BROCKTON HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- BROCKTON HOSPITAL INC (EIN 22-2472997)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-09
- IRS object ID
- 201232229349300963
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-09T14:54:01-05:00 | 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 | 222472997 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROCKTON HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BROC | 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 | 2012-08-08 | 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 | 206098310 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SIGNATURE-HEALTHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1890 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | THE HOSPITAL OPERATES A 253 BED ACUTE CARE FACILITY THAT PROVIDES HEALTH CARE SERVICES TO 20 COMMUNITIES IN SOUTHEASTERN MASSACHUSETTS. IN FISCAL YEAR 2011 THE HOSPITAL PROVIDED $16,538,684 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 11,000 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1937 | TotalNbrEmployees |
| Total Nbr Volunteers | 174 | TotalNbrVolunteers |
| Total Gross UBI | 399257 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -230894 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 60422 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 359394 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 208030249 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 195529352 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1489191 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2024830 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 8450222 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8184734 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 218030084 | TotalRevenuePriorYear |
| Total Revenue Current Year | 206098310 | 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 | 108265722 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 107738311 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 90074266 | OtherExpensePriorYear |
| Other Expenses Current Year | 82172442 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 198339988 | TotalExpensesPriorYear |
| Total Expenses Current Year | 189910753 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 19690096 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 16187557 | RevenuesLessExpensesCY |
| Total Assets BOY | 113969058 | TotalAssetsBOY |
| Total Assets EOY | 121382625 | TotalAssetsEOY |
| Total Liabilities BOY | 106711042 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 115084661 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7258016 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6297964 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 167687104 | Expense |
| Revenue | 201231716 | Revenue |
| Description | THE HOSPITAL OPERATES A 253 BED ACUTE CARE FACILITY THAT PROVIDES HEALTH CARE SERVICES TO 20 COMMUNITIES IN SOUTHEASTERN MASSACHUSETTS. IN FISCAL YEAR 2011 THE HOSPITAL PROVIDED $16,538,684 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-PRIVILEDGED CHILDREN, ACCOMODATED APPROXIMATELY 11,000 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. | Description |
| Total Program Service Expense | 167687104 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| 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 | 1 | 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 | 0 | 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 | 274 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1937 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 0 | QuidProQuoContributions |
| 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| 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 (32 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| ROBERT J MCMAHAN | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| TIMOTHY R LYNCH MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 251245 | 17235 | ||||
| JAMES E LEARY | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| MICHAEL J SULLIVAN | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| PATRICIA TORTORELLA | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| DALE J ELLENBERG MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 216774 | 37206 | ||||
| ROBERT D SULLIVAN | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| ROBERT S GREENBERG MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 274141 | 39297 | ||||
| MICHAEL L DERN MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 355782 | 44061 | ||||
| DAVID R WOLOHOJIAN | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| TIMOTHY J CRUZ | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| DAVID P FRENETTE | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| PATTI ROLAND | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| DAVID DRINKWATER MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 493975 | 30607 | ||||
| WALLACE H PECKHAM III | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| JOSEPH P DRIER III | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| MARY V WALDRON | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| KEVIN P LEONARD | |||||||||
| CFO | 40.00 | 247363 | 0 | 42055 | X | ||||
| KIM N HOLLON | |||||||||
| PRESIDENT/CEO | 40.00 | 239607 | 0 | 21188 | X | ||||
| KIMBERLY WALSH | |||||||||
| VICE PRESIDENT | 40.00 | 213543 | 0 | 30067 | X | ||||
| DEBORAH WILSON | |||||||||
| SR. VP AMBULATORY | 40.00 | 313278 | 0 | 46034 | X | ||||
| STEPHEN BORGES | |||||||||
| VICE PRESIDENT | 40.00 | 158808 | 0 | 32946 | X | ||||
| DAVID J FISHER | |||||||||
| VICE PRESIDENT | 40.00 | 177179 | 0 | 51191 | X | ||||
| STELLA A PARRY | |||||||||
| ATTORNEY | 40.00 | 200410 | 0 | 33937 | X | ||||
| KIM MCCARTHY-WALSH | |||||||||
| CONTROLLER | 40.00 | 162486 | 0 | 29102 | X | ||||
| BEVERLY A CAPECE | |||||||||
| DIRECTOR | 40.00 | 154789 | 0 | 38699 | X | ||||
| KENNETH LUCAS | |||||||||
| DIRECTOR | 40.00 | 149915 | 0 | 38243 | X | ||||
| ELAINE GILL | |||||||||
| EMPLOYEE | 40.00 | 186779 | 0 | 0 | X | ||||
| JULIE WHITE MD | |||||||||
| FORMER TRUSTEE | 0.00 | 0 | 319847 | 29926 | X | ||||
| ROBERT COVETT MD | |||||||||
| FORMER TRUSTEE | 0.00 | 0 | 301043 | 17099 | X | ||||
| NORMAN B GOODMAN | |||||||||
| FORMER PRESIDENT/CEO | 0.00 | 155772 | 0 | 0 | X | ||||
| EUGENE C WALLACE | |||||||||
| FORMER INTERIM CEO/CFO | 40.00 | 478126 | 0 | 32508 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2838055 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2212807 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 611401 | TotalOtherCompensation |
| Number Individuals GT100 K | 110 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MATRIX ANESTHESIA PD | |||||
| 1342 BELMONT STREET | BROCKTON | MA | 02302 | PHYSICIAN SERVICES | 2528341 |
| PRATT PEDIATRIC ASSOCIATES | |||||
| 750 WASHINGTON STREET | BOSTON | MA | 02111 | PHYSICIAN SERVICES | 491420 |
| ROPES & GRAY | |||||
| ONE INTERNATIONAL PLACE | BOSTON | MA | 021102624 | LEGAL | 481456 |
| FISHER COLLEGE | |||||
| 118 BEACON STREET | BOSTON | MA | 02116 | TEACHING SERVICES | 416444 |
| PRICEWATERHOUSECOOPERS | |||||
| PO BOX 7247-8001 | PHILADELPHIA | PA | 19170 | AUDIT SERVICES | 365827 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 16 | NumberOfContractorsGT100K |
| Government Grants | 254625 | GovernmentGrants |
| All Other Contributions | 104769 | AllOtherContributions |
| Total Contributions | 359394 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 900099 | 191487843 | 191487843 | |
| MEANINGFUL USE EHR REV | 900099 | 3642252 | 3642252 | |
| OUTREACH LAB SERVICES | 541380 | 399257 | 399257 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 195529352 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1835495 | TotalRevenueColumn |
| Exclusion | $1,835,495 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 189335 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 189335 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 189335 | TotalRevenueColumn |
| Exclusion | $189,335 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| SCHOOL OF NURSING | 900099 | 4749772 | 4749772 | |
| VANTAGE JOINT VENTURE | 900099 | 1124867 | 1124867 | |
| CAFETERIA | 900099 | 667458 | $667,458 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1642637 | TotalRevenueColumn |
| Related Or Exempt Function Income | 226982 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,415,655 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 8184734 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 206098310 | TotalRevenueColumn |
| Related Or Exempt Function Income | 201231716 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 399257 | UnrelatedBusinessRevenue |
| Exclusion | $4,107,943 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2702612 | Total |
| Program Services | 1972907 | ProgramServices |
| Management And General | 729705 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83277432 | Total |
| Program Services | 76527361 | ProgramServices |
| Management And General | 6750071 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4620725 | Total |
| Program Services | 3373129 | ProgramServices |
| Management And General | 1247596 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10849511 | Total |
| Program Services | 7920143 | ProgramServices |
| Management And General | 2929368 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6288031 | Total |
| Program Services | 4590263 | ProgramServices |
| Management And General | 1697768 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4194147 | Total |
| Program Services | 4142051 | ProgramServices |
| Management And General | 52096 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 891574 | Total |
| Program Services | 650849 | ProgramServices |
| Management And General | 240725 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201000 | Total |
| Program Services | 146730 | ProgramServices |
| Management And General | 54270 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58000 | Total |
| Program Services | 42340 | ProgramServices |
| Management And General | 15660 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 460182 | Total |
| Program Services | 336420 | ProgramServices |
| Management And General | 123762 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3089265 | Total |
| Program Services | 2623707 | ProgramServices |
| Management And General | 465558 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1417363 | Total |
| Program Services | 1034675 | ProgramServices |
| Management And General | 382688 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3196549 | Total |
| Program Services | 2333481 | ProgramServices |
| Management And General | 863068 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55730 | Total |
| Program Services | 45821 | ProgramServices |
| Management And General | 9909 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1726247 | Total |
| Program Services | 1260160 | ProgramServices |
| Management And General | 466087 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6162535 | Total |
| Program Services | 4498651 | ProgramServices |
| Management And General | 1663884 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2058948 | Total |
| Program Services | 1503032 | ProgramServices |
| Management And General | 555916 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OTHER PROFESSIONAL SERV | 18949046 | 17775579 | 1173467 |
| PURCHASED SERVICES | 9449361 | 7925218 | 1524143 |
| MEDICAL AND SURGICAL SU | 9073566 | 9051324 | 22242 |
| DRUGS AND MEDICATIONS | 5977406 | 5970396 | 7010 |
| CLINICAL SUPPLIES | 5845648 | 5828201 | 17447 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9365875 | Total |
| Program Services | 8134666 | ProgramServices |
| Management And General | 1231209 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189910753 | Total |
| Program Services | 167687104 | ProgramServices |
| Management And General | 22223649 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2641451 | BOY |
| EOY | 2114147 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18725912 | BOY |
| EOY | 21183086 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25478617 | BOY |
| EOY | 26537952 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 933518 | BOY |
| EOY | 1456714 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1813185 | BOY |
| EOY | 5555954 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 169995125 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 135081879 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37849104 | BOY |
| EOY | 34913246 | 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 | 13078748 | BOY |
| EOY | 20673148 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113969058 | BOY |
| EOY | 121382625 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21057210 | BOY |
| EOY | 22789167 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1698400 | BOY |
| EOY | 1390839 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38110794 | BOY |
| EOY | 36915292 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6901961 | BOY |
| EOY | 6431372 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1414622 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37528055 | BOY |
| EOY | 47557991 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 106711042 | BOY |
| EOY | 115084661 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2963745 | BOY |
| EOY | 2136591 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1160379 | BOY |
| EOY | 1108286 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3133892 | BOY |
| EOY | 3053087 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7258016 | BOY |
| EOY | 6297964 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113969058 | BOY |
| EOY | 121382625 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 16187557 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -17147609 | 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 | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $214,100 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 214100 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | 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. $40,000 WENT TO DENNIS A. SMITH ASSOCIATES, $40,000 WAS PAID TO NELSON, MULLINS, RILEY AND SCARBOROUGH. $60,800 WAS PAID TO ELLEN MURPHY & ASSOCIATES. THE ALLOCATED PORTION OF DUES TO THE FOLLOWING ORGANIZATIONS: $25,259 MASSACHUSETTS HOSPITAL ASSOCIATION; $9,069 AMERICAN HOSPITAL ASSOCIATION. ADDITIONALLY, $38,972 OF STAFF WAGES HAS BEEN ALLOCATED TO LOBBYING IN RELATION TO STAFF EFFORTS TO SIMILARLY REPRESENT THE INTERESTS OF THE HOSPITAL AND THE HEALTHCARE INDUSTRY AS A WHOLE IN RELATION TO VARIOUS FEDERAL AND STATE LEGISLATION. | Explanation |
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) |
|---|---|---|
| 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 | 30564 | OtherCostOrOtherBasis |
| Book Value | 30564 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56922706 | OtherCostOrOtherBasis |
| Depreciation | 35323012 | Depreciation |
| Book Value | 21599694 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 112561495 | OtherCostOrOtherBasis |
| Depreciation | 99758867 | Depreciation |
| Book Value | 12802628 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 480360 | OtherCostOrOtherBasis |
| Book Value | 480360 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 34913246 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST IN SIGNATURE HEALTHCARE, INC. INVESTMENTS | Description |
| Book Value | 8948378 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 8948378 | TotalOfBookValueSecurities |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ASSETS WHOSE USE IS LIMITED | 19102518 |
| UNAMORTIZED BOND ISSUANCE COSTS | 161618 |
| INVESTMENT IN JOINT VENTURE | 722767 |
| LOAN RECEIVABLE - SPLIT DOLLAR LIFE INSURANCE | 624000 |
| SECURITY DEPOSIT | 62245 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 20673148 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| AMOUNTS DUE 3RD PARTY PAYORS | $4,637,951 |
| PENSION LIABILITY | $42,920,040 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 47557991 | TotalOfAmounts |
| Total Revenue | 206098310 | TotalRevenue |
| Total Expenses | 189910753 | TotalExpenses |
| Excess Or Deficit For Year | 16187557 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -1600492 | NetUnrealizedGLOnInvestments |
| Other | -$15,547,117 | OtherAmount |
| Total Adjustments | -17147609 | TotalAdjustments |
| Excess Or Deficit Per FS | -960052 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 206098310 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 206098310 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 206098310 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 189910753 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 189910753 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 189910753 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 8 - OTHER ADJUSTMENTS: | ADJUSTMENT TO MINIMUM PENSION LIABILITY -10,783,625. CHANGE IN INTEREST IN INVESTMENTS OF SIGNATURE HEALTHCARE, INC. -4,847,035. TRANSFERS FROM SIGNATURE HEALTHCARE CORPORATION FOR CAPITAL 174,945. CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENTS -91,402. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10056000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7346673 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2709327 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01430 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 41816235 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 38229376 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3586859 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01890 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4925422 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4152806 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 772616 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00410 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 56797657 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 49728855 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7068802 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03730 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10136 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10136 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7295210 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7203470 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 91740 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6446829 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4814779 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1632050 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 14500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13766675 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12018249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1748426 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00930 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 70564332 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 61747104 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8817228 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04660 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 45 | NumberOfActivitiesOrPrograms |
| Persons Served | 30 | PersonsServed |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 45 | NumberOfActivitiesOrPrograms |
| Persons Served | 30 | PersonsServed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $12,153,431 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 62618989 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 55955569 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 6663420 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROCKTON HOSPITAL INC | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | TCU/PSYCH | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROCKTON HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Develop Community Plan | X | DevelopCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (6 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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. | |
| PART V, SECTION B, LINE 3: THIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS LEAD BY HEALTH IMPERATIVES WITH PARTICIPATION FROM COMMUNITY AGENCIES AND SIGNATURE HEALTHCARE WAS A PART OF THAT GROUP. THE NEEDS ASSESSMENT USED A FIVE PRONGED APPROACH TO ADDRESS THE AREAS OF FOCUS AND THEY INCLUDE THE FOLLOWING. FIRST AN EMPLOYEE OF HEALTH IMPERATIVES CONDUCTED COMMUNITY IMPRESSION SESSIONS MAINLY WITH BROCKTON RESIDENTS TO EXAMINE THEIR PERCEPTIONS OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH PROBLEMS IN THAT AREA. SECONDLY, EXISTING DATA WAS ANALYZED TO DETERMINE HOW HEALTH OUTCOMES IN THE CITY OF BROCKTON AND SURROUNDING TOWNS DIFFER FROM THE STATES OVERALL NUMBERS. THIRD, ANONYMOUS SURVEYS WERE GIVEN TO AREA RESIDENTS THROUGH BOXES LOCATED IN AREA TOWNS. FOURTH, A REVIEW OF EXISTING PROGRAMS AND SERVICES IN THE AREA WAS DONE TO DETERMINE GAPS IN SERVICES. LASTLY, KEY INFORMANT INTERVIEW WERE GIVEN TO CHNA TOWNS OTHER THAN BROCKTON TO DISCOVER HOW THE NEEDS OF RESIDENTS IN AREA TOWNS COMPARE TO THE NEEDS OF RESIDENTS INSIDE THE CITY. | BROCKTON HOSPITAL |
| PART V, SECTION B, LINE 4: CARITAS GOOD SAMARITAN HOSPITAL | BROCKTON HOSPITAL |
| PART V, SECTION B, LINE 5C: CHNA ORGANIZATION WEBSITE. | BROCKTON HOSPITAL |
| PART V, SECTION B, LINE 7: THE HEALTH NEEDS ASSESSMENT WAS VERY IN DEPTH. THE HOSPITAL DOES NOT BELIEVE THERE WOULD BE ANY WAY FOR IT TO ADDRESS ALL OF THE NEEDS FOUND IN THIS DOCUMENT. FOR INSTANCE, THERE WERE ISSUES FOUND REGARDING HOUSING AND HOMELESSNESS AND WE DON'T BELIEVE THAT WE PROVIDE A SPECIFIC PROGRAM TO ASSIST THESE TYPES OF PEOPLE, BUT WE ARE SURE IF SOMEONE CAME INTO OUR HOSPITAL AND WAS IN NEED OF SHELTER, THAT OUR SOCIAL WORKERS WOULD TRY TO MAKE ARRANGEMENTS FOR THEM. WE DO PROVIDE GREAT ACCESS TO HEALTH CARE IN THE BROCKTON AREA WITH VARIOUS SITES IN THE CITY THAT PROVIDE PRIMARY AND SPECIALTY CARE, LABORATORY AND RADIOLOGY SERVICES AS WELL AS INTERPRETER SERVICES AT OUR AMBULATORY SITES. AS FOR SAFETY, WE DON'T HAVE MUCH TO DO WITH SAFETY FOR THE CITY , BUT DO PROVIDE SECURITY AT AND AROUND OUR HOSPITAL FACILITY. NEXT WOULD BE SUBSTANCE USE AND BEHAVIORAL HEALTH. THIS IS NOT PART OF OUR COMMUNITY BENEFIT PROGRAM, BUT WE DO HAVE PSYCHIATRY SERVICES ALONG WITH PROGRAMS RELATED TO SUBSTANCE ABUSE WITHIN OUR EMERGENCY DEPARTMENT. NEXT IS MATERNAL AND CHILD HEALTH AND AGAIN IT'S NOT NECESSARILY PART OF OUR COMMUNITY BENEFIT, BUT WE DO HAVE OUR FAIRLY NEW CENTER FOR HEALTHY BEGINNINGS PROGRAM. INDIVIDUALS ARE ABLE TO STOP IN AND RECEIVE A FREE PREGNANCY TEST, IF THEY ARE PREGNANT, OUR HEALTHY BEGINNINGS STAFF WILL WORK WITH THEM TO REGISTER FOR INSURANCE IF NEEDED AND GET THEM SCHEDULED WITH AN OB/GYN PROVIDER. THESE PATIENTS ARE FOLLOWED ALL THROUGH THEIR CARE FROM PRE-NATAL CARE TO DELIVERY AND BEYOND. PRIOR TO DELIVERY, THE PATIENTS ARE ABLE TO MEET WITH SOME OF THE PEDIATRICIANS FROM SIGNATURE HEALTHCARE SO THE IMPORTANCE OF HAVING A PRIMARY CARE FOR THEIR CHILDREN BEFORE DELIVERY IS EXPLAINED AND A RELATIONSHIP IS ESTABLISHED. IN ADDITION, WE ALSO HAVE CHILDBIRTH EDUCATION THAT IS PROVIDED BY ONE OF OUR LABOR AND DELIVERY NURSES. NOT ONLY IS EDUCATION GIVEN PRIOR TO DELIVERY BUT BABY AND ME CLASSES ARE OFFERED AT NO COST AFTER DELIVERY AS WELL AS A BREASTFEEDING SUPPORT GROUP. THE NEXT ISSUE THAT CAME UP WAS WITH STD'S AND HIV, AND ALTHOUGH WE DON'T HAVE A PROGRAM THAT DEALS WITH THESE ISSUES WE DO HAVE OB/GYN'S WHO WOULD HANDLE ISSUES AS WELL AS INFECTIOUS DISEASE PROVIDERS IN BROCKTON AND RANDOLPH. IN SECTION 8 IT MENTIONS RISK BEHAVIORS AND HEALTH SCREENINGS AND THIS IS SOMETHING THAT WE DO ON A REGULAR BASIS. WE AS AN ORGANIZATION PARTICIPATE IN OVER 30 COMMUNITY OUTREACH EVENTS PER YEAR AND MANY OF THEM INCLUDE FREE GLUCOSE, CHOLESTEROL AND BLOOD PRESSURE SCREENINGS. WE HAVE IN THE PAST ALSO PROVIDED VASCULAR SCREENINGS AT NO COST WHICH INCLUDES PAD, AAA AND CAROTID ARTERY SCANS. NOT ONLY THAT, BUT OUR RADIATION THERAPY DEPARTMENT HAS WORKED WITH AN AREA ENT GROUP TO OFFER FREE HEAD & NECK CANCER SCREENINGS AS WELL AS PROSTATE CANCER SCREENINGS WHICH ARE FREE TO THE PUBLIC. THE SECTION ON CHRONIC DISEASE IS WHERE OUR COMMUNITY BENEFIT DOES FALL INTO AS WE'VE BEEN FOCUSING IN FY11 AND FY12 ON DIABETES AND OBESITY AND ISSUES AROUND THESE TWO AREAS WERE IDENTIFIED IN THE NEEDS ASSESSMENT. IT DOES ALSO MENTION ASTHMA AS BEING A CONCERN AND ALTHOUGH IT'S NOT THE COMMUNITY BENEFIT, OUR PEDIATRICS DEPARTMENT DOES PROVIDE FREE EDUCATION AND HOSTS A FREE ASTHMA CAMP EACH FALL. | BROCKTON HOSPITAL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 0 | 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 (20 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| ROBERT S GREENBERG MD | |||||||||||||
| 0 | 272426 | 0 | 0 | 0 | 1715 | 0 | 22000 | 0 | 17297 | 0 | 313438 | 0 | 0 |
| MICHAEL L DERN MD | |||||||||||||
| 0 | 355782 | 0 | 0 | 0 | 0 | 0 | 22000 | 0 | 22061 | 0 | 399843 | 0 | 0 |
| DAVID DRINKWATER MD | |||||||||||||
| 0 | 493975 | 0 | 0 | 0 | 0 | 0 | 14419 | 0 | 16188 | 0 | 524582 | 0 | 0 |
| KEVIN P LEONARD | |||||||||||||
| 247363 | 0 | 0 | 0 | 0 | 0 | 20800 | 0 | 21255 | 0 | 289418 | 0 | 0 | 0 |
| KIM N HOLLON | |||||||||||||
| 224276 | 0 | 0 | 0 | 15331 | 0 | 12321 | 0 | 8867 | 0 | 260795 | 0 | 0 | 0 |
| KIMBERLY WALSH | |||||||||||||
| 213543 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 13567 | 0 | 243610 | 0 | 0 | 0 |
| DEBORAH WILSON | |||||||||||||
| 306598 | 0 | 0 | 0 | 6680 | 0 | 33000 | 0 | 13034 | 0 | 359312 | 0 | 0 | 0 |
| STEPHEN BORGES | |||||||||||||
| 158808 | 0 | 0 | 0 | 0 | 0 | 10400 | 0 | 22546 | 0 | 191754 | 0 | 0 | 0 |
| DAVID J FISHER | |||||||||||||
| 177179 | 0 | 0 | 0 | 0 | 0 | 31300 | 0 | 19891 | 0 | 228370 | 0 | 0 | 0 |
| STELLA A PARRY | |||||||||||||
| 200410 | 0 | 0 | 0 | 0 | 0 | 17938 | 0 | 15999 | 0 | 234347 | 0 | 0 | 0 |
| KIM MCCARTHY-WALSH | |||||||||||||
| 162486 | 0 | 0 | 0 | 0 | 0 | 22000 | 0 | 7102 | 0 | 191588 | 0 | 0 | 0 |
| BEVERLY A CAPECE | |||||||||||||
| 154789 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 22199 | 0 | 193488 | 0 | 0 | 0 |
| KENNETH LUCAS | |||||||||||||
| 149915 | 0 | 0 | 0 | 0 | 0 | 21600 | 0 | 16643 | 0 | 188158 | 0 | 0 | 0 |
| ELAINE GILL | |||||||||||||
| 0 | 0 | 0 | 0 | 186779 | 0 | 0 | 0 | 0 | 0 | 186779 | 0 | 0 | 0 |
| JULIE 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 |
| NORMAN B GOODMAN | |||||||||||||
| 0 | 0 | 0 | 0 | 155772 | 0 | 0 | 0 | 0 | 0 | 155772 | 0 | 0 | 0 |
| EUGENE C WALLACE | |||||||||||||
| 365624 | 0 | 0 | 0 | 112502 | 0 | 18615 | 0 | 13893 | 0 | 510634 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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, LINES 4A-B | THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RESIGNED FROM THE HOSPITAL IN JUNE 2009. PURSUANT TO AN AGREEMENT BETWEEN THE PARTIES, THE FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER RECEIVED CERTAIN SEPARATION PAYMENTS FROM THE HOSPITAL IN CALENDAR YEAR 2010 AND CONTINUED TO RECEIVE PAYMENTS THROUGH 2011. 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, 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 ENDING 9/30/2011. 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. THE SENIOR VICE PRESIDENT OF AMBULATORY SERVICES AND PHYSICIAN SERVICES RESIGNED IN JANUARY 2011, AND HAS A SEVERANCE AGREEMENT WHICH STATES THAT IN THE EVENT OF TERMINATION OF EMPLOYMENT WITHOUT CAUSE, THE SENIOR VICE PRESIDENT WOULD RECEIVE BASE SALARY PLUS CONTINUATION OF BENEFITS FOR NINE MONTHS. DURING THE YEAR ENDED 9/30/2011 THE HOSPITAL MADE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS FOR TWO EMPLOYEES. CONSISTENT WITH REPORTING REQUIREMENTS FOR IRS FORM 990, THE HOSPITAL REPORTS COMPENSATION AND OTHER PAYMENTS TO EMPLOYEES AND FORMER EMPLOYEES ON A CALENDAR YEAR (FORM W-2) BASIS. CONSEQUENTLY, THE FOLLOWING AMOUNTS ARE REPORTED FOR THE FISCAL YEAR ENDING 9/30/2011: DEBORAH WILSON - $16,500 DAVID FISHER - $9,300 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MICHAEL L CONNORS | NamePerson |
| Purpose Of Loan | LOAN RECEIVABLE - SPLIT DOLLAR LIFE INSURANCE POLICY | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $624,000 | OriginalPrincipalAmount |
| Balance Due | 624000 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 624000 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ROBERT D SULLIVAN | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SISTER AND BROTHER-IN-LAW | Relationship |
| Amount Of Transaction | 168934 | AmountOfTransaction |
| Description Of Transaction | THE HOSPITAL PAID FOR MOVING SERVICES AND RECORD STORAGE FEES TO THIS INTERESTED PERSON. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| 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 12C | |
| 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 B, LINE 15 | |
| 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 18 | |
| 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. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -1,600,492. TRANSFERS FROM SIGNATURE HEALTHCARE CORPORATION FOR CAPITAL 174,945. ADJUSTMENT TO MINIMUM PENSION LIABILITY -10,783,625. CHANGE IN INTEREST IN SIGNATURE HEALTHCARE CORPORATION INVESTMENTS -4,847,035. CHANGE IN FAIR VALUE OF SPLIT INTEREST AGREEMENTS -91,402. TOTAL TO FORM 990, PART XI, LINE 5: -17,147,609. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
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 | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SIGNATURE HEALTHCARE CORPORATION | |||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 042103554 | FUNDRAISING | MA | 501(C)(3) | PUBLIC CHARITY | N/A | 0 | |
| BROCKTON HOSPITAL AMBASSADORS CLUB | |||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043160078 | FUNDRAISING | MA | 501(C)(3) | PUBLIC CHARITY | 0 | SIGNATURE HEALTHCARE CORPORATION | |
| SIGNATURE HEALTHCARE MEDICAL GROUP | |||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043306782 | MEDICAL CARE | MA | 501(C)(3) | PUBLIC CHARITY | 0 | SIGNATURE HEALTHCARE CORPORATION | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROCKTON RADIATION ONCOLOGY 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 | 222472997 | EIN |
| Primary Activity | RADIATION ONCOLOGY SERVICES | PrimaryActivity |
| Legal Domicile State | MA | LegalDomicileState |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 1124867 | ShareOfTotalIncome |
| Share Of EOY Assets | 1280400 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|
| BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 042530255 | PHYSICIAN GROUP | MA | C | |||
| BROCKTON PHYSICIAN HOSPITAL ORGANIZATION | ||||||||||
| 680 CENTRE STREET | BROCKTON | MA | 02302 | 043189274 | MEDICAL MANAGEMENT | MA | C | 1842 | 145794 | 0.50000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | 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 | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | 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 |