FURP.ORG / PUBLIC DATA EXPLORER

SIGNATURE HEALTHCARE CORPORATION: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
SIGNATURE HEALTHCARE CORPORATION (EIN 04-2103554)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-10
IRS object ID
201112239349300701
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-10T15:46:56-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Feeley & Driscoll PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 Portland StreetAddressLine1
CityBostonCity
StateMAState
ZIP Code02114ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042103554EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Signature Healthcare CorporationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSIGNNameControl
Phone5089417000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1680 CENTRE STREETAddressLine1
CityBROCKTONCity
StateMAState
ZIP Code02302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKim HollonName
TitlePresident/CEOTitle
Phone5089417000Phone
Date Signed2011-07-29DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAlan GarofaloName
Phone6177427788Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKim HollonNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1680 CENTRE STREETAddressLine1
CityBROCKTONCity
StateMAState
ZIP Code02302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts5314546GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitesignature-healthcare.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1890YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionThe 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 Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers162TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year295083ContributionsGrantsPriorYear
Contributions Grants Current Year236421ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year-1346660InvestmentIncomePriorYear
Investment Income Current Year366743InvestmentIncomeCurrentYear
Other Revenue Prior Year1537117OtherRevenuePriorYear
Other Revenue Current Year1764989OtherRevenueCurrentYear
Total Revenue Prior Year485540TotalRevenuePriorYear
Total Revenue Current Year2368153TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year291391TotalFundrsngExpCurrentYear
Other Expense Prior Year277232OtherExpensePriorYear
Other Expenses Current Year453255OtherExpensesCurrentYear
Total Expenses Prior Year277232TotalExpensesPriorYear
Total Expenses Current Year453255TotalExpensesCurrentYear
Revenues Less Expenses Prior Year208308RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1914898RevenuesLessExpensesCY
Total Assets BOY69101687TotalAssetsBOY
Total Assets EOY68135959TotalAssetsEOY
Total Liabilities BOY31715251TotalLiabilitiesBOY
Total Liabilities EOY28786629TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37386436NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY39349330NetAssetsOrFundBalancesEOY
Mission DescriptionThe 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionThe 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 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1kim hollonBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5089417000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1680 CENTRE STREETAddressLine1
CitybrocktonCity
StateMAState
ZIP Code023023395ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Timothy J Cruz
Trustee1.00X000
Joseph P Drier III
Trustee1.00X000
David A Drinkwater MD
Trustee1.00X048944630964
David P Frenette
Trustee1.00X000
Robert S Greenberg MD
Trustee1.00X031286748102
Dennis P Jones
Trustee1.00X000
Allan D Lauer MD
Trustee1.00X000
James E Leary
Trustee1.00X000
Timothy R Lynch MD
Trustee1.00X026651016268
Wallace H Peckham III
Trustee1.00X000
Patti Roland
Trustee1.00X000
Michael J Sullivan
Trustee1.00X000
Robert D Sullivan
Trustee1.00X000
John J Svagzdys
Trustee1.00X000
Eileen D Williams EdD
Trustee1.00X000
David R Wolohojian
Trustee1.00X000
Mary Waldron
Trustee1.00X000
Eugene C Wallace
Interim President/CEO40.00020631532081X
Kevin P Leonard
Chief Financial Officer40.00017839321034X
Kim Hollon
CEO/President40.00000X
Julie G White MD
Former Trustee1.00000X
Norman B Goodman
President/CEO40.00059809331273X
Michael Connors
CFO40.000925507800X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2051624TotalReportableCompFrmRltdOrgs
Total Other Compensation179722TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events36042FundraisingEvents
All Other Contributions200379AllOtherContributions
Total Contributions236421TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column234261TotalRevenueColumn
Exclusion$234,261ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real3753000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2854492Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real898508Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column898508TotalRevenueColumn
Related Or Exempt Function Income898508RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities132482Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities132482Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column132482TotalRevenueColumn
Exclusion$132,482ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events302577GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events36042CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses91901FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column210676TotalRevenueColumn
Exclusion$210,676ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionBlue Cross RevenueDescription
Business Code900099BusinessCode
Total Revenue Column655805TotalRevenueColumn
Related Or Exempt Function Income655805RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue655805TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2368153TotalRevenueColumn
Related Or Exempt Function Income1554313RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$577,419ExclusionAmount

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total24000Total
Management And General24000ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalFundraisingFundraisingManagement And GeneralManagementAndGeneral
fundraising expenses291391291391
administration expenses137864137864

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total453255Total
Program Services0ProgramServices
Management And General161864ManagementAndGeneral
Fundraising291391Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY64678BOY
EOY78254EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY448000BOY
EOY436000EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY31106BOY
EOY31828EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis43933164LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3772062LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY41411125BOY
EOY40161102EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY16864122BOY
EOY13448523EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10282656BOY
EOY13980252EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY69101687BOY
EOY68135959EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY122970BOY
EOY97133EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY31025702BOY
EOY28105920EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY566579BOY
EOY583576EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY31715251BOY
EOY28786629EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY34866215BOY
EOY36733870EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1065140BOY
EOY1160379EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1455081BOY
EOY1455081EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37386436BOY
EOY39349330EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY69101687BOY
EOY68135959EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
Brockton Hospital Ambassadors club inc
0431600789111$0
signature medical group inc
0433067829111$0
Brockton Hospital Inc
2224722973111$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs3TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3187674BeginningOfYearBalance
Investment Earnings Or Losses147716InvestmentEarningsOrLosses
End Of Year Balance3335390EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3404596BeginningOfYearBalance
Contributions250Contributions
Investment Earnings Or Losses-217172InvestmentEarningsOrLosses
End Of Year Balance3187674EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.96000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.04000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis957454OtherCostOrOtherBasis
Book Value957454BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis39101188OtherCostOrOtherBasis
Depreciation1332746Depreciation
Book Value37768442BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2984482OtherCostOrOtherBasis
Depreciation2072261Depreciation
Book Value912221BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis387940OtherCostOrOtherBasis
Depreciation313426Depreciation
Book Value74514BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis502100OtherCostOrOtherBasis
Depreciation53629Depreciation
Book Value448471BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings40161102TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Mellon Long Term Investments11269065F
Temporarily restricted investments724377F
Permanently restricted investments1455081F
FieldValueIRS element (for citing)
Total Of Book Value Securities13448523TotalOfBookValueSecurities

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
due from related party10332866
Split Dollar Life Insurance Policy3246000
Debt Issue Costs, net339141
security deposits62245
FieldValueIRS element (for citing)
Total Book Value Other Assets13980252TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDeferred Asset Retirement ObligationDescription
Amount$583,576Amount
FieldValueIRS element (for citing)
Total Of Amounts583576TotalOfAmounts
Total Revenue2368153TotalRevenue
Total Expenses453255TotalExpenses
Excess Or Deficit For Year1914898ExcessOrDeficitForYear
Other$47,996OtherAmount
Total Adjustments47996TotalAdjustments
Excess Or Deficit Per FS1962894ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4931251TotRevenueEtcAuditedFinclStmt
Other Revenues2563098OtherRevenues
Revenue Not Rptd F9902563098RevenueNotRptdF990
Revenue Subtotal2368153RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902368153TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3016519TotExpensesEtcAuditedFinclStmt
Other Expenses Included2563264OtherExpensesIncluded
Expenses Not Rptd F9902563264ExpensesNotRptdF990
Expenses Subtotal453255ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990453255TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds: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.
Part X:Description of Uncertain Tax Positions Under FIN 48: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 gain on unrestricted investments: 99649. unrealized gain on temp restricted investments: 70741. transfer to affiliate: -122394.
Part XII, Line 2d - Other Adjustments:Fundraising Expenses: -291391. Rental expenses: 2854489.
Part XIII, Line 2d - Other Adjustments:Fundraising expenses: -291391. Rental Expenses: 2854489. ambassador's club expenses: 166.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Phone SolicitationsXPhoneSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref Fundraising1AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (3 entries)

ActivityActivityFundraiser Control Of FundsFundraiserControlOfFundsGross ReceiptsGrossReceiptsAmount Retained By ContractorAmountRetainedByContractorNet To OrganizationNetToOrganization
salient health solutions
grant writer00015000
bmm & tc
event planner00014474
francis edward & cronin inc
grant writer00021000
FieldValueIRS element (for citing)
Total Net To Organization50474TotalNetToOrganization

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Ring of ChampionsNameOfEvent1
Gross Receipts Event143084GrossReceiptsEvent1
Charitable Contributions Event12375CharitableContributionsEvent1
Gross Revenue Event140709GrossRevenueEvent1
Cash Prizes Event1996CashPrizesEvent1
Rent Facility Costs Event13798RentFacilityCostsEvent1
Food And Beverage Event113048FoodAndBeverageEvent1
Entertainment Event1350EntertainmentEvent1
Other Direct Expenses Event14364OtherDirectExpensesEvent1
Name Of Event2Cancer walkNameOfEvent2
Gross Receipts Event2181809GrossReceiptsEvent2
Charitable Contributions Event229588CharitableContributionsEvent2
Gross Revenue Event2152221GrossRevenueEvent2
Non Cash Prizes Event25094NonCashPrizesEvent2
Rent Facility Costs Event26265RentFacilityCostsEvent2
Food And Beverage Event21795FoodAndBeverageEvent2
Other Direct Expenses Event217679OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events113726GrossReceiptsOtherEvents
Charitable Contrib Other Events4079CharitableContribOtherEvents
Gross Revenue Other Events109647GrossRevenueOtherEvents
Cash Prizes Other Events1951CashPrizesOtherEvents
Non Cash Prizes Other Events1466NonCashPrizesOtherEvents
Rent Facility Costs Other Events17500RentFacilityCostsOtherEvents
Food And Beverage Other Events6778FoodAndBeverageOtherEvents
Other Direct Expenses Other Events10817OtherDirectExpensesOtherEvents
Gross Receipts Total338619GrossReceiptsTotal
Charitable Contributions Total36042CharitableContributionsTotal
Gross Revenue Total Events302577GrossRevenueTotalEvents
Cash Prizes Total Events2947CashPrizesTotalEvents
Non Cash Prizes Total Events6560NonCashPrizesTotalEvents
Rent Facility Costs Total Events27563RentFacilityCostsTotalEvents
Food And Beverage Total Events21621FoodAndBeverageTotalEvents
Entertainment Total Events350EntertainmentTotalEvents
Other Direct Expenses Total Events32860OtherDirectExpensesTotalEvents
Direct Expense Summary Events91901DirectExpenseSummaryEvents
Net Income Summary210676NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1home for aged menBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1c/o silverstein creedon 71 legionAddressLine1
Address Line2parkway 3rd floorAddressLine2
CitybrocktonCity
StateMAState
ZIP Code02301ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient042103796EINOfRecipient
Amount Of Cash Grant10000AmountOfCashGrant
Purpose Of GrantTo help fund the elderly indigent care program.PurposeOfGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Funds are placed in restricted account to be used for donor intent. Foundation office, in conjunction with the Finance department, oversees the utilization / withdrawal of funds. Foundation office oversees reporting back to granting agency, when necessary.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs1CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
David A Drinkwater MD
04894460000014696016268052041000
Robert S Greenberg MD
03128670000029054019048036096900
Timothy R Lynch MD
0266510000000016268028277800
Eugene C Wallace
02063150000022000010081023839600
Kevin P Leonard
0175393030000001200009034019942700
Norman B Goodman
028173100031636202223109042062936600

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 5ReturnReference
ExplanationThe Interim CEO was eligible to receive and was paid incentive compensation as a result of the achievement of certain financial goals for the year.Explanation

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonNorman B GoodmanNamePerson
Purpose Of LoanLoan receivable (Split Dollar Life Insurance policy)PurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$3,338,000OriginalPrincipalAmount
Balance Due3246000BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due3246000TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11The 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.
Form 990, Part VI, Section B, line 12cQuestionnaires are circulated on an annual basis and are summarized and presented to the board for review and action.
Form 990, Part VI, Section C, line 19The 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.
Schedule L, Part II, Loans to Interested PersonsThe amount reported as a loan represents premiums made over several years, since 1995, pursuant to a split dollar life insurance arrangement intended to provide life insurance or supplemental retirement income to the participant. Premiums paid by the Organization plus accrued interest will be reimbursed from the proceeds of the policy upon either termination of the policy or the death of the participant.Split Dollar Life Insurance Policy, Loan Receivable - Norman Goodman

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1110 Liberty Street Realty Compnay LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1680 Centre StreetAddressLine1
CityBrocktonCity
StateMAState
ZIP Code02302ZIPCode
FieldValueIRS element (for citing)
EIN320048951EIN
Primary ActivitiesRealty CompanyPrimaryActivities
Legal Domicile StateMALegalDomicileState
Total Income3204000TotalIncome
EOY Assets34120008EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Signature Healthcare CorporationBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Brockton Hospital Ambassadors Club Inc
680 Centre StreetBrocktonMA02302043160078FundraisingMA501c(3)501c(3)Signature Healthcare Corporation
Signature Healthcare Medical Group Inc
680 Centre StreetBrocktonMA02302043306782Medical CareMA501c(3)501c(3)Signature Healthcare Corporation
Brockton Hospital Inc
680 Centre StreetBrocktonMA02302222472297HospitalMA501c(3)501c(3)Signature Healthcare Corporation

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Bridgewater Goddard Park Medical AssociatesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1680 Centre StreetAddressLine1
CitybrocktonCity
StateMAState
ZIP Code02302ZIPCode
FieldValueIRS element (for citing)
EIN042530255EIN
Primary ActivityPhysician PracticePrimaryActivity
Legal Domicile StateMALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Signature Healthcare CorporationBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income41366000ShareOfTotalIncome
Share Of EOY Assets15222589ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
signature medical group inc
I549000
signature medical group inc
P850
brockton Hospital inc
L96000
brockton Hospital inc
N144236
brockton Hospital inc
O55662
brockton Hospital inc
P1217
brockton Hospital inc
Q300660
bridgewater goddard park medical associates
O2400000
bridgewater goddard park medical associates
Q200000
110 liberty street company llc
Q1333334