TY 2022 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) ROBERT HAFFEY...................................................................... President/CEO	50.0 ................. 2.0	X	X				688,766	0	42,009
(2) DAVID DRINKWATER MD...................................................................... Physician, Trustee	1.0 ................. 51.0	X					0	623,772	38,287
(3) KAREN E MURPHY...................................................................... SENIOR VP GENERAL COUNSEL	50.0 ................. 2.0				X		418,142	0	24,170
(4) VICTOR A TSVEYBEL...................................................................... RN/ INSTRUCTOR	50.0 ................. 2.0				X		378,150	0	28,034
(5) KIM N HOLLON...................................................................... FORMER PRESIDENT/CEO	0.0 ................. 0.0					X	389,451	0	7,774
(6) KIMBERLY WALSH...................................................................... SR. VP/CHIEF NURSING OFFICER	50.0 ................. 2.0			X			345,721	0	39,098
(7) NICHOLAS SZYMANSKI...................................................................... VP/Chief Information officer	40.0 ................. 2.0				X		296,225	0	25,209
(8) STEPHEN BORGES...................................................................... VP, Financial Operations	50.0 ................. 2.0				X		278,426	0	42,342
(9) JANINE CABRAL...................................................................... RN	50.0 ................. 2.0				X		286,214	0	29,160
(10) DEEPTI SESHADRI MD...................................................................... President, Medical Staff	1.0 ................. 51.0	X					0	280,823	8,644
(11) KEVIN G MURPHY...................................................................... Former Treasurer/CFO	0.0 ................. 0.0					X	200,790	0	26,594
(12) ROBERT S GREENBERG MD...................................................................... DIR./PHYSICIAN (UNTIL 12/22)	1.0 ................. 51.0	X					0	201,519	19,395
(13) JASON RADZEVICH...................................................................... Treasurer/CFO (From 10/22)	50.0 ................. 2.0		X				130,042	0	3,401
(14) MICHAEL L DERN MD...................................................................... TRUSTEE	1.0 ................. 51.0	X					0	124,203	3,666
(15) JOSEPH P DRIER III...................................................................... IMMEDIATE PAST CHAIRMAN	1.0 ................. 1.0	X					0	0	0
(16) DALE ELLENBERG MD...................................................................... Trustee	1.0 ................. 1.0	X					0	0	0
(17) DAVID F ENGELKEMEYER...................................................................... TRUSTEE-AT-LARGE	1.0 ................. 1.0	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)
(18) MARIA S HARRIS........................................................................ TRUSTEE	1.0 .......................1.0	X
(19) JAMES F LEARY........................................................................ TRUSTEE	1.0 .......................1.0	X
(20) SYDNE MARROW........................................................................ TRUSTEE (From 08/23)	1.0 .......................1.0	X
(21) VINCENT MARTURANO........................................................................ Trustee	1.0 .......................1.0	X
(22) LUKE MCCABE........................................................................ TRUSTEE	1.0 .......................1.0	X
(23) CHERYL MCCALLION MD........................................................................ TRUSTEE (FROM 12/22)	1.0 .......................1.0	X
(24) CLARA MIRANDA........................................................................ Trustee	1.0 .......................1.0	X
(25) FRED NICCOLI........................................................................ CHAIRMAN, DEVELOPMENT OFFICE	1.0 .......................1.0	X
(26) DAVID M OFFUTT........................................................................ Vice Chairman	1.0 .......................1.0	X
(27) PATTI ROLAND........................................................................ TRUSTEE	1.0 .......................1.0	X
(28) EDWARD SMITH........................................................................ TRUSTEE (From 12/22)	1.0 .......................1.0	X
(29) MICHAEL J SULLIVAN........................................................................ TRUSTEE	1.0 .......................1.0	X
(30) JOSEPH L TANSEY........................................................................ TRUSTEE	1.0 .......................1.0	X
(31) DAVID R WOLOHOJIAN........................................................................ Chairman	1.0 .......................1.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
MATRIX ANESTHESIA, 1342 BELMONT ST STE 205 BROCKTON,MA02302	PHYSICIAN SERVICES	5,248,091
UNIVERSAL PROTECTION SERVICE LP, PO BOX 828854 PHILADELPHIA,PA19182	SECURITY SERVICES	2,730,839
PRATT PEDIATRIC ASSOCIATES, 800 WASHINGTON ST NEMC BOX 1013 BOSTON,MA02111	PHYSICIAN SERVICES	1,609,880
DOUGLAS A KING LIMITED PARTNERSHIP, 115 MAIN STREET NORTH EASTON,MA02356	REAL ESTATE	778,535
MM BROCKTON SON LLC, 50 CHESTNUT ST NEEDHAM,MA02492	REAL ESTATE	752,952
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 44

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 5 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 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 on 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 5 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 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2022

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2022

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 0.015 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 0.035	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) 2022

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

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) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2022

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) (2022)

Schedule B (Form 990) (2022) 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
RESTRICTED	,	$ RESTRICTED	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) (2022)

Schedule B (Form 990) (2022)

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) (2022)

Schedule B (Form 990) (2022)

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) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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? .......................

Yes

57,000

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

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

Yes

48,097

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

105,097

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
SCHEDULE C, PART II-B, LINE I, LOBBYING ACTIVITIES:	BROCKTON HOSPITAL PAID A LOBBYING FIRM $57,000 DURING FISCAL YEAR 2023 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 AND AMERICA'S ESSENTIAL HOSPITALS ASSOCIATION OF AMERICA $48,097 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT-FOR-PROFIT ASSOCIATIONS WAS USED FOR LOBBYING ACTIVITIES. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF THE ORGANIZATION'S ACTIVITIES.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE I, LOBBYING ACTIVITIES:

BROCKTON HOSPITAL PAID A LOBBYING FIRM $57,000 DURING FISCAL YEAR 2023 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 AND AMERICA'S ESSENTIAL HOSPITALS ASSOCIATION OF AMERICA $48,097 OF THE TOTAL AMOUNT OF DUES PAID TO THESE NOT-FOR-PROFIT ASSOCIATIONS WAS USED FOR LOBBYING ACTIVITIES. LOBBYING ACTIVITIES REPRESENT AN INSUBSTANTIAL PART OF THE ORGANIZATION'S ACTIVITIES.

Schedule C (Form 990) 2021

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

2021

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) 2021

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 ....	4,993,204	5,926,807	4,969,484	4,834,543	4,717,908
b	Contributions ...	50,000
c	Net investment earnings, gains, and losses	519,029	-933,603	957,323	134,941	116,735
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	5,562,233	4,993,204	5,926,807	4,969,484	4,834,643

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

63.830 %

Term endowment SchDMd Bullet

36.170 %

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 .....	3,519,568		3,519,568
b	Buildings ....	148,092,788	69,894,323	78,198,465
c	Leasehold improvements	11,678,175	6,673,702	5,004,473
d	Equipment ....	104,596,198	80,496,474	24,099,724
e	Other .....	30,450,791	5,183,671	25,267,120
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				136,089,350

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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)BOARD-DESIGNATED INVESTMENTS				67,177,738
(2)RIGHT-OF-USE ASSETS				10,676,425
(3)AMOUNTS DUE FROM THIRD-PARTY				7,856,406
(4)ASSETS HELD IN TRUST				4,502,634
(5)OTHER ASSETS				3,995,734
(6)ASSETS HELD AS COLLATERAL				2,049,301
(7)ASSET HELD UNDER SPLIT-INTREST				1,880,531
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				98,138,769

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	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	32,864,451
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) 2021

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

SCHEDULE D, 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, PART X, LINE 2:

THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE HOSPITAL QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. UNDER ASC 740, INCOME TAXES, AN ORGANIZATION MUST RECOGNIZE THE FINANCIAL STATEMENT EFFECTS OF A TAX POSITION TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY. THE CORPORATION DOES NOT BELIEVE IT HAS TAKEN ANY MATERIAL UNCERTAIN TAX POSITIONS; IT HAS NOT RECORDED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2021

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 20a.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2022

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 400 %

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 400 %

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) . . .	5,036,704	905,519	4,131,185	1.300 %
b	Medicaid (from Worksheet 3, column a) . . . . .	87,703,512	45,660,474	42,043,038	13.250 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	9,665,317	7,958,897	1,706,420	0.540 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	102,405,533	54,524,890	47,880,643	15.090 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	221,521		221,521	0.070 %
f	Health professions education (from Worksheet 5) . . .	8,213,425	5,590,241	2,623,184	0.830 %
g	Subsidized health services (from Worksheet 6) . . . .	8,694,806	7,357,564	1,337,242	0.420 %
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 . .	17,194,752	12,947,805	4,246,947	1.340 %
k	Total. Add lines 7d and 7j .	119,600,285	67,472,695	52,127,590	16.430 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

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	5,753	5,753	0 %
3	Community support	11,750	11,750	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	3,000	3,000	0 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	21,503	21,503	0 %

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. ......

4,486,749

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. ......

1,383,685

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).....

34,375,420

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

63,510,280

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

-29,134,860

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) 2022

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 HOSPITA 680 CENTRE STREET BROCKTON,MA02302 HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/	X	X	X	X	PSYCH

Schedule H (Form 990) 2022

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 HOSPITA
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 22

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. ............................

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 18

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) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SIGNATURE HEALTHCARE BROCKTON HOSPITA
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 100%
and FPG family income limit for eligibility for discounted care of 400.%

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) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	SIGNATURE HEALTHCARE BROCKTON HOSPITA
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) 2022

Page 7

Part VFacility Information (continued)

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

	SIGNATURE HEALTHCARE BROCKTON HOSPITA
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) 2022

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
SCHEDULE H, PART V, SECTION B, LINE 5:	THE 2022 SIGNATURE HEALTHCARE COMMUNITY HEALTH NEEDS ASSESSMENT SOLICITED THE INPUT OF A VARIETY OF COMMUNITIES WITHIN ITS SERVICE AREA, WITH A PARTICULAR FOCUS ON INDIVIDUALS AND GROUPS FACING SOCIAL, ENVIRONMENTAL AND FINANCIAL INEQUITIES. SUCH QUALITATIVE INPUT PROVIDED IMPORTANT CONTEXT FOR THE QUANTITATIVE DATA THAT WAS COLLECTED AND ANALYZED. SEVEN FOCUS GROUPS WERE CONDUCTED WITH SIX OF THOSE DONE VIRTUALLY. PARTICIPANTS RANGED SIGNIFICANTLY IN AGE, SOCIO-ECONOMIC STATUS, RESIDENCY, PRIMARY LANGUAGE, RACE AND ETHNICITY. ONE OF THE FOCUS GROUPS WAS CONDUCTED IN COLLABORATION WITH BETH ISRAEL DEACONESS HOSPITAL-MILTON FOR THE COMMUNITY OF RANDOLPH. FEEDBACK FROM FOCUS GROUPS AND KEY INFORMANTS WERE CODED AND PRIORITIZED BASED ON FREQUENCY. EIGHT KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH A VARIETY OF COMMUNITY STAKEHOLDERS.
SCHEDULE H, PART V, SECTION B, LINE 7A:	HTTPS://SIGNATURE-HEALTHCARE.ORG/PDF/SIGNATURE-HEALTHCARE-COMMUNITY-HEALTH NEEDS-ASSESSMENT-2022.PDF
SCHEDULE H, PART V, SECTION B, LINE 10A:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/2019 COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF
SCHEDULE H, PART V, SECTION B, LINE 11:	HOUSING AND HOMELESSNESS: WE TREAT A LARGE POPULATION OF HOMELESS PATIENTS. THEY RECEIVE TREATMENT REGARDLESS OF THEIR RESIDENCY. WE ARE EXPLORING OPPORTUNITIES TO FURTHER SUPPORT THIS POPULATION WITH THEIR HOUSING NEEDS. SIGNATURE HEALTHCARE & FR. BILLS AND MAINSPRING CONTINUE TO PARTNER TO PROVIDE RESPITE FOR HOMELESS PATIENTS BEING DISCHARGED FROM THE HOSPITAL OR RELEASED FROM THE ED. BECAUSE PATIENTS REQUIRE CONTINUED REST TO PROMOTE HEALING, TWO BEDS ARE UTILIZED IN THE SHELTER FOR PATIENTS TO BE ABLE TO "STAY IN" FOR RECUPERATION AND AVOID BEING OUT ON THE STREETS THROUGHOUT THE DAY, POTENTIALLY EXACERBATING THE CONDITION IN WHICH THEY WERE TREATED. IN ADDITION, THIS COLLABORATION EXTENDS TO BROCKTON VNA TO PROVIDE ADDITIONAL HOME CARE SERVICES TO THE PARTICIPANTS INCLUDING NURSING AND PHYSICAL THERAPY. SIGNATURE HEALTHCARE BROCKTON HOSPITAL PARTNERS WITH FATHER BILLS AND MAINSPRING HOUSE JOB DEVELOPERS ALONG WITH OTHER SUPPORTERS OF LOCAL BUSINESSES 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 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 IN HIRING GRADUATES FROM BOTH PROGRAMS INTO VARIOUS PART TIME, PER DIEM AND FULL TIME POSITIONS WITHIN THE HOSPITAL SETTING. HEALTH CARE ACCESS: SIGNATURE HEALTHCARE AIMS TO LINK THOSE WHO FACE BARRIERS TO HEALTHCARE ACCESS OR DISPARITIES IN HEALTH OUTCOMES DUE TO THE SOCIAL DETERMINANTS OF HEALTH TO APPROPRIATE COMMUNITY BASED SERVICES, SCHEDULE APPOINTMENTS WITH PRIMARY AND SPECIALTY CARE PROVIDERS AND OFFER FREE SCREENINGS. SIGNATURE HEALTHCARE ALSO PROVIDES PHYSICIAN OUTREACH DIRECTLY IN THE COMMUNITIES WHERE SIGNATURE HEALTHCARE CORPORATION PATIENTS RESIDE FOR "ONE ON ONE" INTERACTION. IN FY 23, SIGNATURE HEALTHCARE HELD GETTING HEALTHY TOGETHER. THE GOAL OF THIS EVENT WAS TO HAVE WOMEN FROM OUR PRIMARY AND SECONDARY SERVICE AREA COME AND LEARN ABOUT THE IMPORTANCE OF THEIR ANNUAL SCREENINGS, SPEAK DIRECTLY WITH CLINICIANS AND SCHEDULE THEIR ANNUAL SCREENINGS. MANY WOMEN FROM OUR COMMUNITY ATTENDED AND WALKED AWAY WITH A BETTER UNDERSTANDING OF WHEN THEY SHOULD SCHEDULE CERTAIN SCREENINGS AND WHAT THOSE SCREENINGS ENTAIL. THE EVENT OFFERED EDUCATIONAL PRESENTATIONS, TABLES PROVIDING MATERIALS TO THE ATTENDEES AND AN OPPORTUNITY TO SCHEDULE APPOINTMENTS FOR ANNUAL MAMMOGRAMS AND PRIMARY CARE VISITS. STAFF FROM ONCOLOGY, RADIOLOGY, PRIMARY CARE AND INTERPRETER SERVICES PARTICIPATED. SAFETY: DOMESTIC VIOLENCE WAS SEEN AS AN ISSUE IN THE BROCKTON AREA. OUR CLINICIANS HAVE PROVIDED EDUCATION ON HEALTHY RELATIONSHIPS TO AREA COMMUNITY GROUPS. SIGNATURE HEALTHCARE CONTINUES TO WORK CLOSELY WITH AND SUPPORT FAMILY & COMMUNITY RESOURCES, INC., HEALTH IMPERATIVES AND CAPE VERDEAN WOMEN UNITED, ALL OF WHICH PROVIDE DOMESTIC VIOLENCE SUPPORT TO THOSE LIVING IN OUR COMMUNITY. MATERNAL AND CHILD HEALTH: SIGNATURE HEALTHCARE HAS 10 OB/GYN PHYSICIANS WITHIN ALL SIGNATURE MEDICAL GROUP LOCATIONS ALONG WITH 7 PEDIATRICIANS IN BROCKTON, EASTON, AND RANDOLPH. SIGNATURE HEALTHCARE BROCKTON HOSPITAL HAS AN INPATIENT PEDIATRICS DEPT. WHICH IS STAFFED 24/7 BY TUFTS FLOATING HOSPITALISTS. SIGNATURE HEALTHCARE IS A "BABY FRIENDLY DESIGNATED HOSPITALSTRIVES TO SUPPORT MOTHERS TO BREASTFEED BABIES FOR THE BEST START IN LIFE. SIGNATURE HEALTHCARE WROTE A BREASTFEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTHCARE STAFF AND PROVIDES EDUCATION AND INFORMATION TO ALL EXPECTING MOTHERS ON THE BENEFITS OF BREASTFEEDING. MATERNITY STAFF HELP MOTHERS INITIATE BREASTFEEDING WITHIN ONE HOUR OF BIRTH AND CONTINUE TO SHOW MOTHERS HOW TO BREASTFEED AND MAINTAIN LACTATION EVEN IF THEY ARE SEPARATED FROM THEIR INFANTS. SIGNATURE HEALTHCARE OFFERS BABE-E-NEWS A FREE; OPT-IN, ELECTRONIC NEWSLETTER PROVIDING EDUCATION, TOOLS AND RESOURCES FOR PREGNANCY INTO EARLY CHILDHOOD. THE INFORMATION IS TAILORED TO A MOTHER' S DUE DATE OR CHILD 'S BIRTH DATE, MAKING THE WEEKLY INFORMATION RELEVANT AND USEFUL. THIS NEWSLETTER CAN ALSO BE SHARED WITH ANY NUMBER OF FAMILY MEMBERS WHO CAN SELECT TO READ THE NEWSLETTER IN MULTIPLE LANGUAGES. COMMUNICATING TO PATIENTS IN THEIR NATIVE LANGUAGE HELPS TO PROMOTE COMPLIANCE AND UNDERSTANDING OF THEIR PERSONAL HEALTHCARE. IN FY 20, SIGNATURE HEALTHCARE PARTNERED WITH YOMINGO, AN ONLINE CHILDBIRTH EDUCATION PROGRAM. BY WORKING WITH YOMINGO, SIGNATURE HEALTHCARE WAS ABLE TO HELP OUR PATIENTS ELIMINATE THE HURDLE OF FITTING IN-PERSON CHILDBIRTH CLASSES INTO THEIR SCHEDULE AND PRACTICE SOCIAL DISTANCING AND INSTEAD BRINGS CLASSES TO THEM. THIS IS A FREE PROGRAM FOR OUR PATIENTS AND IS AVAILABLE IN 14 LANGUAGES. YOMINGO'S EVIDENCE-BASED ONLINE MATERNITY EDUCATION INCLUDES EDUCATION ON LABOR AND BIRTH AND TOPICS SUCH AS BREASTFEEDING, NEWBORN CARE, COMMUNITY HEALTH RESOURCES, SUPPORT GROUPS AMONGST VARIOUS OTHER TOOLS. 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 CONTINUES TO WORK WITH STAFF FROM HIGH POINT, THE BROCKTON AREA PREVENTION COLLABORATIVE AND THE PLYMOUTH COUNTY DRUG ABUSE TASK FORCE. SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT PHYSICIANS WORK WITH LOCAL POLICE AND FIRE DEPARTMENTS PROVIDING TRAINING AND MEDICAL GUIDANCE. POLICE DEPARTMENTS FROM NORFOLK and PLYMOUTH COUNTIES WERE TRAINED ON THE PROPER USE OF NASAL NARCAN. THE ED PHYSICIANS ALSO WORKED ON PROJECTS TO PROVIDE LECTURES TO STUDENTS, PARENTS TEACHERS AND OTHER HEALTHCARE PROFESSIONALS ON SUBSTANCE USE AND OTHER HEALTH CONCERNS FACING OUR AREA YOUTH. DR. MUSE SERVES AS THE EMS MEDICAL DIRECTOR FOR 14 LOCAL FIRE DEPARTMENTS, AND IS VERY ACTIVE IN OTHER MATTERS RELATED TO SUBSTANCE USE, INCLUDING THE BROCKTON MAYOR'S OPIOID COALITION INDEPENDENCE ACADEMY, AND PLYMOUTH COUNTIES SUBSTANCE ABUSE COALITION. DR. DAN MUSE, SIGNATURE HEALTHCARE ED PHYSICIAN, OF COORDINATES TEACHING ROUNDS WITH LOCAL EMS TEAMS. THESE INCLUDE EDUCATION ON VARIOUS TOPICS INCLUDING, HUMAN TRAFFICKING: LEGAL AND SOCIAL RAMIFICATIONS, DOMESTIC ABUSE, ADVERSE CHILDHOOD EVENTS, PEDIATRIC TRAUMA CARE AND NEWBORN CARE IN-FIELD DELIVERY, TO NAME A FEW. SIGNATURE HEALTHCARE AND DR. DAN MUSE HAVE ESTABLISHED A VERY CLOSE RELATIONSHIP WITH THE CITY OF BROCKTON. DR. MUSE IS THE MEDICAL DIRECTOR FOR BROCKTON POLICE AND FIRE. HE ALSO SERVES AS THE MEDICAL DIRECTOR FOR THE BROCKTON FIRE DEPARTMENT DISPATCH. HE ALSO WORKS CLOSELY WITH LOCAL POLICE AND FIRE ON SPECIAL PROGRAMS IN THEIR DEPARTMENTS AND TOWNS. 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 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'RE 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 IN AN ONGOING BASIS. EACH YEAR, DR. MUSE, IN CONJUNCTION WITH THE DISTRICT ATTORNEY'S OFFICES, TALKS TO SCHOOLS AND LOCAL GROUPS ABOUT SUBSTANCE ABUSE. DR. MUSE CONTINUES TO TEACH NURSES AND ATHLETIC TRAINERS HOW TO RECOGNIZE AN OPIOID OVERDOSE AND USE NALOXONE. SIGNATURE HEALTHCARE OBAT STAFF PARTICIPATES IN A WEEKLY MEETING OF THE "BROCKTON HUB" WHICH IS CONNECTED TO PLYMOUTH COUNTY OUTREACH. THE HUB IS DESIGNED TO IDENTIFY INDIVIDUALS AND FAMILIES IN THE GREATER BROCKTON AREA WHO ARE FOUND TO BE AT ELEVATED RISK OF HARM DUE TO HOMELESSNESS, FOOD INSECURITY, MENTAL ILLNESS, SUBSTANCE USE, DOMESTIC VIOLENCE, ETC. AGAIN, MANY AGENCIES INCLUDING POLICE DEPARTMENTS, COLLABORATE AND CONNECT VULNERABLE POPULATIONS TO THE SUPPORT SERVICES THEY NEED. CHRONIC DISEASE: BASED ON THE FINDINGS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT SIGNATURE HEA
SCHEDULE H, PART V, LINE 16A, FAP WEBSITE:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT FORMS/FINANCIAL-ASSISTANCE
SCHEDULE H, PART V, LINE 16B, FAP APPLICATION WEBSITE:	HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT-FORMS/FINAN CIAL-ASSISTANCE
SCHEDULE H, PART V, LINE 16C, FAP PLAN LANGUAGE SUMMARY WEBSITE:	HTTPS://WWW. SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT- FORMS/FINANCIAL-ASSISTANCE
SCHEDULE H, 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.
SCHEDULE H, PART V, SECTION B, LINE 16J:	WHEN REGISTERING FOR SERVICES OR IF RECEIVING A BILL, THE HOSPITAL ENCOURAGES PATIENTS TO CONTACT STAFF TO DETERMINE IF THEY AND/OR A FAMILY MEMBER ARE IN NEED OF AND ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL POSTS GENERAL NOTICES AT SERVICE DELIVERY AREAS WHERE THERE IS REGISTRATION OR A CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENTS AND AFFILIATED HEALTH CENTER LOCATIONS, CERTIFIED APPLICATION COUNSELORS ("CAC") OFFICES AND IN GENERAL BUSINESS OFFICE AREAS CUSTOMARILY USED BY PATIENTS THAT INFORM PATIENTS ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE AS WELL AS THE LOCATIONS WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC.

Schedule H (Form 990) 2022

Page 9

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) 2022

Page 10

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
SCHEDULE H, PART I, LINE 6A:	THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE AT https://www.signature-healthcare.org/about/community-benefits.
SCHEDULE H, 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.
SCHEDULE H, 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.
SCHEDULE H, 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.
SCHEDULE H, 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.
SCHEDULE H, 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. THIS FOOTNOTE IS FOUND ON PAGE 36 OF THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, 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.
SCHEDULE H, 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.
SCHEDULE H, 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 MULTI 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 COMPARED TO THE STATE AVERAGE AND LASTLY BY PARTICIPATING IN FOCUS GROUPS TO EXAMINE PERCEPTIONS ON HOW PARTICULAR ISSUES IMPACT THOSE INDIVIDUALS.
SCHEDULE H, 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 PAPER COPIES OF THE FAP DOCUMENTS AVAILABLE UPON REQUEST AND WITHOUT CHARGE BOTH BY MAIL AND AT SERVICE DELIVERY AREAS WHERE THERE IS A REGISTRATION OR 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 OFFICES THAT ARE ACTIVELY OPEN TO THE PUBLIC). IN ADDITION, THE HOSPITAL POSTS NOTICES IN LOCAL COMMUNITY HEALTH CENTERS, SENIOR AND EDUCATION FACILITIES. THE GENERAL NOTICE WILL INFORM THE PATIENT ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE (INCLUDING MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET AND MEDICAL HARDSHIP) AS WELL AS THE LOCATION (S) WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC. INFORMATION ABOUT APPLYING FOR FINANCIAL ASSISTANCE IS ALSO AVAILABLE ONLINE AT WWW.SIGNATURE-HEALTHCARE.ORG. THE GOAL OF THESE NOTICES IS TO ASSIST INDIVIDUALS IN APPLYING FOR COVERAGE WITHIN ONE OR MORE OF THESE PROGRAMS.
SCHEDULE H, 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. 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.
SCHEDULE H, 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.
SCHEDULE H, PART VI, LINE 7, LIST OF STATES REC. COMMUNITY BENEFIT REPORT:	MA

Schedule H (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

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

2022

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? .............

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

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) 2022

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1ROBERT HAFFEY President/CEO	(i) (ii)	591,266 ------------- 0	50,000 ------------- 0	47,500 ------------- 0	3,000 ------------- 0	39,009 ------------- 0	730,775 ------------- 0	0 ------------- 0
2DAVID DRINKWATER MD Physician, Trustee	(i) (ii)	0 ------------- 577,215	0 ------------- 0	0 ------------- 46,557	0 ------------- 6,100	0 ------------- 32,187	0 ------------- 662,059	0 ------------- 0
3ROBERT S GREENBERG MD DIR./PHYSICIAN (UNTIL 12/22)	(i) (ii)	0 ------------- 182,755	0 ------------- 0	0 ------------- 18,764	0 ------------- 4,170	0 ------------- 15,225	0 ------------- 220,914	0 ------------- 0
4DEEPTI SESHADRI MD President, Medical Staff	(i) (ii)	0 ------------- 260,323	0 ------------- 0	0 ------------- 20,500	0 ------------- 8,578	0 ------------- 66	0 ------------- 289,467	0 ------------- 0
5STEPHEN BORGES VP, Financial Operations	(i) (ii)	230,856 ------------- 0	0 ------------- 0	47,570 ------------- 0	15,628 ------------- 0	26,714 ------------- 0	320,768 ------------- 0	0 ------------- 0
6KIMBERLY WALSH SR. VP/CHIEF NURSING OFFICER	(i) (ii)	298,211 ------------- 0	0 ------------- 0	47,510 ------------- 0	22,875 ------------- 0	16,223 ------------- 0	384,819 ------------- 0	0 ------------- 0
7KAREN E MURPHY SENIOR VP GENERAL COUNSEL	(i) (ii)	370,642 ------------- 0	0 ------------- 0	47,500 ------------- 0	18,300 ------------- 0	5,870 ------------- 0	442,312 ------------- 0	0 ------------- 0
8JANINE CABRAL RN	(i) (ii)	265,714 ------------- 0	0 ------------- 0	20,500 ------------- 0	5,238 ------------- 0	23,922 ------------- 0	315,374 ------------- 0	0 ------------- 0
9VICTOR A TSVEYBEL RN/ INSTRUCTOR	(i) (ii)	357,640 ------------- 0	0 ------------- 0	20,510 ------------- 0	6,506 ------------- 0	21,528 ------------- 0	406,184 ------------- 0	0 ------------- 0
10NICHOLAS SZYMANSKI VP/Chief Information officer	(i) (ii)	279,957 ------------- 0	0 ------------- 0	16,268 ------------- 0	11,934 ------------- 0	13,275 ------------- 0	321,434 ------------- 0	0 ------------- 0
11KIM N HOLLON FORMER PRESIDENT/CEO	(i) (ii)	102,280 -------------	0 -------------	287,171 -------------	5,531 -------------	2,243 -------------	397,225 -------------	0 -------------
12KEVIN G MURPHY Former Treasurer/CFO	(i) (ii)	159,690 -------------	0 -------------	41,100 -------------	12,360 -------------	14,234 -------------	227,384 -------------	0 -------------

Schedule J (Form 990) 2022

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
SCHEDULE J, PART I, LINE 3:	THE ORGANIZATION'S BOARD OF TRUSTEES STANDING COMPENSATION COMMITTEE IS EMPOWERED BY THE BOARD OF TRUSTEES 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. THE COMPENSATION COMMITTEE SHALL REVIEW AND APPROVE THE OVERALL COMPENSATION PHILOSOPHY FOR THE HOSPITAL PRESIDENT AND CEO, MEMBERS OF THE HOSPITAL SENIOR MANAGEMENT TEAM, PHYSICIAN COMPENSATION FOR SMG AND HOSPITAL CHIEFS OF SERVICE, AND ANY INDIVIDUAL WHO FALLS WITHIN THE INTERNAL REVENUE SERVICE DEFINITION OF A DISQUALIFIED PERSON AND SHALL BE RESPONSIBLE FOR THE GENERAL OVERSIGHT OF ALL COMPENSATION RELATED DECISIONS WITH THE EXCEPTION OF THOSE INDIVIDUALS WHOSE SALARY AND BENEFITS ARE SUBJECT TO COLLECTIVE BARGAINING AGREEMENTS. THE COMMITTEE WILL BE RESPONSIBLE FOR REVIEWING, AT LEAST EVERY 3 YEARS, THE OVERALL COMPENSATION RANGE OF THE HOSPITAL AND ITS AFFILIATES AS COMPARED TO COMPARABLE ORGANIZATIONS AND SHALL ESTABLISH THE GENERAL PERCENTILE FOR AVERAGE COMPENSATION IN MAKING THIS DETERMINATION. THE COMMITTEE SHALL ENGAGE A BENEFIT CONSULTING FIRM TO CONDUCT MARKET ANALYSIS BASED ON THE RECOMMENDATIONS OF THE VICE PRESIDENT OF HUMAN RESOURCES. THE COMMITTEE SHALL HAVE THE POWER TO: APPROVE ALL FINAL DETERMINATIONS WITH RESPECT TO COMPENSATION; RETAIN AND TERMINATE A QUALIFIED COMPENSATION CONSULTANT TO ASSIST IN THE ASSESSMENT OF COMPENSATION; AND RETAIN AND TERMINATE LEGAL, ACCOUNTING OR OTHER EXPERTS NECESSARY TO CARRY OUT ITS DUTIES. THE MINUTES OF THE COMPENSATION COMMITTEE SHALL REFLECT THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE.
SCHEDULE J, PART II, COLUMN D - DEFINED BENEFIT PLAN:	THE HOSPITAL MAINTAINS TWO DEFINED BENEFIT PENSION PLANS COVERING HOSPITAL EMPLOYEES WITH AT LEAST ONE YEAR OF SERVICE. PRIOR TO JANUARY 2016, ALL PARTICIPANTS WERE COVERED BY ONE PLAN. EFFECTIVE JANUARY 2016, ALL INACTIVE PARTICIPANTS AND ACTIVE PARTICIPANTS WITH FROZEN BENEFITS WERE SPUN OFF TO A NEW PLAN, THE SIGNATURE HEALTHCARE RETIREMENT PLAN. THE REMAINING PLAN IS FOR ACTIVE PARTICIPANTS WHO CONTINUE TO ACCRUE BENEFITS. IN DECEMBER 2008, THE BOARD APPROVED AMENDEMENTS TO FREEZE THE PENSION PLANS FOR CERTAIN EMPLOYEES EFFECTIVE MARCH 2009, AFTER WHICH NO BENEFIT WILL ACCRUE FOR THOSE EMPLOYEES. EFFECTIVE 2012 AND 2014, ANY NEW HIRES COVERED BY THE SERVICE EMPLOYEES INTERNATIONAL UNION AND MASSACHUSETTS NURSES ASSOCIATION AGREEMENTS, RESPECTIVELY, ARE NOT ELIGIBLE TO PARTICIPATE IN THE PENSION PLANS.
SCHEDULE J, PART II, COLUMN D - DEFINED CONTRIBUTION PLAN:	IN APRIL 2009, THE CORPORATION IMPLEMENTED A DEFINED CONTRIBUTION 403(B) PLAN FOR CERTAIN HOSPITAL EMPLOYEES AND IN OCTOBER 2010, THE PLAN WAS MADE AVAILABLE TO CERTAIN SIGNATURE HEALTHCARE MEDICAL GROUP EMPLOYEES. THE CORPORATION MAINTAINS CONTRIBUTORY, DEFINED CONTRIBUTION PLANS THAT ARE AVAILABLE TO EMPLOYEES WHO MEET CERTAIN MINIMUM REQUIREMENTS. THE PLANS REQUIRE THAT THE CORPORATION MATCH SPECIFIED PERCENTAGES OF PARTICIPANT CONTRIBUTIONS UP TO CERTAIN MAXIMUM LEVELS. THE CORPORATION'S CONTRIBUTIONS WERE FUNDED PERIODICALLY DURING THE YEAR.
SCHEDULE J, PART II, COLUMN D - DEFERRED COMPENSATION PLANS:	THE CORPORATION MAINTAINS A 457(B) DEFERRED COMPENSATION PLAN WHICH COVERS KEY EMPLOYEES. UNDER THIS PLAN, EMPLOYEES MAY ELECT TO DEFER A PORTION OF THEIR COMPENSATION. THE CORPORATION MAINTAINS A 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR ACTIVELY EMPLOYED ELIGIBLE PHYSICIANS. EMPLOYEES WILL BE VESTED IN THE CONTRIBUTION FOR A PLAN YEAR ON JANUARY 1 TEN YEARS FROM THE YEAR IN WHICH EMPLOYEE CONTRIBUTIONS ARE MADE OR ON JANUARY 1 IN THE YEAR IN WHICH THEY REACH THE RETIREMENT AGE OF 65 AND HAVE TWO YEARS OF PLAN SERVICE.
SCHEDULE J, PART II, COLUMN D:	THE CORPORATION IS SELF-INSURED FOR ITS MEDICAL AND DENTAL INSURANCE PLANS.

Schedule J (Form 990) 2022

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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

2021

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	NONEAVAIL	12-21-2017	50,047,441	SEE PART VI		X		X		X
B	MASSACHUSETTS DEVELOPMENT FINANCE AGENCY (MDFA)	04-3431814	NONEAVAIL	08-23-2021	20,000,000	SEE PART VI		X		X		X
C	MASSACHUSETTS DEVELOPMENT FINANCE AGENCY (MDFA')	04-3431814	NONEAVAIL	05-12-2022	19,400,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0		0		0
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	50,047,441		20,000,000		19,400,000
4 Gross proceeds in reserve funds .............	0		0		0
5 Capitalized interest from proceeds .............	0		0		0
6 Proceeds in refunding escrows ...............	0		0		0
7 Issuance costs from proceeds ...............	483,298		631,570		378,520
8 Credit enhancement from proceeds .............	0		0		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	8,376,978		19,368,430		10,793,445
11 Other spent proceeds .............	41,670,863		0		8,606,555
12 Other unspent proceeds .............	0		0		0
13 Year of substantial completion .............	2019		2021		2022
	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 2020, a current refunding issue)? ........	X			X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

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			X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X			X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X			X		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 ....	0.710 %		0 %		0 %
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 .............	0.710 %
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X		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? .............		X		X		X
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		X		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		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........		X		X		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			X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........	0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........	0		0		0
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		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		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?	X		X		X

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)

ROW A (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. ROW B (A) ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCING AGENCY ("MDFA") (F) DESCRIPTION OF PURPOSE: ACQUIRE PROPERTY ROW C (A) ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCING AGENCY ("MDFA") (F) DESCRIPTION OF PURPOSE: Consolidate existing debt and finance construction/renovations for ASC and ED units

Schedule K (Form 990) 2021

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Brockton Hospital Inc

Employer identification number

22-2472997

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) NICCOLI BROTHERS OIL	SEE PART V	121,190	SUPPLIES PURCHASE		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART IV, COLUMN (B):	FRED NICCOLI GREATER THAN 35% CONTROLLED ENTITY

Schedule L (Form 990) 2021

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

Brockton Hospital Inc

Employer identification number

22-2472997

Return Reference	Explanation
FORM 990, PART I, LINE I, DESCRIPTION OF ORGANIZATION MISSION:	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 CATHERITIZATION, LEVEL II NURSERY AND MAGNETIC RESONANCE IMAGING.
FORM 990, PART III, LINE I:	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 SYSTEM 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 (1) 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 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 PROVIDING 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 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 PRESIDENT) 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, CHANGE IN NET ASSETS:	PENSION-RELATED CHANGES $ 8,748,990 NET ASSETS RELEASED FROM DONOR RESTRICTIONS $ 727,910 CHANGE IN INTEREST IN NET ASSETS OF SHC $ 448,049 CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENTS $ 133,132 TRANSFERS FROM (TO) AFFILIATES $(12,839,745) TOTAL TO LINE 9: $(2,781,664)
FORM 990 PART IX LINE 24 - OTHER EXPENSES	DESCRIPTION:TEMPORARY HELP TOTAL EXPENSES:7762814 PROGRAM SERVICES:7712601 MANAGEMENT AND GENERAL:50213
FORM 990 PART IX LINE 24 - OTHER EXPENSES	DESCRIPTION:ALL OTHER EXPENSES TOTAL EXPENSES:26891717 PROGRAM SERVICES:23144700 MANAGEMENT AND GENERAL:3747017

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

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	MGMT & FUNDRA	MA	501(C)(3)	12B	NA		No
(2)SIGNATURE HEALTHCARE MEDICAL GROUP INC 680 CENTRE STREET BROCKTON,MA02302 04-3306782	PHYSICIAN PRA	MA	501(C)(3)	10	SHC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

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) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

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 (CONTINUED ON SCHEDULE O)
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	17
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,642
6	Total number of volunteers (estimate if necessary) .............	6	140
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	442,337
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	16,713,883	10,257,034
9	Program service revenue (Part VIII, line 2g) .........	323,492,751	193,859,478
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,559,575	5,936,123
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	28,554,106	157,242,506
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	372,320,315	367,295,141
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)	193,837,885	159,242,398
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)....	167,462,033	157,955,784
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	361,299,918	317,198,182
19	Revenue less expenses. Subtract line 18 from line 12.......	11,020,397	50,096,959
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	282,009,414	322,843,764
21	Total liabilities (Part X, line 26).............	189,356,930	181,784,196
22	Net assets or fund balances. Subtract line 21 from line 20.....	92,652,484	141,059,568

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 292,062,895 including grants of $ 0 ) (Revenue $ 350,096,831 )
	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 WELLINFANT 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. 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, 2023 THE HOSPITAL HAD 5,377 TOTAL DISCHARGES AND OBSERVATIONS, 19,713 TOTAL PATIENT DAYS, AND 192,130 OUTPATIENT CLINIC VISITS. THE HOSPITAL'S EMERGENCY DEPARTMENT HAD 19,798 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. DURING FISCAL YEAR 2023, BROCKTON HOSPITAL HAD A FIRE ON FEBUARY 7, 2023 CAUSING THE CLOSURE OF THE HOSPITAL. AFTER THE FIRE, BROCKON HOSPITAL OPENED 2 URGENT CARE CENTERS TO SERVICE THE COMMUNITY AND HAD 23,500 VISITS FROM FEBRUARY 2023 THROUGH SEPTEMBER 2023.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses292,062,895

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,411,927	1,230,317	337,783

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	10,257,034

f	All other contributions, gifts, grants, and similar amounts not included above		1f	0

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

h Total. Add lines 1a-1f.......		10,257,034

		Business Code
2a	PATIENT SERVICE REVENUE	622110	181,255,231	181,255,231
b	INTERCOMPANY REVENUE	622110	8,560,446	8,560,446
c	SCHOOL OF NURSING	622110	2,699,841	2,699,841
d	INTERCOMPANY RENT	622110	823,003	823,003
e	NONPATIENT LAB REVENUE	541380	3,568		3,568
f	All other program service revenue.		517,389	517,389
g	Total. Add lines 2a–2f .....		193,859,478

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,401,421			2,401,421
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		562,816	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	562,816	6c
d	Net rental income or (loss).......			562,816			562,816
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		67,464,104	7a
b	Less: cost or other basis and sales expenses	223,668	63,705,734	7b
c	Gain or (loss)	-223,668	3,758,370	7c
d	Net gain or (loss).........			3,534,702			3,534,702
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	FIRE RELATED RECOVERIES		622110	110,417,057	110,417,057
b	PHARMACY		622110	13,253,510	12,814,741	438,769
c	ALL OTHER REVENUE		622110	33,009,123	33,009,123
d	All other revenue ....
e	Total. Add lines 11a–11d ......			156,679,690
12	Total revenue. See instructions.....			367,295,141	350,096,831	442,337	6,498,939

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	1,545,080		1,545,080
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	126,724,183	117,778,455	8,945,728
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,868,873	4,342,056	526,817
9	Other employee benefits .......	17,171,228	15,812,750	1,358,478
10	Payroll taxes ...........	8,933,034	8,277,071	655,963
11	Fees for services (non-employees):
a	Management ......	5,209,639	5,209,639
b	Legal .........	1,359,312		1,359,312
c	Accounting ...........	345,480	25,104	320,376
d	Lobbying ...........	105,097		105,097
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	0
12	Advertising and promotion ....	943,875	76,959	866,916
13	Office expenses .......	3,772,267	3,094,502	677,765
14	Information technology ......	1,910,234	1,781,787	128,447
15	Royalties ..	0
16	Occupancy ...........	5,469,299	4,874,772	594,527
17	Travel ............	131,819	64,965	66,854
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	3,825,166	3,557,404	267,762
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	12,279,024	11,419,492	859,532
23	Insurance ...	2,666,421	2,574,820	91,601
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	DRUGS AND MEDICATIONS	33,682,875	33,682,875
b	PURCHASED SERVICES	30,348,274	27,381,088	2,967,186
c	MEDICAL & SURGICAL SUPPLIES	12,608,715	12,608,099	616
d	MD CONTRACTED	8,643,756	8,643,756
e	All other expenses	34,654,531	30,857,301	3,797,230
25	Total functional expenses. Add lines 1 through 24e	317,198,182	292,062,895	25,135,287	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 ........			3,085	1	1,225
2	Savings and temporary cash investments .........			15,005,150	2	54,527,758
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			35,835,963	4	9,402,388
5	Loans and other receivables from 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) ...
				0	6	0
7	Notes and loans receivable, net ...........			986,579	7	1,084,186
8	Inventories for sale or use ............			6,456,237	8	5,467,260
9	Prepaid expenses and deferred charges ......			6,614,102	9	11,579,278
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	298,337,520
b	Less: accumulated depreciation	10b	162,248,170	122,520,238	10c	136,089,350
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			3,973,393	12	5,563,550
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			990,000	14	990,000
15	Other assets. See Part IV, line 11 ...........			89,624,667	15	98,138,769
16	Total assets. Add lines 1 through 15 (must equal line 33)...			282,009,414	16	322,843,764

17	Accounts payable and accrued expenses .....	70,733,273	17	61,158,265
18	Grants payable ...	0	18	0
19	Deferred revenue .........	6,786,423	19	9,907,311
20	Tax-exempt bond liabilities .........	72,621,947	20	68,804,169
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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 .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	12,277,963	23	9,050,000
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	26,937,324	25	32,864,451
26	Total liabilities. Add lines 17 through 25..	189,356,930	26	181,784,196

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	84,376,865	27	127,547,964
28	Net assets with donor restrictions ...........	8,275,619	28	13,511,604
	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 ...........	92,652,484	32	141,059,568
33	Total liabilities and net assets/fund balances ........	282,009,414	33	322,843,764