SIGNATURE HEALTHCARE CORPORATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- SIGNATURE HEALTHCARE CORPORATION (EIN 04-2103554)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-06
- IRS object ID
- 201202199349301020
- Schema version
- 2010v3.4
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-06T15:10:39-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FEELEY & DRISCOLL PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042103554 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SIGN | NameControl |
| Phone | 5089417000 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KIM HOLLON | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 5089417000 | Phone |
| Date Signed | 2012-07-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALAN GAROFALO | Name |
| Phone | 6177427788 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KIM HOLLON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 5147490 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | SIGNATURE-HEALTHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1890 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 191 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 236421 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 194997 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 366743 | InvestmentIncomePriorYear |
| Investment Income Current Year | 395471 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1764989 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1523827 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2368153 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2114295 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 20000 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 402799 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 453255 | OtherExpensePriorYear |
| Other Expenses Current Year | 557820 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 453255 | TotalExpensesPriorYear |
| Total Expenses Current Year | 577820 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1914898 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1536475 | RevenuesLessExpensesCY |
| Total Assets BOY | 68135959 | TotalAssetsBOY |
| Total Assets EOY | 65184942 | TotalAssetsEOY |
| Total Liabilities BOY | 28786629 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 25866130 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 39349330 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 39318812 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Revenue | 1291373 | Revenue |
| Description | 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. | Description |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 7 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MA | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM HOLLON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5089417000 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|
| TIMOTHY J CRUZ | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JOSEPH P DRIER III | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DAVID A DRINKWATER MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 493975 | 30607 | ||
| DAVID P FRENETTE | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT S GREENBERG MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 274141 | 39297 | ||
| ROBERT J MCMAHAN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PATRICIA TORTORELLA | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JAMES E LEARY | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| TIMOTHY R LYNCH MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 251245 | 17235 | ||
| WALLACE H PECKHAM III | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PATTI ROLAND | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL J SULLIVAN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT D SULLIVAN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DALE J ELLENBERG MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 216774 | 37206 | ||
| MICHAEL L DERN MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 355782 | 44061 | ||
| DAVID R WOLOHOJIAN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MARY WALDRON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| KEVIN P LEONARD | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0 | 247363 | 42055 | X | ||
| KIM HOLLON | |||||||
| CEO/PRESIDENT | 40.00 | 0 | 239607 | 21188 | X | ||
| JULIE G WHITE MD | |||||||
| FORMER TRUSTEE | 0.00 | 0 | 319847 | 29926 | X | ||
| ROBERT COVETT MD | |||||||
| TRUSTEE | 0.00 | 0 | 301043 | 17099 | X | ||
| EUGENE C WALLACE | |||||||
| FORMER INTERIM PRESIDENT/CEO | 0.00 | 0 | 478126 | 32508 | X | ||
| NORMAN B GOODMAN | |||||||
| FORMER PRESIDENT/CEO | 0.00 | 0 | 155772 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3333675 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 311182 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRESCENT CREDIT UNION | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 4290 | AddressLine1 |
| City | BROCKTON | City |
| State | MA | State |
| ZIP Code | 02303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | FACILITIES | DescriptionOfServices |
| Compensation | 137660 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Fundraising Events | 49129 | FundraisingEvents |
| All Other Contributions | 145868 | AllOtherContributions |
| Total Contributions | 194997 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 343768 | TotalRevenueColumn |
| Exclusion | $343,768 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 3753000 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2892227 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 860773 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 860773 | TotalRevenueColumn |
| Related Or Exempt Function Income | 860773 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 51703 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 51703 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51703 | TotalRevenueColumn |
| Exclusion | $51,703 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 373422 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 49129 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 140968 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 232454 | TotalRevenueColumn |
| Exclusion | $232,454 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BLUE CROSS REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 430600 | TotalRevenueColumn |
| Related Or Exempt Function Income | 430600 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 430600 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2114295 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1291373 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $627,925 | ExclusionAmount |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
| Fundraising | 20000 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| FUNDRAISING EXPENSES | 382799 | 382799 | |
| ADMINISTRATION EXPENSES | 175021 | 175021 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 577820 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 175021 | ManagementAndGeneral |
| Fundraising | 402799 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78254 | BOY |
| EOY | 116426 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 436000 | BOY |
| EOY | 494500 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31828 | BOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 45966986 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7077484 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40161102 | BOY |
| EOY | 38889502 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13448523 | BOY |
| EOY | 8948378 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13980252 | BOY |
| EOY | 16736136 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68135959 | BOY |
| EOY | 65184942 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97133 | BOY |
| EOY | 78909 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28105920 | BOY |
| EOY | 25186137 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 583576 | BOY |
| EOY | 601084 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28786629 | BOY |
| EOY | 25866130 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36733870 | BOY |
| EOY | 36849618 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1160379 | BOY |
| EOY | 1014113 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1455081 | BOY |
| EOY | 1455081 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39349330 | BOY |
| EOY | 39318812 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68135959 | BOY |
| EOY | 65184942 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1536475 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1566993 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (3 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| BROCKTON HOSPITAL AMBASSADORS CLUB INC | |||||
| 043160078 | 9 | 1 | 1 | 1 | $0 |
| SIGNATURE MEDICAL GROUP INC | |||||
| 043306782 | 9 | 1 | 1 | 1 | $0 |
| BROCKTON HOSPITAL INC | |||||
| 222472297 | 3 | 1 | 1 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 3 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3335390 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -168892 | InvestmentEarningsOrLosses |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 3166498 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3187674 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 147716 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3335390 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3404596 | BeginningOfYearBalance |
| Contributions | 250 | Contributions |
| Investment Earnings Or Losses | -217172 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3187674 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.96000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.04000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2857454 | OtherCostOrOtherBasis |
| Book Value | 2857454 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39193950 | OtherCostOrOtherBasis |
| Depreciation | 4341570 | Depreciation |
| Book Value | 34852380 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2989692 | OtherCostOrOtherBasis |
| Depreciation | 2335430 | Depreciation |
| Book Value | 654262 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 423790 | OtherCostOrOtherBasis |
| Depreciation | 334302 | Depreciation |
| Book Value | 89488 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 502100 | OtherCostOrOtherBasis |
| Depreciation | 66182 | Depreciation |
| Book Value | 435918 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38889502 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| LONG TERM INVESTMENTS | 6479184 | F |
| TEMPORARILY RESTRICTED INVESTMENTS | 1014113 | F |
| PERMANENTLY RESTRICTED INVESTMENTS | 1455081 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 8948378 | TotalOfBookValueSecurities |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM RELATED PARTY | 13982055 |
| SPLIT DOLLAR LIFE INSURANCE POLICY | 2461500 |
| DEBT ISSUE COSTS, NET | 292581 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 16736136 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEFERRED ASSET RETIREMENT OBLIGATION | Description |
| Amount | $601,084 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 601084 | TotalOfAmounts |
| Total Revenue | 2114295 | TotalRevenue |
| Total Expenses | 577820 | TotalExpenses |
| Excess Or Deficit For Year | 1536475 | ExcessOrDeficitForYear |
| Other | -$1,566,993 | OtherAmount |
| Total Adjustments | -1566993 | TotalAdjustments |
| Excess Or Deficit Per FS | -30518 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 4603723 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 2489428 | OtherRevenues |
| Revenue Not Rptd F990 | 2489428 | RevenueNotRptdF990 |
| Revenue Subtotal | 2114295 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2114295 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3067248 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 2489428 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 2489428 | ExpensesNotRptdF990 |
| Expenses Subtotal | 577820 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 577820 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | EFFECTIVE OCTOBER 2008, NEW ACCOUNTING GUIDANCE WAS ISSUED FOR ACCOUNTING AND REPORTING FOR UNCERTAINTY IN INCOME TAXES. THE CORPORATION ADOPTED THIS STANDARD AND IT DID NOT HAVE A MATERIAL IMPACT ON ITS FINANCIAL STATEMENTS. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | UNREALIZED LOSS ON UNRESTRICTED INVESTMENTS -693,732. UNREALIZED LOSS ON TEMP RESTRICTED INVESTMENTS -201,884. TRANSFER FROM AFFILIATE 10,623. CHANGE IN FAIR VALUE OF SPLIT DOLLAR LIFE POLICY -682,000. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 2,892,227. FUNDRAISING EXPENSES -402,799. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 2,892,227. FUNDRAISING EXPENSES -402,799. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Phone Solicitations | X | PhoneSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
Name Of Organization NameOfOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALIENT HEALTH SOLUTIONS | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 99 SUMMER STREET | AddressLine1 |
| City | BOSTON | City |
| State | MA | State |
| ZIP Code | 02110 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | GRANT WRITER | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 0 | GrossReceipts |
| Amount Retained By Contractor | 0 | AmountRetainedByContractor |
| Net To Organization | 20000 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net To Organization | 20000 | TotalNetToOrganization |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | RING OF CHAMPIONS | NameOfEvent1 |
| Gross Receipts Event1 | 84101 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 2375 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 81726 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 50 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1044 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1449 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 15397 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 350 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 3379 | OtherDirectExpensesEvent1 |
| Name Of Event2 | CANCER WALK | NameOfEvent2 |
| Gross Receipts Event2 | 213387 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 32955 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 180432 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 614 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 6196 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 6230 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 2364 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 105 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 85543 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 125063 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 13799 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 111264 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 60 | CashPrizesOtherEvents |
| Non Cash Prizes Other Events | 3359 | NonCashPrizesOtherEvents |
| Food And Beverage Other Events | 11228 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 3600 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 422551 | GrossReceiptsTotal |
| Charitable Contributions Total | 49129 | CharitableContributionsTotal |
| Gross Revenue Total Events | 373422 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 724 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 10599 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 7679 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 28989 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 455 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 92522 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 140968 | DirectExpenseSummaryEvents |
| Net Income Summary | 232454 | NetIncomeSummary |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID A DRINKWATER MD | |||||||||||||
| 0 | 493975 | 0 | 0 | 0 | 0 | 0 | 14419 | 0 | 16188 | 0 | 524582 | 0 | 0 |
| ROBERT S GREENBERG MD | |||||||||||||
| 0 | 272426 | 0 | 0 | 0 | 1715 | 0 | 22000 | 0 | 17297 | 0 | 313438 | 0 | 0 |
| TIMOTHY R LYNCH MD | |||||||||||||
| 0 | 251245 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 17235 | 0 | 268480 | 0 | 0 |
| DALE J ELLENBERG MD | |||||||||||||
| 0 | 216774 | 0 | 0 | 0 | 0 | 0 | 20000 | 0 | 17206 | 0 | 253980 | 0 | 0 |
| MICHAEL L DERN MD | |||||||||||||
| 0 | 355782 | 0 | 0 | 0 | 0 | 0 | 22000 | 0 | 22061 | 0 | 399843 | 0 | 0 |
| KEVIN P LEONARD | |||||||||||||
| 0 | 247363 | 0 | 0 | 0 | 0 | 0 | 20800 | 0 | 21255 | 0 | 289418 | 0 | 0 |
| KIM HOLLON | |||||||||||||
| 0 | 224276 | 0 | 0 | 0 | 15331 | 0 | 12321 | 0 | 8867 | 0 | 260795 | 0 | 0 |
| JULIE G WHITE MD | |||||||||||||
| 0 | 319847 | 0 | 0 | 0 | 0 | 0 | 16120 | 0 | 13806 | 0 | 349773 | 0 | 0 |
| ROBERT COVETT MD | |||||||||||||
| 0 | 276043 | 0 | 25000 | 0 | 0 | 0 | 8914 | 0 | 8185 | 0 | 318142 | 0 | 0 |
| EUGENE C WALLACE | |||||||||||||
| 0 | 365624 | 0 | 0 | 0 | 112502 | 0 | 18615 | 0 | 13893 | 0 | 510634 | 0 | 0 |
| NORMAN B GOODMAN | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 155772 | 0 | 0 | 0 | 0 | 0 | 155772 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINES 4A-B | ReturnReference |
| Explanation | THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RESIGNED IN JUNE 2009. PURSUANT TO AN AGREEMENT BETWEEN THE PARTIES, THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RECEIVED CERTAIN SEPARATION PAYMENTS FROM BROCKTON HOSPITAL (A RELATED ORGANIZATION) IN CALENDAR YEAR 2010. CONSISTENT WITH REPORTING REQUIREMENTS FOR IRS FORM 990, COMPENSATION AND OTHER PAYMENTS TO EMPLOYEES AND FORMER EMPLOYEES ARE REPORTED ON A CALENDAR YEAR (FORM W-2) BASIS. CONSEQUENTLY, SEPARATION PAYMENTS TO THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER MADE IN CALENDAR YEAR 2010 AMOUNTING TO $155,772 ARE REPORTED FOR THE FISCAL YEAR ENDED 9/30/11. THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RESIGNED IN SEPTEMBER 2010, AND HAS A SEVERANCE ARRANGEMENT WHICH STATES THAT THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER WILL RECEIVE BASE SALARY PLUS CONTINUATION OF BENEFITS FOR THREE MONTHS. THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RECEIVED SEPARATION PAYMENTS TOTALING $112,502 DURING CALENDAR YEAR 2010. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NORMAN B GOODMAN | NamePerson |
| Purpose Of Loan | LOAN RECEIVABLE (SPLIT DOLLAR LIFE INSURANCE POLICY) | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $2,461,500 | OriginalPrincipalAmount |
| Balance Due | 2461500 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 2461500 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| 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 12C | |
| 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 VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | UNREALIZED LOSS ON UNRESTRICTED INVESTMENTS -693,732. UNREALIZED LOSS ON TEMP RESTRICTED INVESTMENTS -201,884. TRANSFER FROM AFFILIATE 10,623. CHANGE IN FAIR VALUE OF SPLIT DOLLAR LIFE POLICY -682,000. TOTAL TO FORM 990, PART XI, LINE 5: -1,566,993. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 110 LIBERTY STREET REALTY COMPANY LLC | BusinessNameLine1 |
Address US AddressUS
| 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 | PrimaryActivities |
| Legal Domicile State | MA | LegalDomicileState |
| Total Income | 3204000 | TotalIncome |
| EOY Assets | 33218237 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| BROCKTON HOSPITAL AMBASSADORS CLUB INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043160078 | FUNDRAISING | MA | 501C(3) | 501C(3) | SIGNATURE HEALTHCARE CORPORATION | 0 |
| SIGNATURE HEALTHCARE MEDICAL GROUP INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043306782 | MEDICAL CARE | MA | 501C(3) | 501C(3) | SIGNATURE HEALTHCARE CORPORATION | 0 |
| BROCKTON HOSPITAL INC | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 222472297 | MEDICAL CARE | MA | 501C(3) | 501C(3) | SIGNATURE HEALTHCARE CORPORATION | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | PHYSICIAN PRACTICE | PrimaryActivity |
| Legal Domicile State | MA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIGNATURE HEALTHCARE CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 42433980 | ShareOfTotalIncome |
| Share Of EOY Assets | 14196195 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (12 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SIGNATURE MEDICAL GROUP INC | ||
| I | 549000 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| P | 13567 | FMV |
| SIGNATURE MEDICAL GROUP INC | ||
| R | 19000 | FMV |
| BROCKTON HOSPITAL INC | ||
| B | 174945 | FMV |
| BROCKTON HOSPITAL INC | ||
| N | 289963 | FMV |
| BROCKTON HOSPITAL INC | ||
| O | 127400 | FMV |
| BROCKTON HOSPITAL INC | ||
| P | 150541 | FMV |
| BROCKTON HOSPITAL INC | ||
| Q | 815120 | FMV |
| BROCKTON HOSPITAL INC | ||
| R | 200030 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| O | 2300000 | FMV |
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||
| Q | 10000 | FMV |
| 110 LIBERTY STREET COMPANY LLC | ||
| Q | 1333334 | FMV |
Comments