013 SIGNATURE HEALTHCARE EARNED "TOP PERFORMER ON KEY QUALITY MEASURES" FROM THE JOINT COMMISSION, ONE OF ONLY 17 HOSPITALS IN MASSACHUSETTS TO RECEIVE THIS DISTINCTION AND ONE OF EIGHT (8) ACHIEVING EXCELLENCE IN FOUR MEASURE SETS: HEART ATTACK, HEART FAILURE, SURGERY AND PNEUMONIA. IN 2008 SIGNATURE HEALTHCARE ACQUIRED A GEOGRAPHICALLY DISPERSED MULTI-SPECIALTY GROUP OF EMPLOYED PHYSICIANS COMPRISED OF SEVENTEEN (17) SPECIALTIES, NOW CALLED SIGNATURE MEDICAL GROUP. SIGNATURE MEDICAL GROUP HAS LONG EMBRACED PROVIDING CARE FOR THE MEDICALLY COMPLEX, UNDERINSURED PATIENTS WHO ARE UNDERSERVED BY BOTH PRIMARY CARE AND SPECIALISTS IN THE AREA: MANY PHYSICIAN PRACTICES, OUTSIDE OF SIGNATURE HEALTHCARE AND THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER, LIMIT THEIR PRACTICES' ACCEPTANCE OF MEDICAID AND HEALTH SAFETY NET PATIENTS. SIGNATURE MEDICAL GROUP, WHICH SERVES A TOTAL OF 60,000 PATIENTS, IS COMMITTED TO THE CARE OF THE NEED POPULATION WHICH HAS RESULTED IN SIGNIFICANT FINANCIAL LOSSES. PART V, SECTION B, LINE 9 SIGNAGE AND WRITTEN INFORMATION REGARDING HOW TO APPLY FOR FINANCIAL ASSISTANCE IS AVAILABLE IN BROCKTON HOSPITAL EMERGENCY SERVICE AND PATIENT REGISTRATION AREAS. INFORMATION ABOUT APPLYING FOR FINANCIAL ASSISTANCE IS ALSO AVAILABLE ON LINE AT WWW.SIGNATURE-HEALTHCARE.ORG. PART VI, LINE 6 SIGNATURE HEALTHCARE AFFILIATED WITH BETH ISRAEL DEACONESS MEDICAL CENTER IN JUNE OF 2013 FOR THE PROVISION OF ADULT MEDICAL AND SURGICAL SERVICES. THIS AFFILIATION IS AIMED AT PROVIDING THE PATIENTS OF GREATER BROCKTON WITH ENHANCED ACCESS TO TERTIARY LEVEL SERVICES CLOSE TO HOME AND COORDINATED CARE MANAGEMENT FOR PATIENTS WHO MUST SEEK CARE AT THE TERTIARY LEVEL HOSPITAL IN BOSTON, MA.SIMILARLY, SIGNATURE HEALTHCARE EXPANDED UPON ITS AFFILIATION WITH TUFTS FLOATING HOSPITAL FOR CHILDREN IN JUNE OF 2013. WITH THIS EXPANDED AFFILIATION, SIGNATURE HEALTHCARE BUILDS ON THE HOSPITALS' EXISTING COLLABORATION TO CARE FOR NEWBORNS; FLOATING HOSPITAL NEONATOLOGISTS HAVE CARED FOR BABIES IN SIGNATURE HEALTHCARE BROCKTON HOSPITAL'S LEVEL II NURSERY SINCE 2005. WE HAVE ALREADY ENABLED THOUSANDS OF CHILDREN TO RECEIVE THEIR CARE CLOSER TO HOME. WHEN KIDS NEED TERTIARY CARE AT FLOATING HOSPITAL, OUR HOSPITALISTS HELP MAKE THAT TRANSITION SEAMLESS. SIGNATURE HEALTHCARE PEDIATRICIANS ARE ABLE TO COMMUNICATE DIRECTLY WITH THE HOSPITALISTS DURING AND FOLLOWING THEIR PATIENTS' HOSPITALIZATION TO ENABLE EASY TRANSITIONS OF CARE. X 0 1 X X X X X X 0 1 0 0 0 0 0 0 0 KIM HOLLON 567243 0 0 0 0 0 11250 0 22700 0 601193 0 0 0 DAVID DRINKWATER MD 0 533077 0 0 0 0 0 0 0 22325 0 555402 0 0 DALE J ELLENBERG MD 0 235787 0 0 0 0 0 2500 0 22325 0 260612 0 0 MICHAEL L DERN MD 0 530116 0 0 0 0 0 5000 0 14491 0 549607 0 0 ROBERT S GREENBERG MD 0 276562 0 0 0 0 0 5000 0 16948 0 298510 0 0 JAMES PAPADAKOS 178992 0 0 0 0 0 2365 0 12330 0 193687 0 0 0 STEPHEN BORGES 185827 0 0 0 0 0 8100 0 20663 0 214590 0 0 0 DAVID J FISHER 200400 0 0 0 0 0 11713 0 15408 0 227521 0 0 0 KIMBERLY WALSH 239211 0 0 0 0 0 11250 0 8310 0 258771 0 0 0 KAREN MURPHY 283192 0 0 0 0 0 8681 0 2772 0 294645 0 0 0 MARIE F GROSS 263646 0 0 0 0 0 6025 0 3055 0 272726 0 0 0 JEFFREY MILLER 189187 0 0 0 0 0 6299 0 21206 0 216692 0 0 0 DENNIS RENAUD 176740 0 0 0 0 0 4543 0 41 0 181324 0 0 0 KIM MCCARTHY-WALSH 166227 0 0 0 0 0 6981 0 997 0 174205 0 0 0 TIMOTHY R LYNCH MD 0 282195 0 0 0 0 0 0 0 22325 0 304520 0 0 ROBERT COVETT MD 0 372242 0 0 0 0 0 0 0 9369 0 381611 0 0 KEN LAWSON 0 412260 0 0 0 0 0 9048 0 24483 0 445791 0 0 GEORGE C BROWN 0 604623 0 0 0 0 0 1908 0 15457 0 621988 0 0 JEAN-PIERRE GEAGEA 0 681497 0 0 0 0 0 3683 0 81 0 685261 0 0 MARC GREENWALD 0 350965 0 0 0 0 0 5000 0 15457 0 371422 0 0 DANIEL MUSE 0 446685 0 0 0 0 0 14964 0 1746 0 463395 0 0 ABDEL-HAI HAMMO 0 528012 0 0 0 0 0 0 0 22325 0 550337 0 0 PART I, LINE 1B THE COMPENSATION ELEMENTS INDICATED ON SCHEDULE J, PART I (TAX INDEMNIFICATION/GROSS-UP PAYMENTS) WERE PROVIDED PURSUANT TO THE EMPLOYMENT CONTRACT MAINTAINED BETWEEN THE HOSPITAL AND THE INDIVIDUAL. PART I, LINE 4B DURING THE YEAR ENDED 9/30/2013 THE HOSPITAL MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS FOR THREE 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 9/30/2013: JAMES PAPADAKOS - $2,365 KAREN MURPHY - $3,008 DAVID FISHER - $861 MICHAEL L CONNORS LOAN RECEIVABLE - SPLIT DOLLAR LIFE INSURANCE POLICY X 895000 895000 0 1 1 895000 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT IN CONJUCTION WITH INPUT PROVIDED BY ORGANIZATION MANAGEMENT. THE COMPLETED FORM 990 WAS PROVIDED TO EACH BOARD MEMBER ELECTRONICALLY. IN ADDITION, A BOARD MEETING WAS CONVENED TO REVIEW THE FORM 990 IN ADVANCE OF THE FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE ORGANIZATION CIRCULATES A CONFLICT OF INTEREST QUESTIONNAIRE. RESPONSES TO THE STATEMENT ARE REVIEWED 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 18 THE ORGANIZATION MAKES ITS 990 AND 990-T AVAILABLE UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FORM 990 IS AVAILABLE ON THE WEBSITE OF THE MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST, FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE WEBSITE OF THE MASSACHUSETTS ATTORNEY GENERAL AS WELL AS WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 19,182,794. CHANGE IN INTEREST IN INVESTMENTS OF SIGNATURE HEALTHCARE, INC. -509,831. TRANSFERS (TO) FROM AFFILIATES 799,184. CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENTS 44,311. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 461,246. 110 LIBERTY STREET REALTY COMPANY LLC 680 CENTRE STREET BROCKTON MA 02302 320048951 REALTY COMPANY MA 1764000 31420007 SIGNATURE HEALTHCARE CORPORATION SIGNATURE HEALTHCARE CORPORATION 680 CENTRE STREET BROCKTON MA 02302 042103554 FUNDRAISING MA 501(C)(3) PUBLIC CHARITY N/A 0 SIGNATURE HEALTHCARE MEDICAL GROUP 680 CENTRE STREET BROCKTON MA 02302 043306782 MEDICAL CARE MA 501(C)(3) PUBLIC CHARITY SIGNATURE HEALTHCARE CORPORATION 0 BROCKTON RADIATION ONCOLOGY LLC 680 CENTRE STREET BROCKTON MA 02302 222472997 RADIATION ONCOLOGY SERVICES MA N/A RELATED 1122312 1036000 0 0 0.40000 BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES 680 CENTRE STREET BROCKTON MA 02302 042530255 PHYSICIAN GROUP MA N/A C 0 BROCKTON PHYSICIAN HOSPITAL ORGANIZATION 680 CENTRE STREET BROCKTON MA 02302 043189274 MEDICAL MANAGEMENT MA N/A C 741 140376 0.50000 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1