2011-08-10T15:46:56-05:00 2010-09-30 Feeley & Driscoll PC 200 Portland Street Boston MA 02114 990 2009-10-01 042103554 Signature Healthcare Corporation SIGN 5089417000 680 CENTRE STREET BROCKTON MA 02302 Kim Hollon 5089417000 2011-07-29 1 Alan Garofalo 6177427788 2009 2016-02-24 21:20:13Z Kim Hollon 680 CENTRE STREET BROCKTON MA 02302 5314546 0 X signature-healthcare.org X 1890 MA The maintenance of donor restricted Funds for Brockton Hospital as well as solicitation of contributions on behalf of the Hospital, including the Cancer Walk and Golf Tournament. 18 14 0 162 0 0 295083 236421 0 -1346660 366743 1537117 1764989 485540 2368153 0 0 0 0 291391 277232 453255 277232 453255 208308 1914898 69101687 68135959 31715251 28786629 37386436 39349330 The mission of signature Healthcare is to be the leading community base healthcare delivery system in Southeastern Massachusetts providing the full range of primary care, specialty care, hospital care and related ancillary services on a coordinated basis. Signature Healthcare physicians and Signature Healthcare Brockton Hospital strive to be recognized as the "Providers of Choice" by staff, patients, and the community. 0 0 The maintenance of donor restricted Funds for Brockton Hospital as well as solicitation of contributions on behalf of the Hospital, including the Cancer Walk and Golf Tournament. 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 9 0 1 0 0 0 0 0 0 0 0 0 0 18 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X X kim hollon 5089417000 680 CENTRE STREET brockton MA 023023395 X Timothy J Cruz 1.00 X 0 0 0 Joseph P Drier III 1.00 X 0 0 0 David A Drinkwater MD 1.00 X 0 489446 30964 David P Frenette 1.00 X 0 0 0 Robert S Greenberg MD 1.00 X 0 312867 48102 Dennis P Jones 1.00 X 0 0 0 Allan D Lauer MD 1.00 X 0 0 0 James E Leary 1.00 X 0 0 0 Timothy R Lynch MD 1.00 X 0 266510 16268 Wallace H Peckham III 1.00 X 0 0 0 Patti Roland 1.00 X 0 0 0 Michael J Sullivan 1.00 X 0 0 0 Robert D Sullivan 1.00 X 0 0 0 John J Svagzdys 1.00 X 0 0 0 Eileen D Williams EdD 1.00 X 0 0 0 David R Wolohojian 1.00 X 0 0 0 Mary Waldron 1.00 X 0 0 0 Eugene C Wallace 40.00 X 0 206315 32081 Kevin P Leonard 40.00 X 0 178393 21034 Kim Hollon 40.00 X 0 0 0 Julie G White MD 1.00 X 0 0 0 Norman B Goodman 40.00 X 0 598093 31273 Michael Connors 40.00 X 0 92550 7800 0 2051624 179722 0 1 1 0 0 36042 200379 236421 234261 234261 3753000 2854492 898508 898508 898508 132482 132482 132482 132482 302577 36042 91901 210676 210676 Blue Cross Revenue 900099 655805 655805 655805 2368153 1554313 0 577419 24000 24000 fundraising expenses 291391 291391 administration expenses 137864 137864 453255 0 161864 291391 64678 78254 448000 436000 31106 31828 43933164 3772062 41411125 40161102 16864122 13448523 10282656 13980252 69101687 68135959 122970 97133 31025702 28105920 566579 583576 31715251 28786629 X 34866215 36733870 1065140 1160379 1455081 1455081 37386436 39349330 69101687 68135959 X 0 1 1 X 0 X X 0 0 0 Brockton Hospital Ambassadors club inc 043160078 9 1 1 1 0 signature medical group inc 043306782 9 1 1 1 0 Brockton Hospital Inc 222472297 3 1 1 1 0 3 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3187674 147716 3335390 3404596 250 -217172 3187674 0.00000 0.96000 0.04000 0 0 957454 957454 39101188 1332746 37768442 2984482 2072261 912221 387940 313426 74514 502100 53629 448471 40161102 Mellon Long Term Investments 11269065 F Temporarily restricted investments 724377 F Permanently restricted investments 1455081 F 13448523 due from related party 10332866 Split Dollar Life Insurance Policy 3246000 Debt Issue Costs, net 339141 security deposits 62245 13980252 Deferred Asset Retirement Obligation 583576 583576 2368153 453255 1914898 47996 47996 1962894 4931251 2563098 2563098 2368153 0 2368153 3016519 2563264 2563264 453255 0 453255 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. X X X X X 1 salient health solutions grant writer 0 0 0 15000 bmm & tc event planner 0 0 0 14474 francis edward & cronin inc grant writer 0 0 0 21000 50474 Ring of Champions 43084 2375 40709 996 3798 13048 350 4364 Cancer walk 181809 29588 152221 5094 6265 1795 17679 1 113726 4079 109647 1951 1466 17500 6778 10817 338619 36042 302577 2947 6560 27563 21621 350 32860 91901 210676 1 home for aged men c/o silverstein creedon 71 legion parkway 3rd floor brockton MA 02301 042103796 10000 To help fund the elderly indigent care program. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. 0 0 0 0 1 0 0 0 0 David A Drinkwater MD 0 489446 0 0 0 0 0 14696 0 16268 0 520410 0 0 Robert S Greenberg MD 0 312867 0 0 0 0 0 29054 0 19048 0 360969 0 0 Timothy R Lynch MD 0 266510 0 0 0 0 0 0 0 16268 0 282778 0 0 Eugene C Wallace 0 206315 0 0 0 0 0 22000 0 10081 0 238396 0 0 Kevin P Leonard 0 175393 0 3000 0 0 0 12000 0 9034 0 199427 0 0 Norman B Goodman 0 281731 0 0 0 316362 0 22231 0 9042 0 629366 0 0 Part I, Line 5 The Interim CEO was eligible to receive and was paid incentive compensation as a result of the achievement of certain financial goals for the year. Norman B Goodman Loan receivable (Split Dollar Life Insurance policy) X 3338000 3246000 0 1 1 3246000 Form 990, Part VI, Section B, line 11 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Additionally, the organization's financial statements are available on the public charities website maintained by the Commonwealth of Massachusetts Attorney General. Form 990 was provided to each board member electronically. In addition, a board meeting was convened to review the 990 in advance of the filing date. Form 990, Part VI, Section B, line 12c Questionnaires are circulated on an annual basis and are summarized and presented to the board for review and action. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Additionally, the organization's financial statements are available on the public charities website maintained by the Commonwealth of Massachusetts Attorney General. Schedule L, Part II, Loans to Interested Persons Split Dollar Life Insurance Policy, Loan Receivable - Norman Goodman The 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. 110 Liberty Street Realty Compnay LLC 680 Centre Street Brockton MA 02302 320048951 Realty Company MA 3204000 34120008 Signature Healthcare Corporation Brockton Hospital Ambassadors Club Inc 680 Centre Street Brockton MA 02302 043160078 Fundraising MA 501c(3) 501c(3) Signature Healthcare Corporation Signature Healthcare Medical Group Inc 680 Centre Street Brockton MA 02302 043306782 Medical Care MA 501c(3) 501c(3) Signature Healthcare Corporation Brockton Hospital Inc 680 Centre Street Brockton MA 02302 222472297 Hospital MA 501c(3) 501c(3) Signature Healthcare Corporation Bridgewater Goddard Park Medical Associates 680 Centre Street brockton MA 02302 042530255 Physician Practice MA Signature Healthcare Corporation C 41366000 15222589 1.00000 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 1 0 signature medical group inc I 549000 signature medical group inc P 850 brockton Hospital inc L 96000 brockton Hospital inc N 144236 brockton Hospital inc O 55662 brockton Hospital inc P 1217 brockton Hospital inc Q 300660 bridgewater goddard park medical associates O 2400000 bridgewater goddard park medical associates Q 200000 110 liberty street company llc Q 1333334