TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) JAMES LEARY...................................................................... CHAIRMAN	1.00 ................. 1.00	X	X	0	0	0
(2) JOSEPH DRIER III...................................................................... VICE CHAIRMAN	1.00 ................. 1.00	X	X	0	0	0
(3) KIM N HOLLON...................................................................... PRESIDENT/CEO	40.00 ................. 2.00	X	X	697,581	0	27,891
(4) TIMOTHY CRUZ...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0
(5) MICHAEL L DERN MD...................................................................... TRUSTEE	1.00 ................. 41.00	X		0	506,345	29,758
(6) DAVID DRINKWATER MD...................................................................... VP SPECIALTY CARE	1.00 ................. 41.00	X		0	534,634	29,334
(7) DAVID F ENGELKEMEYER...................................................................... TRUSTEE (START 12/12/17)	1.00 ................. 0.00	X		0	0	0
(8) DAVID FRENETTE...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0
(9) ROBERT S GREENBERG MD...................................................................... TRUSTEE	1.00 ................. 41.00	X		0	303,199	10,360
(10) REV CHERYL HARRIS...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0
(11) STEVEN LANE MD...................................................................... PRES MEDICAL STAFF (START 1/22/18)	1.00 ................. 1.00	X		0	0	0
(12) EUGENE MARROW...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0
(13) CHERYL MCCALLION MD...................................................................... PRES MEDICAL STAFF (END 1/22/2018)	1.00 ................. 0.00	X		0	0	0
(14) FRED NICCOLI...................................................................... CHAIRMAN BH FOUNDATION	1.00 ................. 1.00	X		0	0	0
(15) DAVID M OFFUTT...................................................................... TRUSTEE (START 1/26/17)	1.00 ................. 0.00	X		0	0	0
(16) WALLACE PECKHAM III...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0
(17) PATTI ROLAND...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MICHAEL SULLIVAN........................................................................ TRUSTEE	1.00 .......................1.00	X				0	0
(19) ROBERT SULLIVAN........................................................................ TRUSTEE	1.00 .......................1.00	X				0	0
(20) PATRICIA TORTORELLA........................................................................ TRUSTEE	1.00 .......................1.00	X				0	0
(21) DAVID WOLOHOJIAN........................................................................ TRUSTEE	1.00 .......................1.00	X				0	0
(22) JAMES PAPADAKOS........................................................................ CFO/TREASURER	40.00 .......................2.00		X			360,753	24,119
(23) DAVID J FISHER........................................................................ VP CORPORATE SERVICES	40.00 .......................0.00			X		208,067	21,187
(24) KIMBERLY WALSH........................................................................ SENIOR VP PATIENT SERVICES	40.00 .......................0.00			X		248,801	11,167
(25) STEPHEN BORGES........................................................................ VP OPERATIONS	40.00 .......................0.00			X		228,270	27,185
(26) KAREN E MURPHY........................................................................ VP & GENERAL COUNSEL	40.00 .......................0.00				X	297,449	2,926
(27) MITCHELL SELINGER MD........................................................................ VP POPULATION MEDICINE	40.00 .......................1.00				X	452,353	22,609
(28) JEFFREY C MILLER........................................................................ VP PHILANTHROPY	40.00 .......................0.00				X	224,881	27,754
(29) VERA ADEPALO MD........................................................................ FORMER CHIEF MEDICAL OFFICER	40.00 .......................1.00				X	407,665	5,281
(30) MICHELLE L TAUTKUS........................................................................ PHYSICIAN ASSISTANT	40.00 .......................0.00				X	209,823	15,620

(A) Name and business address	(B) Description of services	(C) Compensation
MATRIX ANESTHESIA 1342 BELMONT ST BROCKTON,MA02302	PHYSICIAN SERVICES	3,942,296
MM BROCKTON CC LLC 50 CHESTNUT ST NEEDHAM,MA02492	CONSTRUCTION/CONTRACTING SERVICES	2,901,057
SECURAMERICA LLC 3399 PEACHTREE RD STE 1000 ATLANTA,GA30326	SECURITY SERVICES	1,422,946
PRATT PEDIATRIC ASSOCIATES 800 WASHINGTON ST BOSTON,MA20111	PHYSICIAN SERVICES	1,196,722
HR CONCEPTS LLC 111 CHARLES ST MANCHESTER,NH03101	THIRD PARTY ADMINISTRATOR	696,634
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 40

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization BROCKTON HOSPITAL INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization BROCKTON HOSPITAL INC		Employer identification number 22-2472997

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization BROCKTON HOSPITAL INC			Employer identification number 22-2472997
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

226,198

Total. Add lines 1c through 1i ....................................................................................................

226,198

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	BROCKTON HOSPITAL PAID A LOBBYING FIRM $57,000 DURING FISCAL YEAR 2018 TO LOBBY ON ITS BEHALF ON VARIOUS FEDERAL AND STATE LEGISLATIVE ISSUES IMPACTING THE ORGANIZATION AND THE HEALTHCARE INDUSTRY AS A WHOLE. AS PART OF THE ORGANIZATION'S MEMBERSHIP IN THE MASSACHUSETTS AND AMERICAN HOSPITALS ASSOCIATION, AMERICA'S ESSENTIAL HOSPITALS AND THE MASSACHUSETTS COUNCIL OF COMMUNITY HOSPITALS $169,198 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT FOR PROFIT ASSOCIATIONS WAS USED FOR LOBBYING. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF BROCKTON HOSPITAL'S ACTIVITIES.

Return Reference

Explanation

PART II-B, LINE 1:

BROCKTON HOSPITAL PAID A LOBBYING FIRM $57,000 DURING FISCAL YEAR 2018 TO LOBBY ON ITS BEHALF ON VARIOUS FEDERAL AND STATE LEGISLATIVE ISSUES IMPACTING THE ORGANIZATION AND THE HEALTHCARE INDUSTRY AS A WHOLE. AS PART OF THE ORGANIZATION'S MEMBERSHIP IN THE MASSACHUSETTS AND AMERICAN HOSPITALS ASSOCIATION, AMERICA'S ESSENTIAL HOSPITALS AND THE MASSACHUSETTS COUNCIL OF COMMUNITY HOSPITALS $169,198 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT FOR PROFIT ASSOCIATIONS WAS USED FOR LOBBYING. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF BROCKTON HOSPITAL'S ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	4,502,193	4,090,994	3,763,490	4,017,169	3,742,703
b	Contributions ...	25,000	0	1,539	82,461	82,000
c	Net investment earnings, gains, and losses	190,715	411,199	325,965	-288,537	192,466
d	Grants or scholarships ...		0	0	0	0
e	Other expenditures for facilities and programs ...		0	0	47,603	0
f	Administrative expenses ....		0	0	0	0
g	End of year balance ......	4,717,908	4,502,193	4,090,994	3,763,490	4,017,169

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

74.000 %

Term endowment SchDMd Bullet

26.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

Yes

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	2,947,951		2,947,951
b	Buildings ....	122,212,797	53,749,857	68,462,940
c	Leasehold improvements	9,596,932	2,030,094	7,566,838
d	Equipment ....	86,534,379	58,639,293	27,895,086
e	Other .....	6,116,732		6,116,732
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				112,989,547

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)ASSETS WHOSE USE IS LIMITED				65,153,317
(2)INVESTMENT IN JOINT VENTURES				695,427
(3)SECURITY DEPOSITS				564,477
(4)MALPRACTICE INSURANCE RESERVES				2,771,077
(5)PRATT PEDI RENT RECEIVABLE LONG TERM				11,936
(6)DUE FROM THIRD PARTY PAYORS				8,972,430
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				78,168,664

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	35,197,167
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	THE HOSPITAL'S ENDOWMENT CONSISTS OF INDIVIDUAL DONOR RESTRICTED ENDOWMENT FUNDS HELD FOR A VARIETY OF PURPOSES AS WELL AS SPLIT INTEREST AGREEMENTS, WHICH HAVE BEEN DESIGNATED FOR ENDOWMENT.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 60500.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	4,146,342	221,724	3,924,618	1.430 %
b	Medicaid (from Worksheet 3, column a) . . . . .	75,788,191	74,955,360	832,831	0.300 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	6,237,315	5,402,687	834,628	0.300 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	86,171,848	80,579,771	5,592,077	2.030 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	147,497		147,497	0.050 %
f	Health professions education (from Worksheet 5) . . .	9,720,153	6,492,512	3,227,641	1.170 %
g	Subsidized health services (from Worksheet 6) . . . .	24,415,335	20,064,768	4,350,567	1.580 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	65,000		65,000	0.020 %
j	Total. Other Benefits . .	34,347,985	26,557,280	7,790,705	2.820 %
k	Total. Add lines 7d and 7j .	120,519,833	107,137,051	13,382,782	4.850 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	1,000	1,000	0 %
2	Economic development	4,988	4,988	0 %
3	Community support	22,416	22,416	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	3,000	3,000	0 %
7	Community health improvement advocacy	27,329	27,329	0.010 %
8	Workforce development	2,300	2,300	0 %
9	Other	29,161	29,161	0.010 %
10	Total	90,194	90,194	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,666,375

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

1,789,362

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

63,020,041

Enter Medicare allowable costs of care relating to payments on line 5.....

68,944,737

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-5,924,696

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Other (describe)
1	SIGNATURE HEALTHCARE BROCKTON HOSPITAL 680 CENTRE STREET BROCKTON,MA02302 WWW.SIGNATURE-HEALTHCARE.ORG/ABOUT/COM 2118	X	X	X	X	PSYCH

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SIGNATURE HEALTHCARE BROCKTON HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SIGNATURE HEALTHCARE BROCKTON HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 605.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	SIGNATURE HEALTHCARE BROCKTON HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	SIGNATURE HEALTHCARE BROCKTON HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SIGNATURE HEALTHCARE BROCKTON HOSPITAL	PART V, SECTION B, LINE 5: SIGNATURE HEALTHCARE IS PART OF THE GREATER BROCKTON HEALTH ALLIANCE WHICH PROVIDED FUNDING TO COMMUNITY CONNECTIONS. COMMUNITY CONNECTIONS HAD A GOAL TO DEVELOP A GRASSROOTS COMMUNITY PLANNING, PARTICIPATION AND ACTION PROCESS AMONG ITS RESIDENTS THAT INFORMS, EDUCATES AND IDENTIFIES STRATEGIC PRIORITIES THAT WILL IMPROVE HEALTH AND QUALITY OF LIFE ISSUES FOR ALL RESIDENTS IN THE BROCKTON AREA. COMMUNITY CONNECTIONS DEVELOPED A CONVERSATION/SURVEY INSTRUMENT TO CONDUCT COMMUNITY QUALITY AND KNOWLEDGE "ONE ON ONES AND NEIGHBORHOOD CIRCLE DISCUSSIONS/CAMPAIGNS THAT INFORMED AND DISCUSSED THE HEALTH PRIORITIES THAT HAD BEEN IDENTIFIED IN PREVIOUS COMMUNITY ASSESSMENTS. THE CONVERSATIONS CREATED INFORMATION SHARING, PEOPLE SPOKE ON HEALTH PRIORITIES FROM THEIR OWN EXPERIENCE, BEGAN STRATEGICALLY THINKING ABOUT COMMUNITY CHANGE AND SOUGHT PEOPLE'S VISIONS FOR THE FUTURE. ALONG WITH THESE COMMUNITY DISCUSSIONS/FOCUS GROUPS, SIGNATURE HEALTHCARE HELD KEY INFORMANT INTERVIEWS WITH INDIVIDUALS FROM VARIOUS SECTORS INCLUDING HEALTHCARE, EDUCATION AND LAW ENFORCEMENT. BY HOLDING THESE INTERVIEWS, THE ORGANIZATION HELPED IDENTIFY MAJOR GAPS IN THE COMMUNITIES AND HOW THESE COULD POSSIBLY BE FILLED.
SIGNATURE HEALTHCARE BROCKTON HOSPITAL	PART V, SECTION B, LINE 6B: THE OLD COLONY YMCA, GREATER BROCKTON HEALTH ALLIANCE, COMMUNITY CONNECTIONS IN PARTNERSHIP WITH STONEHILL COLLEGE CENTER FOR COMMUNITY BASED LEARNING, BROCKTON NEIGHBORHOOD HEALTH CENTER.
PART V, SECTION B, LINE 7A:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/NEEDS-ASSESSMENT-2016-AND-ADDENDUM_1.PDF
PART V, SECTION B, LINE 10A:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/NEEDS-ASSESSMENT-2016-AND-ADDENDUM_1.PDF
PART V, SECTION B, LINE 11:	HOUSING AND HOMELESSNESS: HOUSING 101 IS A WORKSHOP OFFERED AT SIGNATURE HEALTHCARE'S 110 LIBERTY ST. LOCATION IN BROCKTON. THIS WORKSHOP AIMS TO ENSURE PARTICIPANTS ARE RECEIVING ALL OF THE BENEFITS FOR WHICH THEY ARE ELIGIBLE AND WILL APPLY THEM FOR BENEFITS, INCLUDING SNAP (FOOD STAMPS), CASH ASSISTANCE, AND UTILITY DISCOUNTS. ALSO, IF THE INDIVIDUAL IS CURRENTLY EXPERIENCING A HOUSING CRISIS AND/OR NEEDS ANY LANDLORD MEDIATION ONE OF THE ADVOCATES CAN ASSIST AND CONNECT THE INDIVIDUAL WITH RESOURCES IN THEIR COMMUNITY. THIS IS A PARTNERSHIP BETWEEN SIGNATURE HEALTHCARE AND THE MASSACHUSETTS COALITION FOR THE HOMELESS. IN FY 18, 50 OF OUR SIGNATURE HEALTHCARE PATIENTS WERE ABLE TO TAKE ADVANTAGE OF THIS SERVICE. SIGNATURE HEALTHCARE BROCKTON HOSPITAL PARTNERS WITH FATHER BILLS AND MAINSPRING HOUSE JOB DEVELOPERS ALONG WITH OTHER SUPPORTERS INCLUDING BRIDGEWATER STATE UNIVERSITY, DEPARTMENT OF TRANSITIONAL ASSISTANCE, ARBELLA INSURANCE FOUNDATION, STATE STREET, UNITED WAY OF GREATER PLYMOUTH COUNTY AND CITIZENS BANK. WE RECRUIT GRADUATES FROM THE WORK EXPRESS AND WORK READY FAMILY PROGRAM INTO PAYING JOBS WHERE THEY CAN WORK TO BROADEN THEIR SKILLS AND EXPERIENCE VARIOUS HEALTHCARE EMPLOYMENT OPPORTUNITIES. IN MANY CASES, PARTICIPATION IN THIS PROGRAM HELPS REBUILD THEIR LIVES AND PROVIDE FOR THEIR FAMILIES. SIGNATURE HEALTHCARE HAS BEEN SUCCESSFUL WITH HIRING GRADUATES FROM BOTH PROGRAMS INTO VARIOUS PART TIME, PER DIEM AND FULL TIME POSITIONS WITHIN THE HOSPITAL SETTING.HEALTH CARE ACCESS: SIGNATURE HEALTHCARE PROVIDES PHYSICIAN OUTREACH DIRECTLY IN THE COMMUNITIES WHERE SIGNATURE HEALTHCARE CORPORATION PATIENTS RESIDE FOR "ONE ON ONE" INTERACTION. ONE EXAMPLE IS LADIES NIGHT, WHICH WE HOST EACH OCTOBER IN RECOGNITION OF BREAST CANCER AWARENESS MONTH. WE HAVE CLINICIANS FROM SIGNATURE HEALTHCARE COME AND EDUCATE ATTENDEES ON TOPICS SUCH AS THE IMPORTANCE OF PRIMARY CARE, THE NEED FOR ANNUAL OB/GYN VISITS AND SCREENING CRITERIA INCLUDING WHEN TO HAVE MAMMOGRAMS AND COLONOSCOPIES. DURING THIS EVENT WE ALSO HAVE EDUCATION STATIONS WHICH INCLUDE OPPORTUNITIES TO MEET WITH OUR STAFF AND SCHEDULE APPOINTMENTS THAT ATTENDEES MIGHT NEED. WE PROVIDE INTERPRETER SERVICES WHEN NEEDED. SAFETY: DOMESTIC VIOLENCE WAS SEEN AS AN ISSUE IN THE BROCKTON AREA. OUR CLINICIANS HAVE PROVIDED EDUCATION ON HEALTHY RELATIONSHIPS TO AREA COMMUNITY GROUPS. MATERNAL AND CHILD HEALTH - SIGNATURE HEALTHCARE HAS A HEALTHY BEGINNINGS PROGRAM WHICH ASSISTS WOMEN THROUGHOUT THEIR PREGNANCY AND BEYOND. THEY CAN WALK IN AND RECEIVE A FREE PREGNANCY TEST AND IF THEY ARE EXPECTING, ARE SET UP WITH ALL PRE AND POST NATAL CARE. THE PATIENT NAVIGATORS FROM HEALTHY BEGINNINGS ARE TRAINED IN FINANCIAL COUNSELING, SO IF PATIENTS ARE IN NEED OF INSURANCE THEY CAN RECEIVE ASSISTANCE WITH APPLYING FOR HEALTH INSURANCE AS WELL. THIS PROGRAM HAS RELATIONSHIPS WITH A VARIETY OF COMMUNITY RESOURCES, SO IF THE EXPECTANT MOMS ARE IN NEED OF CLOTHING, DIAPERS, CAR SEATS ETC., WE WORK WITH THEM TO ASSIST WITH THESE NEEDS AS WELL. SIGNATURE HEALTHCARE HAS 10 OB/GYN PHYSICIANS WITHIN ALL SIGNATURE MEDICAL GROUP LOCATIONS ALONG WITH 7 PEDIATRICIANS IN BROCKTON AND EASTON. SIGNATURE HEALTHCARE BROCKTON HOSPITAL HAS AN INPATIENT PEDIATRICS DEPT. WHICH IS STAFFED 24/7 BY TUFTS FLOATING HOSPITALISTS. STD HIV/AIDS - REFER TO FAMILY PLANNING FOR EVALUATION AND TREATMENT AND WITH THE POSSIBILITY OF BEING REFERRED TO OUR INFECTIOUS DISEASE PHYSICIAN FOR FURTHER TREATMENT AND FUTURE HEALTH CARE NEEDS.RISKY BEHAVIORS AND HEALTH SCREENINGS: SIGNATURE HEALTHCARE PEDIATRICS OFFICES ARE EVALUATING EDUCATIONAL MATERIALS PROVIDED BY THE BROCKTON AREA PREVENTION COLLABORATIVE. THE DATA SHOWS EDUCATION IS NEEDED PRIOR TO HIGH SCHOOL SO WE'RE LOOKING AT PROVIDING EDUCATIONAL TOOLS TO PATIENTS WHEN THEY COME IN FOR THEIR ANNUAL PHYSICALS STARTING AT AGE 11.SIGNATURE HEALTHCARE CONTINUES TO WORK WITH STAFF FROM THE BROCKTON AREA PREVENTION COLLABORATIVE AND THE PLYMOUTH COUNTY DRUG ABUSE TASK FORCE. THE PLYMOUTH COUNTY DRUG ABUSE TASK FORCE PUBLISHED A PAPER IN 2017 TITLED "WOULD YOU PRESCRIBE YOUR PATIENT HEROIN? PLYMOUTH COUNTY'S RESPONSE TO THE OPIOID CRISIS". DR. DAN MUSE AND LISA HARRINGTON, RN FROM SIGNATURE HEALTHCARE'S EMERGENCY DEPARTMENT BOTH AUTHORED SECTIONS OF THIS PAPER. DR. MUSE PROVIDED THE INTRODUCTION AND FOCUSED ON PRESCRIBING PRACTICES AND RECOMMENDATIONS. LISA FOCUSED HER EFFORTS ON REASONS FOR COLLECTING DATA, LEVEL OF DATA REPORTING AND COMPONENTS OF DATA TO BE COLLECTED. SIGNATURE HEALTHCARE HOSTED "LUNCH AND LEARNS" TO SHARE INFORMATION ON THIS RESEARCH WITH OUR EMPLOYEES. ATTENDEES RECEIVED A BACKGROUND ON THE OPIOID EPIDEMIC, RECOMMENDATIONS ON HOW HEALTHCARE PROFESSIONALS CAN DO THEIR PART IN REVERSING THE CRISIS, AND COMMUNITY-BASED RESOURCES TO ADDRESS SUBSTANCE ABUSE PREVENTION. DAN MUSE, EMERGENCY DEPARTMENT PHYSICIAN FROM SIGNATURE HEALTHCARE AND HILLARY DUBOIS, HIGH POINT TREATMENT CENTER PRESENTED AND ANSWERED QUESTIONS. THESE PRESENTATIONS WERE HELD AT BOTH SIGNATURE HEALTHCARE BROCKTON HOSPITAL AND OUR SIGNATURE MEDICAL GROUP LOCATION AT 110 LIBERTY ST. IN BROCKTON. IN JUNE 2018, SIGNATURE HEALTHCARE HOSTED "HIDDEN IN PLAIN SIGHT," A HANDS ON PRESENTATION DESIGNED TO PREPARE PARENTS ON THE SIGNS AND HIDDEN SIGHTS OF SUBSTANCE USE. THIS WAS AN INTERACTIVE EVENT CENTERED ON A TEENAGER'S "MOCK" BEDROOM, ALLOWING ATTENDEES THE OPPORTUNITY TO EXPLORE AND SEE IF THEY COULD IDENTIFY DRUG PARAPHERNALIA AND HIDING PLACES ALONG WITH OTHER SIGNS INDICATING ALCOHOL OR OTHER DRUG USE BY A TEEN. AS PART OF THE PROGRAM, A PREVENTION SPECIALIST FROM THE BROCKTON AREA PREVENTION COLLABORATIVE ATTENDED TO GUIDE ATTENDEES THROUGH THE BEDROOM AND EXPLAIN VARIOUS SUBSTANCE USE TRENDS, SIGNS AND SYMPTOMS IN AN EFFORT TO BRING AWARENESS AND LOCAL RESOURCE OPTIONS. SIGNATURE HEALTHCARE ALSO OFFERED MULTIPLE TRAININGS TO OUR ASSOCIATES WHERE THE BROCKTON AREA PREVENTION COLLABORATIVE PROVIDED EDUCATION AND ALLOWED STAFF TO REVIEW THE "HIDDEN IN PLAIN SITE" DEMONSTRATION. SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT PHYSICIANS WORK WITH LOCAL POLICE AND FIRE DEPARTMENTS TO PROVIDE TRAINING AND MEDICAL GUIDANCE. POLICE DEPARTMENTS FROM NORFOLK, PLYMOUTH AND BRISTOL COUNTIES WERE TRAINED ON THE PROPER USE OF NASAL NARCAN. THE ED PHYSICIANS ALSO WORKED ON PROJECTS WITH THE NORFOLK, PLYMOUTH AND MIDDLESEX COUNTY DISTRICT ATTORNEY'S OFFICES TO PROVIDE LECTURES TO STUDENTS, PARENTS, TEACHERS AND OTHER HEALTHCARE PROFESSIONALS ON CONCUSSIONS, SPORTS INJURIES AND SUBSTANCE ABUSE. DR. MUSE SERVES AS THE EMS MEDICAL DIRECTOR FOR 14 LOCAL FIRE DEPARTMENTS, AND IS VERY ACTIVE IN OTHER MATTERS RELATED TO SUBSTANCE ABUSE, INCLUDING THE BROCKTON MAYOR'S OPIOID COALITION, INDEPENDENCE ACADEMY, AND PLYMOUTH COUNTY'S SUBSTANCE ABUSE COALITION. WITHIN THE SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT, OVERDOSE PATIENTS RECEIVE NASAL NARCAN, A LIST OF DETOX FACILITIES, AND COUNSELING. THE ED PHYSICIANS ARE ALSO LIMITING THE NUMBER OF NARCOTICS THEY PRESCRIBE TO PATIENTS. THEY WILL NOT FILL LOST PRESCRIPTIONS AND ARE ADVANCING THE USE OF THE STATE'S "PRESCRIPTION MONITORING PROGRAM." SIGNATURE HEALTHCARE CREATED A PAIN AND OPIOID MANAGEMENT COMMITTEE WHO DEVELOPED A CHARTER TO GUIDE OUR PURPOSE AND ENSURE WE ARE MEETING THE REGULATORY REQUIREMENTS OF THE JOINT COMMISSION AS THEY RELATE TO PAIN AND OPIOID MANAGEMENT. WE STARTED BY ENSURING APPROPRIATE PAIN AND OPIOID MANAGEMENT POLICIES WERE DEVELOPED TO MEET THE NEEDS OF OUR PATIENT POPULATIONS. AT THE SAME TIME, WE HAVE BEEN MONITORING THE EFFECTIVENESS OF PATIENT PAIN ASSESSMENTS AND PAIN MANAGEMENT THROUGHOUT THE ORGANIZATION. PART OF OUR EFFORT INCLUDES RAISING AWARENESS OF AVAILABLE SERVICES FOR CONSULTATION AND REFERRAL FOR PATIENTS WITH COMPLEX PAIN MANAGEMENT NEEDS AMONG STAFF AND OUR LICENSED INDEPENDENT PRACTITIONERS. THE COMMITTEE WORKS TO ENSURE EDUCATIONAL RESOURCES AND PROGRAMS ARE AVAILABLE TO IMPROVE PAIN ASSESSMENT, PAIN MANAGEMENT, AND SAFE USE OF OPIOID MEDICATIONS THROUGHOUT THE ORGANIZATION ON AN ONGOING BASIS. IN OUR CONTINUED COMMITMENT TO PROMOTE THE HEALTH OF STUDENT ATHLETES, SIGNATURE HEALTHCARE SUPPORTED THE SPORTSMART SCHOOLS WITH FUNDING IN 2018. THESE FUNDS PROVIDE FUNDING FOR INJURY PREVENTION, EDUCATION AND EQUIPMENT. STAFF FROM SIGNATURE HEALTHCARE'S SPORTSMART PROGRAM OFFERED IN-SERVICES AND A LECTURE SERIES WHICH PROVIDED CONTINUING EDUCATION FOR ATHLETIC TRAINERS AND SCHOOL NURSES. SOME OF THE TOPICS COVERED INCLUDE CONCUSSION MANAGEMENT, SUBSTANCE ABUSE AND THE ROLE OF NALOXONE AND UPPER AND LOWER EXTREMITY INJURY MANAGEMENT.
CHRONIC DISEASE:	ASTHMA - IDENTIFIED THE NEED AND HIRED AN ADDITIONAL FULL TIME PULMONOLOGIST THEREBY EXPANDING THIS SERVICE LINE TO INCREASE PATIENT ACCESS. DIABETES - BASED ON THE FINDINGS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNATURE HEALTHCARE CONTINUED ITS WELLNESS PROGRAM. ELEMENTS INCLUDED FREE EXERCISE CLASSES, FREE HEALTH SCREENINGS, HEALTHY COOKING DEMONSTRATIONS, AND FREE HEALTHY RECIPES. SIGNATURE HEALTHCARE OFFERS FREE YOGA AND ZUMBA CLASSES TO THE COMMUNITY AND EMPLOYEES EVERY TUESDAY AND WEDNESDAY EVENING FROM 5-6PM, TO COMBAT COST AND SAFETY CONCERNS CITED AS REASONS FOR A SEDENTARY COMMUNITY. THESE CLASSES, ATTENDED BY 20-30 PEOPLE WEEKLY, ARE WELL RECEIVED. THE PROGRAM IS IN ITS 8TH YEAR AND CONTINUES TO THRIVE. MASSASOIT COMMUNITY COLLEGE HOSTS THE CLASSES, PROVIDING ADDITIONAL SPACE AND AFFORDING THE OPPORTUNITY FOR COLLEGE FACULTY, STAFF AND STUDENTS TO ATTEND. IN JANUARY 2015, SIGNATURE HEALTHCARE BEGAN WORKING WITH THE LOCAL "BLESSINGS IN A BACKPACK" PROGRAM AFTER A MEETING WITH SCHOOL COMMITTEE MEMBERS AND STAFF OF THE KENNEDY SCHOOL IN BROCKTON. BLESSINGS IN A BACKPACK HAS A HIGH NUMBER OF STUDENTS ON THE FREE AND REDUCED BREAKFAST AND LUNCH PROGRAM AT THE SCHOOL AND WANTED TO ENSURE THESE SAME STUDENTS HAD HEALTHY FOOD FOR WEEKENDS AS WELL. SIGNATURE HEALTHCARE WORKED WITH SODEXO, OUR FOOD SERVICES PROVIDER, TO PUT TOGETHER MEALS FOR THE 60 STUDENTS AT THE KENNEDY SCHOOL. EACH WEEKEND, THESE CHILDREN ARE PROVIDED NUTRITIOUS FOOD TO TAKE HOME SUCH AS SOUPS, FRESH FRUIT AND HEALTHY GRAINS. SIGNATURE HEALTHCARE IS NOW IN ITS THIRD YEAR OF WORKING WITH THIS PROGRAM AND WILL CONTINUE TO HELP EXPAND TO OTHER CHILDREN IN OUR COMMUNITY. ON MANY OCCASIONS THROUGHOUT FISCAL 2018, SIGNATURE HEALTHCARE STAFF MEMBERS OFFERED NUTRITION INFORMATION AND HANDS-ON ACTIVITIES TO THE COMMUNITY. ONE MAJOR EVENT WAS THE "HEALTH & WELLNESS EXPO." THIS EVENT HAD MANY COMPONENTS INCLUDING: FREE SCREENINGS FOR VASCULAR AND METABOLIC DISEASE, A HEALTHY COOKING DEMONSTRATION, HEALTHY RECIPES, AND AN AREA WHERE SIGNATURE AND COMMUNITY PARTNERS HIGHLIGHTED NUTRITION & DIABETES SERVICES. THERE WAS AN EXERCISE AREA WITH KICKBOXING AND ZUMBA FOR ADULTS AND AN OBSTACLE COURSE FOR CHILDREN PROVIDED BY THE EASTON CHILDREN'S MUSEUM. THIS EVENT WAS A GREAT SUCCESS WITH MORE THAN 250 PEOPLE IN ATTENDANCE AND MORE THAN 100 OF THOSE SCREENED. FOR THE SEVENTH YEAR, SIGNATURE HEALTHCARE CONTINUES TO BE PART OF A LARGER COMMUNITY-WIDE "BROCKTON KNOCKS DOWN DIABETES" (BKDD) INITIATIVE; KICKING IT OFF WITH THE HEALTH & WELLNESS EXPO, PROVIDING CLINICIANS WHERE NEEDED, ASSISTING WITH COORDINATION AND STAFFING FOR VARIOUS EVENTS, AND OFFERING CLASSES THROUGHOUT THE WEEK. BKDD IS A WEEKLONG INITIATIVE TO PROVIDE EDUCATION AND AWARENESS AROUND DIABETES. NUMEROUS LOCAL PARTNERS PARTICIPATE IN THIS EVENT INCLUDING THE OLD COLONY YMCA, HARBOR ONE, BROCKTON VNA AND THE AMERICAN DIABETES ASSOCIATION. THIS GROUP WORKED DILIGENTLY ON CREATING PROGRAMMING THE COMMUNITY WOULD FIND BENEFICIAL. ACTIVITIES PLANNED INCLUDED EDUCATIONAL PRESENTATIONS AS WELL AS FITNESS CLASSES.ONCOLOGY:IN OCTOBER 2017, THE SIGNATURE HEALTHCARE CANCER CENTER IN AFFILIATION WITH BETH ISRAEL DEACONESS MEDICAL CENTER AND HARVARD MEDICAL SCHOOL TEACHING HOSPITAL HOSTED "CONVERSATIONS ON CANCER - WHAT YOU NEED TO KNOW ABOUT THE CHANGING LANDSCAPE." THIS EVENT PROVIDED FREE DINNER AND PRICELESS INFORMATION TO COMMUNITY MEMBERS IN ATTENDANCE. THEY LEARNED ABOUT DRAMATIC ADVANCES IN CANCER RESEARCH AND CLINICAL CARE. AN OPPORTUNITY TO JOIN THE CONVERSATION WITH LOCAL EXPERTS FROM THE CANCER CENTER AT BETH ISRAEL DEACONESS MEDICAL CENTER AND THE GREENE CANCER CENTER AT SIGNATURE HEALTHCARE WAS PROVIDED. NONPROFIT ORGANIZATION LOOKING AND FEELING FAB, INC. IS THE FIRST OF ITS KIND IN THE COUNTRY, STAFFED WITH LICENSED AESTHETICIANS WHO ARE ONCOLOGY-TRAINED. THEY OFFER CUSTOMIZED SKIN CARE TREATMENTS TO COMBAT THE SKIN SIDE EFFECTS RESULTING FROM CHEMOTHERAPY, RADIATION, SURGERY AND A MIX OF MEDICATIONS. MODERATE TO SEVERE SKIN REACTIONS RESULTING FROM TREATMENT CAN HAVE A DEVASTATING EFFECT, DECREASING ONE'S QUALITY OF LIFE. LOOKING AND FEELING FAB, INC. BEGAN OFFERING THIS SERVICE TO OUR SIGNATURE HEALTHCARE PATIENTS IN JUNE 2016. THEY TREATED 16 PATIENTS IN FY 18 WHO EXPERIENCED SKIN SIDE EFFECTS FROM CANCER TREATMENT. THE PROGRAM IS FULLY FUNDED BY THE CHRISTINE M. SULLIVAN FOUNDATION AND ALLOWS THE PATIENTS TO TAKE ADVANTAGE OF THE SERVICE AT NO COST. INDIGENT MEDICATION PROGRAM: SIGNATURE HEALTHCARE BROCKTON HOSPITAL'S INDIGENT MEDICATION PROGRAM HAS BEEN IN PLACE FOR MORE THAN 20 YEARS AND STANDS ALONE IN THE COMMUNITY PROVIDING FREE MEDICATIONS TO INPATIENTS, OUTPATIENTS, AND EMERGENCY PATIENTS WHO ARE UNABLE TO PAY FOR THEIR REQUIRED PRESCRIPTION DRUGS. THE HOSPITAL PROVIDES UP TO A 30-DAY SUPPLY OF PRESCRIPTION DRUGS TO ITS MOST NEEDY PATIENTS. IN FY18, THE HOSPITAL PROVIDED 220 FREE MEDICATIONS TO 85 PATIENTS VALUED AT OVER $22,000 AND COLLABORATED WITH LOCAL PHARMACIES FOR FOLLOW-UP CARE AS REQUIRED. IN ADDITION, 341 PRESCRIPTIONS WERE PROVIDED TO 105 PATIENTS VALUED AT APPROXIMATELY $45,000 THROUGH SIGNATURE HEALTHCARE'S PATIENT ADVOCACY FUND. ANOTHER 115 PRESCRIPTIONS WERE PROVIDED TO 41 PATIENTS VALUED AT APPROXIMATELY $18,000 THROUGH AN ELDER GRANT.TRANSPORTATION: THE NEED FOR TRANSPORTATION ASSISTANCE AMONG OUR PATIENTS CONTINUES TO GROW SINCE SIGNATURE HEALTHCARE BEGAN HELPING WITH THIS NEED IN THE LATE 1990'S. PATIENTS WHO ARE HOSPITALIZED OR TREATED IN THE EMERGENCY DEPARTMENT ARE MOST OFTEN TRANSPORTED BY AMBULANCE AND DO NOT HAVE THE PHYSICAL OR FINANCIAL MEANS TO GET HOME WHEN DISCHARGED FROM THE HOSPITAL. AT TIMES, PATIENTS ARE REFERRED FOR POST-HOSPITAL TREATMENT WHICH IT IS NOT MEDICALLY NECESSARY, AND THUS NOT COVERED BY INSURANCE. IN FY 18, SIGNATURE HEALTHCARE COVERED THE COST OF TRANSPORTATION VIA TAXI FOR 790 PATIENTS COSTING $10,089. IN ADDITION, FUNDRAISING FROM EVENTS THROUGHOUT THE YEAR SUPPORTS THE SENATOR THOMAS P. KENNEDY ADVOCACY FUND. IN FY 18, $7,761 WAS USED FROM THIS FUND TO ASSIST OUR PATIENTS WITH TRANSPORTATION NEEDS. SIGNATURE HEALTHCARE RECEIVED COMMUNITY FUNDING DESIGNATED SPECIFICALLY FOR PATIENTS AGED 60 AND OLDER; THE ELDER GRANT, WHICH ALSO ASSISTED 179 PATIENTS THROUGHOUT THE YEAR AT A TOTAL COST OF $3,104. COMMUNITY HEALTH AND WELLNESS PROGRAMS:SIGNATURE HEALTHCARE BROCKTON HOSPITAL CONTINUES TO OFFER THE COMMUNITYA WIDE RANGE OF HEALTH AND WELLNESS PROGRAMS, SCREENINGS AND SPECIALLECTURES AND EVENTS DESIGNED TO PREVENT DISEASE AND PROMOTE HEALTHYLIFESTYLES. FOR EXAMPLE, OUR RELATIONSHIP WITH THE OLD COLONY YMCAHELPED DEVELOP COLLABORATIVE HEALTH AND WELLNESS PROGRAMS THROUGHOUTSOUTHEASTERN MASSACHUSETTS, INCLUDING HEALTH EDUCATION EVENTS ANDSCREENINGS.THE SENIOR CELEBRATION IN MAY 2018 - FIVE HUNDRED AREA SENIORS HEARD NUMEROUS PRESENTATIONS ON A VARIETY OF TOPICS INCLUDING JOINT CARE AND CANCER PREVENTION. SIGNATURE HEALTHCARE STAFF ALSO PROVIDED VASCULAR AND CHOLESTEROL SCREENINGS TO OVER 100 INDIVIDUALS.SIGNATURE HEALTHCARE CONTINUES TO SUPPORT A LOCAL GRASSROOTS PROGRAM, "KIDS ROAD RACES." THIS 30-YEAR-OLD PROGRAM IS LED BY BROCKTON RESIDENT DAVE GORMAN AND HIS WIFE WITH TWO 8-WEEK SESSIONS, ONE IN THE FALL AND ANOTHER IN THE SPRING. CHILDREN COME EACH WEEK AND RUN A 2-MILE ROAD RACE AT DW FIELD PARK. THIS PROGRAM PROMOTES CHILDHOOD PHYSICAL HEALTH AND PROVIDES THEM WITH A SENSE OF ACCOMPLISHMENT AND PRIDE. SIGNATURE HEALTHCARE PROVIDES AN EDUCATIONAL SERIES AT THE EAST BRIDGEWATER AND BROCKTON SENIOR CENTERS EACH MONTH. THESE PRESENTATIONS HAVE BEEN COINED "THE SIGNATURE SERIES AND COVER TOPICS INCLUDING EYE HEALTH, DIABETES EDUCATION, COLON CANCER AWARENESS, JOINT CARE, BREAST CANCER AWARENESS AND ONCOLOGY. WHEN THE HEALTH SERVICE DEPARTMENT WAS ELIMINATED AT MASSASOIT COMMUNITY COLLEGE IN BROCKTON, THE DIRECTOR OF THE WOMEN'S CENTER REACHED OUT TO SIGNATURE HEALTHCARE. SHE FELT THERE WAS A VOID BY ELIMINATING HEALTH EDUCATION TO STUDENTS. SIGNATURE HEALTHCARE STEPPED IN AND WORKS WITH THE WOMEN'S CENTER TO BUILD A CALENDAR EACH YEAR, WHERE EACH MONTH THROUGHOUT THE SEMESTER A DIFFERENT HEALTH TOPIC IS COVERED DURING LUNCH TIME. SUCH TOPICS INCLUDE SUBSTANCE ABUSE, VAPING, NUTRITION, SLEEP, AND STRESS AND A VARIETY OF OTHERS.
HOMEWARD BOUND:	HOMEWARD BOUND, INITIATED IN 2012, ENGAGES NURSING STUDENTS FROM THE BROCKTON HOSPITAL SCHOOL OF NURSING, CURRY COLLEGE AND MASSASOIT COMMUNITY COLLEGE TO VISIT PATIENTS WITH CONGESTIVE HEART FAILURE OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN THEIR HOMES. STUDENTS AND FACULTY ASSESS THE PATIENT'S UNDERSTANDING OF THE TREATMENT PLANS, ENSURE PATIENTS KNOW HOW TO MONITOR THEIR OWN HEALTH, PROVIDE SUPPORT, AND REVIEW THE PROCESS OF DAILY PATIENT TRANSMITTAL OF HEALTH DATA VIA TELEHEALTH IPAD. BOTH THE HEART FAILURE AND COPD TEAMS HAVE AN RN ACCESS COORDINATOR AVAILABLE AT SIGNATURE HEALTHCARE WHO FOLLOWS EACH PATIENT'S PROGRESS AND SERVES AS A RESOURCE TO STUDENTS AND FACULTY. THE PROGRAM CURRENTLY HAS A CAPACITY OF 50 COPD AND 10 CHF PATIENTS. THIS REPLICABLE MODEL HAS SHOWN MARKED REDUCTIONS IN EMERGENCY ROOM VISITS, HOSPITAL ADMISSIONS AND VISITS TO CARDIOLOGISTS AND PRIMARY CARE PROVIDERS. THE CURRENT HOMEWARD BOUND CENSUS IS 57 WITH A COPD READMISSION RATE OF 10%. IN FY 17, THE PROGRAM EXPANDED BY OFFERING "LUNCH EXPRESSON," A UNIQUE PROGRAM FOR PATIENTS ENROLLED IN HOMEWARD BOUND WHERE THEY RECEIVE A WEEKLY MEAL DELIVERY TO THEIR HOMES BY STUDENTS FROM BROCKTON HOSPITAL SCHOOL OF NURSING. MEALS ARE PREPARED AT THE SIGNATURE HEALTHCARE BROCKTON HOSPITAL CAFETERIA AND INCLUDE A FRESH SALAD, TWO SANDWICHES, AND TWO BALANCED ENTRE MEALS WITH A FRUIT/DESSERT OPTION THREE TIMES A WEEK. HEALTHY EATING IS AN IMPORTANT PART OF MAINTAINING YOUR HEALTH AND THE HOMEWARD BOUND PROGRAM IS DEDICATED TO ASSISTING PATIENTS WITH DIETARY NEEDS AND MEETING THEIR GOALS. THIS SERVICE IS CURRENTLY OFFERED TO 27 HOMEWARD BOUND PARTICIPANTS WITH 5 LUNCHES WEEKLY. THIS IS A FREE PROGRAM FOR PARTICIPANTS DUE TO GRANT FUNDING RECEIVED.
PART V, LINE 16A, FAP WEBSITE:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINANCIAL-ASSISTANCE
PART V, LINE 16B, FAP APPLICATION WEBSITE:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINANCIAL-ASSISTANCE
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINANCIAL-ASSISTANCE
PART V, SECTION B, LINE 16H:	THE HOSPITAL, IN COLLABORATION WITH LOCAL NOT FOR PROFIT ORGANIZATIONS SUCH AS THE UNITED WAY AND MASSASOIT COMMUNITY COLLEGE, MAINTAINS COPIES OF ITS ONE PAGE PLAIN LANGUAGE SUMMARY FINANCIAL ASSISTANCE POLICY ON-SITE AT THESE ORGANIZATIONS IN AN EFFORT TO NOTIFY MEMBERS OF ITS COMMUNITIES WHO ARE MOST LIKELY IN NEED OF FINANCIAL ASSISTANCE ABOUT THE AVAILABILITY OF SUCH ASSISTANCE.
PART V, SECTION B, LINE 16J:	WHEN REGISTERING FOR SERVICES OR IF RECEIVING A BILL, THE HOSPITALENCOURAGES PATIENTS TO CONTACT STAFF TO DETERMINE IF THEY AND/OR AFAMILY MEMBER ARE IN NEED OF AND ELIGIBLE FOR FINANCIAL ASSISTANCE. THEHOSPITAL POSTS GENERAL NOTICES AT SERVICE DELIVERY AREAS WHERE THERE ISREGISTRATION OR A CHECK-IN AREA(INCLUDING, BUT NOT LIMITED TO,INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENTS AND AFFILIATED HEALTHCENTER LOCATIONS, CERTIFIED APPLICATION COUNSELORS ("CAC") OFFICES ANDIN GENERAL BUSINESS OFFICE AREAS CUSTOMARILY USED BY PATIENTS THATINFORM PATIENTS ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE ANDHOSPITAL FINANCIAL ASSISTANCE AS WELL AS THE LOCATIONS WITHIN THEHOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENTWITH A CAC.

Schedule H (Form 990) 2019

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7:	COSTS FOR FIGURES USED IN THE LINE 7 TABLE ARE DERIVED USING WORKSHEET 2 FOR 7 A-D, DIRECT COSTS FOR 7E AND 7I, AND THE HOSPITAL'S COST ACCOUNTING SYSTEM FOR 7F-G.
PART II, COMMUNITY BUILDING ACTIVITIES:	SIGNATURE HEALTHCARE COLLABORATES WITH AND SUPPORTS AREA ORGANIZATIONS BOTH FINANCIALLY AND WITH OUR CLINICAL EXPERTISE. WE BELIEVE THAT BY SUPPORTING AND WORKING WITH COMMUNITY PARTNERS, WE ARE ABLE TO MAKE A LARGER IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY.
PART III, LINE 2:	THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE
PART III, LINE 3:	THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE FOR THOSE PATIENTS ELIGIBLE FOR CHARITY CARE
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 FOOTNOTE IS FOUND ON PAGE 32 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	THE HOSPITAL CONTINUES TO SERVE ITS VULNERABLE INDIGENT POPULATION AMIDST RISING COSTS WHILE MANY AREAS OF REIMBURSEMENT CONTINUE TO ERODE. THE CHANGE IN DSH PAYMENT METHODOLOGY, AS ONE SIGNIFICANT EXAMPLE, HAS REDUCED THE HOSPITAL'S DSH PAYMENT BY NEARLY HALF OF WHAT IT WAS UNDER THE FORMER METHODOLOGY. THE HOSPITAL USES THE MEDICARE COST REPORT AS THE COST ACCOUNTING SYSTEM TO CALCULATE ITS MEDICARE COSTS.
PART III, LINE 9B:	THE FOLLOWING PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS AND POLICIES: PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO , MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN (EAEDC), CHILDREN'S MEDICAL SECURITY PLAN (CMSP), IF MAGI INCOME IS EQUAL TO OR LESS THAN 300% OF THE FPL; LOW INCOME PATIENTS AS DETERMINED BY MASSHEALTH AND SAFETY NET, INCLUDING THOSE WITH MAGI HOUSEHOLD INCOME OR MEDICAL HARDSHIP FAMILY COUNTABLE INCOME BETWEEN 150.1% TO 300% OF THE FPL; AND MEDICAL HARDSHIP, SUBJECT TO THE FOLLOWING EXCEPTIONS: (A) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY PATIENT ENROLLED IN THE ABOVE MENTIONED PROGRAMS FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM; (B) THE HOSPITAL MAY ALSO INITIATE BILLING OR COLLECTION FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM (INCLUDING RECEIPT OR VERIFICATION OF SIGNED APPLICATION) THE HOSPITAL SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES; (C) THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED, EXPIRED, OR NOT OTHERWISE IDENTIFIED ON THE STATE ELIGIBILITY VERIFICATION SYSTEM OR MEDICAID MANAGEMENT INFORMATION SYSTEM. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN MASSHEALTH, THE PREMIUM ASSISTANCE PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PLAN, OR MEDICAL HARDSHIP, THE HOSPITAL WILL CEASE COLLECTION ACTIVITY FOR SERVICES (WITH THE EXCEPTION OF ANY COPAYMENTS AND DEDUCTIBLES) PROVIDED PRIOR TO THE BEGINNING OF THEIR ELIGIBILITY. (D) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR SUCH SERVICE(S). HOWEVER, EVEN IN THESE CIRCUMSTANCES, THE HOSPITAL MAY NOT BILL THE PATIENT FOR CLAIMS RELATED TO MEDICAL ERRORS OR CLAIMS DENIED BY THE PATIENT'S PRIMARY INSURER DUE TO AN ADMINISTRATIVE OR BILLING ERROR.
PART VI, LINE 2:	SIGNATURE HEALTHCARE WORKS COLLABORATIVELY WITH THE BROCKTON DEPARTMENT OF PUBLIC HEALTH, THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER AND NUMEROUS COMMUNITY SOCIAL SERVICE AGENCIES TO COORDINATE PUBLIC HEALTH INITIATIVES TO ADDRESS THE NEEDS OF THE AT-RISK POPULATION. SIGNATURE HEALTHCARE FOLLOWS THE GUIDELINES BY PARTICIPATING IN A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. WE USE A FOUR PRONGED APPROACH TO THESE ASSESSMENTS THAT INCLUDES: CONDUCTING KEY INFORMANT INTERVIEWS WITH PEOPLE WHO WORK WITHIN OUR SERVICE AREA TO DETERMINE HOW THE NEEDS OF THE RESIDENTS ARE MET, BY REVIEWING EXISTING PROGRAMS/STRATEGIES AND SERVICES IN THE AREA, BY ANALYZING DATA TO DETERMINE HOW HEALTH OUTCOMES IN THE CITY AND SURROUNDING TOWNS COMPARE TO THE STATE AVERAGE AND LASTLY BY PARTICIPATING IN FOCUS GROUPS TO EXAMINE PERCEPTIONS ON HOW PARTICULAR ISSUES IMPACT THOSE INDIVIDUALS.
PART VI, LINE 3:	FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN-PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE. IN ADDITION, THE HOSPITAL ALSO POSTS GENERAL NOTICES AND MAKES PAPERCOPIES OF THE FAP DOCUMENTS AVAILABLE UPON REQUEST AND WITHOUT CHARGE,BOTH BY MAIL AND AT SERVICE DELIVERY AREAS WHERE THERE IS A REGISTRATIONOR CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO, INPATIENT, OUTPATIENT,EMERGENCY DEPARTMENTS, AND AFFILIATED COMMUNITY HEALTH CENTER LOCATIONS),IN CERTIFIED APPLICATION COUNSELOR ("CAC") OFFICES, AND IN GENERAL BUSINESS OFFICE AREAS THAT ARE CUSTOMARILY USED BY PATIENTS (E.G.,ADMISSIONS AND REGISTRATION AREAS, OR PATIENT FINANCIAL SERVICES OFFICESTHAT ARE ACTIVELY OPEN TO THE PUBLIC). IN ADDITION, THE HOSPITAL POSTSNOTICES IN LOCAL COMMUNITY HEALTH CENTERS, SENIOR AND EDUCATIONFACILITIES. THE GENERAL NOTICE WILL INFORM THE PATIENT ABOUT THEAVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE(INCLUDING MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BYTHE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTHSAFETY NET AND MEDICAL HARDSHIP) AS WELL AS THE LOCATION(S) WITHIN THEHOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITHA CAC. INFORMATION ABOUT APPLYING FOR FINANCIAL ASSISTANCE IS ALSOAVAILABLE ON LINE AT WWW.SIGNATURE-HEALTHCARE.ORG. THE GOAL OF THESENOTICES IS TO ASSIST INDIVIDUALS IN APPLYING FOR COVERAGE WITHIN ONE ORMORE OF THESE PROGRAMS.
PART VI, LINE 4:	SHBH SERVES OVER 100,000 PATIENTS ON AN ANNUAL BASIS. AS A DISPROPORTIONATE SHARE HOSPITAL AND THE HUB AND SOLE HOSPITAL OF SIGNATURE HEALTHCARE, WE PROVIDE A FULL RANGE OF PRIMARY AND SPECIALTY CARE SERVICES FOR ECONOMICALLY DISADVANTAGED AND AT-RISK INDIVIDUALS. THE POVERTY IN OUR SERVICE AREA IS SO SEVERE (72% OF PATIENTS QUALIFY FOR GOVERNMENT INSURANCE) AND RESIDENTS LACK RESOURCES FOR BASIC LIVING EXPENSES. ADD TO THAT THE FEAR OF NAVIGATING A CANCER DIAGNOSIS.TWO OF THE LARGEST COMMUNITIES WE SERVE - BROCKTON AT 35.3% FOLLOWED BY BRIDGEWATER AT 27.8% - HAVE THE HIGHEST PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL AS COMPARED TO 14.8% STATEWIDE. (SOURCE: CITY-DATA.COM 2015).ADDITIONALLY, SHBH SERVES PATIENTS FOR WHOM ENGLISH IS NOT ONLY THEIR SECOND LANGUAGE, 37% OF THEM DESCRIBE SPEAKING IT AS "LESS THAN WELL." (SOURCE: COMMUNITY HEALTH NEEDS ASSESSMENT 2016)OUR SERVICE AREA ALSO INCLUDES LARGE NUMBERS OF IMMIGRANT AND FIRST-GENERATION FAMILIES FROM HAITI AND CAPE VERDE, AMONG OTHERS, FOR WHOM ENGLISH IS A STRUGGLE. MASSACHUSETTS HAS THE HIGHEST CAPE VERDEAN POPULATION - 53,174 - IN THE UNITED STATES. THE MAJORITY - 11,709 - RESIDE IN BROCKTON, MASSACHUSETTS. MASSACHUSETTS IS ALSO A TOP STATE IN THE UNITED STATES FOR HAITIAN POPULATION AT NEARLY 37,000 OF LEGAL RESIDENCE. THE BROCKTON AREA IS, IN FACT, HOME TO THE LARGEST HAITIAN COMMUNITY IN THE UNITED STATES.(SOURCE: CENTER FOR IMMIGRATION STUDIES)WITH EXTENSIVE TRANSLATION SERVICES, A HIGH PERCENTAGE OF STAFF WHO SPEAK MORE THAN ONE LANGUAGE AND A FULL UNDERSTANDING OF THE MULTICULTURAL POPULATION IN OUR COMMUNITIES, SHBH IS UNIQUELY ABLE TO ASSIST PATIENTS AND THEIR FAMILIES THROUGHOUT THE COMMUNITIES WE SERVE. THE IMPORTANCE OF CLEAR COMMUNICATION, SUPPORT AND ACCESS TO QUALITY CARE WHEN FACING A MEDICAL CHALLENGE CANNOT BE OVERSTATED.
PART VI, LINE 6:	BROCKTON HOSPITAL (BH) IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. UNDER THE CONTROL OF ITS PARENT ORGANIZATION, SIGNATURE HEALTHCARE CORPORATION, INC.(SHC) AFFILIATES BH AND SIGNATURE HEALTHCARE MEDICAL GROUP, INC. (SMG) COORDINATE THE PROVISION OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF BROCKTON AND ITS SURROUNDING CITIES AND TOWNS.
PART VI, LINE 7, REPORTS FILED WITH STATES	MA

Schedule H (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1KIM N HOLLON PRESIDENT/CEO	(i) (ii)	604,714 ------------- 0	71,066 ------------- 0	21,801 ------------- 0	0 ------------- 0	27,891 ------------- 0	725,472 ------------- 0	0 ------------- 0
2MICHAEL L DERN MD TRUSTEE	(i) (ii)	0 ------------- 500,945	0 ------------- 0	0 ------------- 5,400	0 ------------- 424	0 ------------- 29,334	0 ------------- 536,103	0 ------------- 0
3DAVID DRINKWATER MD VP SPECIALTY CARE	(i) (ii)	0 ------------- 531,341	0 ------------- 0	0 ------------- 3,293	0 ------------- 0	0 ------------- 29,334	0 ------------- 563,968	0 ------------- 0
4ROBERT S GREENBERG MD TRUSTEE	(i) (ii)	0 ------------- 297,799	0 ------------- 0	0 ------------- 5,400	0 ------------- 196	0 ------------- 10,164	0 ------------- 313,559	0 ------------- 0
5JAMES PAPADAKOS CFO/TREASURER	(i) (ii)	342,475 ------------- 0	0 ------------- 0	18,278 ------------- 0	0 ------------- 0	24,119 ------------- 0	384,872 ------------- 0	0 ------------- 0
6DAVID J FISHER VP CORPORATE SERVICES	(i) (ii)	191,931 ------------- 0	0 ------------- 0	16,136 ------------- 0	0 ------------- 0	21,187 ------------- 0	229,254 ------------- 0	0 ------------- 0
7KIMBERLY WALSH SENIOR VP PATIENT SERVICES	(i) (ii)	229,341 ------------- 0	0 ------------- 0	19,460 ------------- 0	0 ------------- 0	11,167 ------------- 0	259,968 ------------- 0	0 ------------- 0
8STEPHEN BORGES VP OPERATIONS	(i) (ii)	186,342 ------------- 0	29,000 ------------- 0	12,928 ------------- 0	0 ------------- 0	27,185 ------------- 0	255,455 ------------- 0	0 ------------- 0
9KAREN E MURPHY VP & GENERAL COUNSEL	(i) (ii)	274,116 ------------- 0	0 ------------- 0	23,333 ------------- 0	0 ------------- 0	2,926 ------------- 0	300,375 ------------- 0	0 ------------- 0
10MITCHELL SELINGER MD VP POPULATION MEDICINE	(i) (ii)	419,018 ------------- 0	0 ------------- 0	33,335 ------------- 0	0 ------------- 0	22,609 ------------- 0	474,962 ------------- 0	0 ------------- 0
11JEFFREY C MILLER VP PHILANTHROPY	(i) (ii)	182,917 ------------- 0	30,000 ------------- 0	11,964 ------------- 0	0 ------------- 0	27,754 ------------- 0	252,635 ------------- 0	0 ------------- 0
12VERA ADEPALO MD FORMER CHIEF MEDICAL OFFICER	(i) (ii)	364,953 ------------- 0	0 ------------- 0	42,712 ------------- 0	0 ------------- 0	5,281 ------------- 0	412,946 ------------- 0	0 ------------- 0
13MICHELLE L TAUTKUS PHYSICIAN ASSISTANT	(i) (ii)	190,445 ------------- 0	14,975 ------------- 0	4,403 ------------- 0	0 ------------- 0	15,620 ------------- 0	225,443 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	THE STANDING COMMITTEE OF THE BOARD OF TRUSTEES OF THE ORGANIZATION'S PARENT, SIGNATURE HEALTHCARE CORPORATION, SERVES AS THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND IS EMPOWERED TO REVIEW AND APPROVE ALL MATTERS PERTAINING TO COMPENSATION AND SHALL REPORT ALL ACTIONS TAKEN BY IT ON THESE MATTERS TO THE BOARD OF TRUSTEES. ANNUALLY, THE COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM TO PREPARE AN EXECUTIVE COMPENSATION ANALYSIS WHICH INCLUDES A COMPETITIVE ASSESSMENT OF THE TOTAL COMPENSATION PROGRAM FOR THE ORGANIZATION'S EXECUTIVE POSITIONS (CEO, CFO AND VICE PRESIDENTS) FOR REVIEW BY THE COMPENSATION COMMITTEE. THE MINUTES OF THE COMPENSATION COMMITTEE REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE.
PART I, LINE 4A:	A SEVERANCE AGREEMENT WAS ENTERED INTO BETWEEN THE ORGANIZATION AND VERA DEPALO, VP, CMO EFFECTIVE JUNE 2017. THE AGREEMENT PROVIDED FOR 26 WEEKS OF SEVERANCE AT HER CURRENT REGULAR BASE SALARY LESS LEGALLY REQUIRED TAXES AND WITHHOLDINGS. DURING CALENDAR YEAR 2017 THE FORMER CMO RECEIVED $212,940 OF SEVERANCE PAY AS PART OF A SEPARATION OF EMPLOYMENT AGREEMENT.
PART I, LINE 4B:	DURING THE YEAR ENDED 12/31/2017 THE ORGANIZATION MADE 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS FOR ELIGIBLE PLAN PARTICIPANTS. THE PLAN WAS CREATED BY SIGNATURE HEALTHCARE FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR A SELECT GROUP OF EMPLOYED PHYSICIANS UPON MEETING THE ELIGIBILITY REQUIREMENT OF COMPLETING TWO YEARS OF PLAN SERVICE. FOR YEARS IN WHICH THE ORGANIZATION MEETS ITS OPERATIONAL MARGIN GOAL THE ORGANIZATION WILL CONTRIBUTE TO THE PLAN. THE ORGANIZATION MAY CREDIT TO THE ACCOUNT OF EACH PARTICIPANT UP TO 4% OF THE PARTICIPANT'S TOTAL CASH COMPENSATION FOR THE PRIOR PLAN YEAR. PARTICIPANT'S REMAIN PARTICIPANTS IN THE PLAN UNTIL FORFEITURE OR DISTRIBUTION OF HIS/HER ACCOUNT. COMMENCEMENT OF DISTRIBUTIONS BEGIN UPON THE LAPSE OF FORFEITURE RISK AND ARE MADE IN SINGLE LUMP-SUM DISTRIBUTIONS NET OF APPLICABLE FEDERAL AND STATE WITHHOLDING TAXES. NO DISTRIBUTIONS WERE MADE FROM THE PLAN TO ANY LISTED PERSONS DURING THE YEAR.

Schedule J (Form 990) 2019

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
BROCKTON HOSPITAL INC

Employer identification number
22-2472997

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MASSACHUSETTS DEVELOPMENT FINANCE AGENCY(MDFA)	04-3431814	000000000	12-21-2017	50,000,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	50,047,441
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	483,298
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	8,376,978
11 Other spent proceeds .............	38,365,252
12 Other unspent proceeds .............	3,305,211
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.730 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.730 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X
b Exception to rebate? ........		X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
SCHEDULE K, PART I, COLUMN (F):	(A) ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCING AGENCY ("MDFA") (F) DESCRIPTION OF PURPOSE: REFINANCE DEBT ISSUED 9/30/2014 AND FINANCE CONSTRUCTION, RENOVATIONS AND ACQUISITIONS OF CAPITAL EQUIPMENT.

Schedule K (Form 990) 2019

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Return Reference	Explanation
FORM 990, PART III, LINE 1:	SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-BASED TEACHING HOSPITAL SERVING MORE THAN 460,000 RESIDENTS IN MORE THAN 20 SOUTHEASTERN MASSACHUSETTS COMMUNITIES. OUR MISSION IS TO BE THE LEADING COMMUNITY BASED HEALTHCARE DELIVERY SYSTEM IN SOUTHEASTERN MASSACHUSETTS, PROVIDING THE FULL RANGE OF INTEGRATED PRIMARY CARE, SPECIALTY CARE, ACUTE HOSPITAL CARE AND RELATED ANCILLARY HEALTHCARE SERVICES. SIGNATURE HEALTHCARE PHYSICIANS AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL STRIVE TO BE RECOGNIZED AS THE "PROVIDERS OF CHOICE" BY STAFF, PATIENTS AND THE COMMUNITY. SIGNATURE HEALTHCARE IS GUIDED BY THESE PRINCIPLES: - TAKE A LEADERSHIP ROLE IN ASSESSING THE HEALTH CARE NEEDS OF THE METRO SOUTH AREA BY COMMITTING TO A HOSPITAL-COMMUNITY PARTNERSHIP AND BY COLLABORATING WITH OTHER PROVIDERS AND COMMUNITY MEMBERS TO OFFER A BROAD RANGE OF EDUCATION, HEALTH SERVICES AND OTHER ACTIVITIES FOR ALL PATIENTS AND, IN PARTICULAR, THE UNDERSERVED AND DISADVANTAGED POPULATIONS. - DEVELOP NEW SERVICES AND PROGRAMS, AND PARTICIPATE IN ALTERNATIVE DELIVERY AND REGIONAL HEALTH CARE SYSTEMS TO RESPOND TO COMMUNITY NEED AND ENHANCE ACCESS TO CARE. - PARTICIPATE IN THE EDUCATION OF HEALTH CARE PROFESSIONALS TO ENHANCE THE HOSPITAL'S ACCESS TO MEDICAL EXPERTISE AND TO ASSURE THE MOST UP-TO-DATE APPROACHES FOR PROVIDING CARE. - COMMIT TO AN ELECTRONIC MEDICAL RECORD ENVIRONMENT AIMED AT (I) REDUCING MEDICAL ERRORS WITH MORE ACCURATE AND TIMELY INFORMATION FOR PROVIDERS, (II) ENHANCING PHYSICIAN PRODUCTIVITY AND JOB SATISFACTION, (III) RESPONDING TO CONSUMER REQUESTS FOR ELECTRONIC COMMUNICATION. - BE AN EQUITABLE EMPLOYER THAT VALUES AND REWARDS EXCELLENCE IN ITS ASSOCIATES. - MANAGE FINANCES AGGRESSIVELY TO REMAIN COST EFFECTIVE AND FISCALLY SOUND. PART OF SIGNATURE HEALTHCARE BROCKTON HOSPITAL'S COMMUNITY FOCUS, AND INDEED THE VERY CORE OF OUR MISSION, IS TO CARE FOR THOSE IN GREATEST NEED. WE ARE ESPECIALLY PROUD OF OUR DISTINGUISHED, CENTURY-PLUS TRADITION OF REACHING OUT TO ALL PATIENTS IN OUR COMMUNITY, FROM EVERY WALK OF LIFE, REGARDLESS OF THEIR ABILITY TO PAY.
FORM 990, PART III, LINE 4A:	THE HOSPITAL PROVIDES FREE CARE TO THOSE WHO ARE UNABLE TO PAY, SPONSORS FREE HEALTH SCREENINGS, VARIOUS SUPPORT GROUPS AND EDUCATIONAL PROGRAMS, INCLUDING PUBLIC HEALTH EDUCATION, WELLNESS PROGRAMS AND THE TRAINING OF HEALTH PROFESSIONALS SUCH AS FIRST RESPONDER EDUCATION AND TRAINING. DURING THE YEAR ENDED SEPTEMBER 30, 2018 THE HOSPITAL HAD 14,611 TOTAL DISCHARGES AND OBSERVATIONS, 48,527 TOTAL PATIENT DAYS, 9,896 PEDIATRIC CLINIC VISITS AND 84,568 OTHER OUTPATIENT CLINIC VISITS. THE HOSPITAL'S EMERGENCY DEPARTMENT HAD 48,737 VISITS DURING THE FISCAL YEAR AND IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR AND PROVIDES CARE REGARDLESS OF ONE'S ABILITY TO PAY.
FORM 990, PART VI, SECTION A, LINE 2	TIMOTHY CRUZ, DAVID FRENETTE, PATTI ROLAND, ROBERT SULLIVAN, DAVID WOLOHOJIAN, WALLACE PECKHAM, III, JOSEPH DRIER, III, JAMES LEARY, MICHAEL SULLIVAN, PATRICIA TORTORELLA, REV. CHERYL HARRIS, EUGENE MARROW, CHERYL MCCALLION, FRED NICCOLI, ROBERT S. GREENBERG, M.D., DAVID DRINKWATER, M.D., KIM N. HOLLON, MICHAEL L. DERN, M.D., JAMES PAPADAKOS, DAVID ENGELKEMEYER, DAVID OFFUTT, AND STEVEN LANE, M.D. HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS THEY ARE ALSO TRUSTEES OF SIGNATURE HEALTHCARE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 6	SIGNATURE HEALTHCARE CORPORATION, A CHARITABLE ORGANIZATION ORGANIZED UNDER THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS, ACTING THROUGH ITS BOARD OF TRUSTEES, IS THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11B	THE ORGANIZATION'S FORM 990 IS PREPARED BY AN OUTSIDE INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM AND IS PRESENTED TO AND REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER AND COPIES OF FORM 990 ARE PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES SHALL BE SUBMITTED TO THE PRESIDENT OR HIS DESIGNEE BY DECEMBER 1ST, PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR. THE PRESIDENT OR HIS DESIGNEE SHALL, IN WRITING, ADVISE MEMBERS (TRUSTEES, SENIOR MANAGEMENT, DEPARTMENT MANAGERS AND PHYSICIANS) AND INDIVIDUALS ON THE MEDICAL EXECUTIVE COMMITTEE WHO ARE NOT MEMBERS OF THE CONFLICT OF INTEREST POLICY AND REQUEST THAT EACH INDIVIDUAL COMPLETE AND SUBMIT TO THE PRESIDENT OR HIS DESIGNEE, A QUESTIONNAIRE OUTLINING ANY POSSIBLE CONFLICTS OF INTEREST OR INDICATING THAT NO SUCH CONFLICT OF INTEREST EXISTS. THE PRESIDENT OR HIS DESIGNEE SHALL REVIEW ALL CONFLICT OF INTEREST QUESTIONNAIRES AND AT LEAST ANNUALLY DISCLOSE TO THE EXECUTIVE COMMITTEE THE RESULTS OF THE QUESTIONNAIRES. AT LEAST ANNUALLY THE PRESIDENT OR HIS DESIGNEE SHALL REQUEST A COMMITTEE OF THE BOARD TO REVIEW STANDARD RELATIONSHIPS WITH LOCAL BANKS, INSURANCE FIRMS, VENDORS AND OTHER ENTITIES SERVING THE INSTITUTION TO ASSURE THAT THE RELATIONSHIP IS IN THE BEST INTEREST OF THE INSTITUTION AND IS OTHERWISE CONSISTENT WITH THE TERMS OF THE CONFLICT OF INTEREST POLICY. ANY MEMBER HAVING A POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE, USE HIS/HER PERSONAL INFLUENCE OR MAKE AN ADMINISTRATIVE DECISION ON THE MATTER, AND IN THE CASE OF A TRUSTEE, SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE ACTION OF THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A FULL AND ACCURATE DISCLOSURE WAS MADE, THAT THE MEMBER ABSTAINED FROM VOTING OR DECISION MAKING AND THE QUORUM OTHERWISE PRESENT. THE CONFLICT OF INTEREST POLICY SHALL BE REVIEWED ANNUALLY BY THE MEMBERS AND EACH NEW MEMBER SHALL BE ADVISED OF THE POLICY PRIOR TO THE INDIVIDUAL'S SELECTION AS A MEMBER, AND SHALL BE REQUIRED TO FILE WITHIN 30 DAYS THEREAFTER A COMPLETED QUESTIONNAIRE.
FORM 990, PART VI, SECTION B, LINE 15	THE STANDING COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE ORGANIZATION'S PARENT, SIGNATURE HEALTHCARE CORPORATION, SERVES AS THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND IS EMPOWERED TO REVIEW AND APPROVE ALL MATTERS PERTAINING TO COMPENSATION AND SHALL REPORT ALL ACTIONS TAKEN BY IT ON THESE MATTERS TO THE BOARD OF TRUSTEES. ANNUALLY, THE COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM TO PREPARE AN EXECUTIVE COMPENSATION ANALYSIS WHICH INCLUDES A COMPETITIVE ASSESSMENT OF THE TOTAL COMPENSATION PROGRAM FOR THE ORGANIZATION'S EXECUTIVE POSITIONS (CEO, CFO AND VICE PRESIDENTS) FOR REVIEW BY THE COMPENSATION COMMITTEE. THE MINUTES OF THE COMPENSATION COMMITTEE REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 18	FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE LOCATED AT WWW.MASS.GOV .
FORM 990, PART VI, SECTION C, LINE 19	THE ARTICLES OF ORGANIZATION ARE OPEN TO THE PUBLIC ON THE MASSACHUSETTS SECRETARY OF STATE'S WEBSITE AND THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE.
FORM 990, PART XI, LINE 9:	TRANSFER (TO) FROM AFFILIATES -6,386,434. PENSION RELATED CHANGES 10,322,637. CHANGE IN INTEREST IN INVESTMENTS OF SHC 90,485. CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENTS 53,969. NET ASSETS RELEASED FROM RESTRICTION FOR PURCHASE OF PP&E 1,216,000.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BROCKTON HOSPITAL INC

Employer identification number

22-2472997

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SIGNATURE HEALTHCARE CORPORATION INC 680 CENTRE STREET BROCKTON,MA02302 04-2103554	MANAGEMENT AND FUNDRAISING	MA	501(C)(3)	12B	N/A		No
(2)SIGNATURE HEALTHCARE MEDICAL GROUP INC 680 CENTRE STREET BROCKTON,MA02302 04-3306782	PHYSICIAN PRACTICES	MA	501(C)(3)	10	SIGNATURE HEALTHCARE CORPORATION		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES 680 CENTRE STREET BROCKTON,MA02302 04-2530255	PHYSICIAN PRACTICE	MA	N/A	C				No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

Yes

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SIGNATURE HEALTHCARE BROCKTON HOSPITAL IS A COMMUNITY-BASED NOT-FOR-PROFIT (SEE SCHEDULE O) TEACHING HOSPITAL SERVING MORE THAN 460,000 RESIDENTS IN MORE THAN 20 SOUTHEASTERN MASSACHUSETTS COMMUNITIES. THE HOSPITAL HAS 216 LICENSED BEDS AND PROVIDES A FULL RANGE OF CLINICAL SERVICES INCLUDING MEDICAL/SURGICAL, PEDIATRICS, OBSTETRICS, INPATIENT AND OUTPATIENT PSYCHIATRY, RADIATION AND MEDICAL ONCOLOGY, CARDIAC CATHETERIZATION, LEVEL II NURSERY AND MAGNETIC RESONANCE IMAGING. OUR MISSION IS TO BE THE LEADING COMMUNITY BASED HEALTHCARE DELIVERY SYSTEM IN SOUTHEASTERN MASSACHUSETTS, PROVIDING A FULL RANGE OF INTEGRATED PRIMARY CARE, SPECIALTY CARE, HOSPITAL CARE AND RELATED ANCILLARY HEALTHCARE SERVICES. SIGNATURE HEALTHCARE PHYSICIANS AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL STRIVE TO BE RECOGNIZED AS THE "PROVIDERS OF CHOICE" BY STAFF, PATIENTS AND THE COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	2,270
6	Total number of volunteers (estimate if necessary) .............	6	100
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	22,433
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,062,018	264,538
9	Program service revenue (Part VIII, line 2g) .........	270,502,327	276,873,704
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,488,776	10,440,199
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	7,469,349	7,644,939
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	281,522,470	295,223,380
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	160,072,570	167,256,291
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	104,456,059	108,021,563
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	264,528,629	275,277,854
19	Revenue less expenses. Subtract line 18 from line 12.......	16,993,841	19,945,526
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	240,748,890	245,000,101
21	Total liabilities (Part X, line 26).............	170,446,141	156,180,550
22	Net assets or fund balances. Subtract line 21 from line 20.....	70,302,749	88,819,551

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 249,277,618 including grants of $ ) (Revenue $ 283,728,424 )
	BROCKTON HOSPITAL IS AN ACUTE CARE HOSPITAL LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE 216 ACUTE CARE BEDS (COMPOSED OF 131 MEDICAL/SURGICAL, 16 INTENSIVE CARE, 8 PEDIATRIC, 20 OBSTETRIC, 22 PSYCHIATRIC), AND 19 BASSINETS (COMPOSED OF 13 WELL INFANT AND 6 SPECIAL CARE). THE HOSPITAL OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO MEET DIVERSE COMMUNITY NEEDS INCLUDING EMERGENCY CARE, ACUTE CARE (INCLUDING MEDICAL/SURGICAL, OBSTETRICS, PEDIATRIC, PSYCHIATRIC, CARDIAC AND CANCER CARE). (SEE SCHEDULE O)

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses249,277,618

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,335,643	1,344,178	255,191

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	192,032

f	All other contributions, gifts, grants, and similar amounts not included above		1f	72,506

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		264,538

		Business Code
2a	PATIENT SERVICE REV.	900099	258,468,343	258,468,343
b	INTERCOMPANY REVNUE	900099	7,799,760	7,799,760
c	SCHOOL OF NURSING	900099	4,657,484	4,657,484
d	INTERCOMPANY RENT	900099	1,955,520	1,955,520
e	NONPATIENT LAB REVENUE	900099	22,433		22,433
f	All other program service revenue.		3,970,164	3,970,164
g	Total. Add lines 2a–2f .....		276,873,704

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,888,060			1,888,060
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		773,516	6a
b	Less: rental expenses		5,730	6b
c	Rental income or (loss)		767,786	6c
d	Net rental income or (loss).......			767,786			767,786
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	20,000	92,045,372	7a
b	Less: cost or other basis and sales expenses	51,758	83,461,475	7b
c	Gain or (loss)	-31,758	8,583,897	7c
d	Net gain or (loss).........			8,552,139			8,552,139
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	PHARMACY		900099	4,926,998	4,926,998
b	VANTAGE JOINT VENTURE		900099	263,419	263,419
c	SHIELDS JOINT VENTURE		900099	247,792	247,792
d	All other revenue ....			1,438,944	1,438,944
e	Total. Add lines 11a–11d ......			6,877,153
12	Total revenue. See instructions.....			295,223,380	283,728,424	22,433	11,207,985

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,743,472	1,656,298	87,174
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	134,746,083	125,870,563	8,875,520
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,313,093	5,108,009	1,205,084
9	Other employee benefits .......	15,100,794	13,378,793	1,722,001
10	Payroll taxes ...........	9,352,849	8,710,364	642,485
11	Fees for services (non-employees):
a	Management ......	5,047,288	5,047,288
b	Legal .........	305,793	220,171	85,622
c	Accounting ...........	350,200	254,944	95,256
d	Lobbying ...........	226,198	226,198
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
12	Advertising and promotion ....	919,060	704,205	214,855
13	Office expenses .......	3,990,826	3,356,010	634,816
14	Information technology ......	974,089	741,256	232,833
15	Royalties ..
16	Occupancy ...........	7,452,204	5,365,587	2,086,617
17	Travel ............	188,992	150,059	38,933
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	2,770,805	1,994,980	775,825
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	11,311,153	8,144,030	3,167,123
23	Insurance ...	1,364,530	1,164,047	200,483
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PURCHASED SERVICES	17,492,662	14,541,286	2,951,376
b	MEDICAL & SURGICAL SUPP	14,018,941	13,986,478	32,463
c	DRUGS & MEDICATIONS	12,997,033	12,981,204	15,829
d	MD CONTRACTED SERVICES	8,877,815	8,619,111	258,704
e	All other expenses	19,733,974	17,056,737	2,677,237
25	Total functional expenses. Add lines 1 through 24e	275,277,854	249,277,618	26,000,236	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,135	1	2,135
2	Savings and temporary cash investments .........			3,781,071	2	8,218,858
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			34,305,258	4	31,548,383
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			1,127,581	7	1,180,331
8	Inventories for sale or use ............			2,769,870	8	3,127,889
9	Prepaid expenses and deferred charges ......			5,474,392	9	5,035,724
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	227,408,791
b	Less: accumulated depreciation	10b	114,419,244	106,906,507	10c	112,989,547
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			3,523,937	12	3,738,570
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			990,000	14	990,000
15	Other assets. See Part IV, line 11 ...........			81,868,139	15	78,168,664
16	Total assets. Add lines 1 through 15 (must equal line 33)...			240,748,890	16	245,000,101

17	Accounts payable and accrued expenses .....	39,519,417	17	43,748,663
18	Grants payable ...		18
19	Deferred revenue .........	1,522,778	19	4,235,191
20	Tax-exempt bond liabilities .........	38,991,855	20	50,000,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	41,954,135	23	22,999,529
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	48,457,956	25	35,197,167
26	Total liabilities. Add lines 17 through 25..	170,446,141	26	156,180,550

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	70,302,749	32	88,819,551
33	Total liabilities and net assets/fund balances ........	240,748,890	33	245,000,101