Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
CAPITAL HEALTH SYSTEM INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
750 BRUNSWICK AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
TRENTON, NJ08638
D Employer identification number

22-3548695
E Telephone number

G Gross receipts $ 511,021,580
F Name and address of principal officer:
AL MAGHAZEHE PHD FACHE
750 BRUNSWICK AVENUE
TRENTON,NJ08638
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CAPITALHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1997
M State of legal domicile: NJ
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION IS COMMITTED TO PROVIDING COMPREHENSIVE, QUALITY HEALTHCARE SERVICES WHICH IMPROVE AND SUSTAIN THE HEALTH STATUS OF THE RESIDENTS PRIMARILY IN CENTRAL NEW JERSEY AND LOWER BUCKS COUNTY.
2 Check this box MediumBullet
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 14
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 3,658
6 Total number of volunteers (estimate if necessary) .... 6 373
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 1,246,129
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -35,738
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,959,762 4,801,891
9 Program service revenue (Part VIII, line 2g) ......... 506,583,706 493,761,505
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 7,126,730 7,529,559
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,998,409 3,008,976
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 521,668,607 509,101,931
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 281,580 202,000
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) 239,642,820 264,493,712
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 246,577,259 224,308,597
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 486,501,659 489,004,309
19 Revenue less expenses. Subtract line 18 from line 12...... 35,166,948 20,097,622
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 755,891,510 965,266,420
21 Total liabilities (Part X, line 26)............ 471,039,924 637,480,517
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 284,851,586 327,785,903
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: THE ORGANIZATION IS COMMITTED TO PROVIDING COMPREHENSIVE, QUALITY HEALTHCARE SERVICES WHICH IMPROVE AND SUSTAIN THE HEALTH STATUS OF THE RESIDENTS PRIMARILY IN CENTRAL NEW JERSEY AND LOWER BUCKS COUNTY. THE ORGANIZATION ASSURES ACCESSIBLE, COMPASSIONATE HEALTHCARE SERVICES THAT HONOR THE DIGNITY OF EVERY PERSON. THE ORGANIZATION WILL BE A LEADER IN DEFINING THE COMMUNITY'S HEALTHCARE NEEDS, IN PROVIDING APPPROPRIATE SOLUTIONS, AND DEVELOPING A COMPREHENSIVE CONTINUUM OF CARE INCLUDING EDUCATION, PREVENTION, DISEASE MANAGEMENT AND RESTORATIVE PROGRAMS. THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 117,840,044 including grants of $ 0 ) (Revenue $ 91,611,165 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY PERIOPERATIVE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4b (Code:   ) (Expenses $ 42,423,719 including grants of $ 0 ) (Revenue $ 66,892,301 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY EMERGENCY ROOM AND EMS SERVICES 24/7 365 DAYS A YEAR TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4c (Code:   ) (Expenses $ 37,583,381 including grants of $ 0 ) (Revenue $ 31,080,654 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY MATERNAL CHILD HEALTH SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 242,266,744 including grants of $ 202,000 ) (Revenue $ 305,423,514 )
4e Total program service expensesMediumBullet$ 440,113,888
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
637
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,658
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
21
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NJ
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
RONALD J GUY
750 BRUNSWICK AVENUE
TRENTON,NJ08638
(609) 394-6029
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) SAMUEL J PLUMERI JR
CHAIRMAN - TRUSTEE
 10.0 X   X       0 0 0
(2) NANCY H BECKER
VICE CHAIR - TRUSTEE
 8.0 X   X       0 0 0
(3) GILBERT W LUGOSSY
SECRETARY - TRUSTEE
 8.0 X   X       0 0 0
(4) MILES W TRUESDELL JR
TREASURER - TRUSTEE
 5.0 X   X       0 0 0
(5) CARMEN M GARCIA ESQ
ASSISTANT SECRETARY - TRUSTEE
 5.0 X   X       0 0 0
(6) JUDGE GERALD J COUNCIL JSC
TRUSTEE
 3.0 X           0 0 0
(7) LOUIS DAMELIO MD
TRUSTEE
 55.0 X           753,434 0 32,608
(8) ANTHONY C HOOPER
TRUSTEE
 3.0 X           0 0 0
(9) JOSEPH R JINGOLI
TRUSTEE
 3.0 X           0 0 0
(10) MARTIN P JOHNSON
TRUSTEE
 3.0 X           0 0 0
(11) RAMAN KAPUR
TRUSTEE
 3.0 X           0 0 0
(12) DANIEL J LEE MD
TRUSTEE
 3.0 X           101,461 0 0
(13) AL MAGHAZEHE PHD FACHE
TRUSTEE - PRESIDENT/CEO
 55.0 X   X       1,496,696 0 620,826
(14) SEAN S MURRAY
TRUSTEE
 3.0 X           0 0 0
(15) CLINTON OGOLO MD
TRUSTEE - VP, MEDICAL STAFF
 3.0 X           0 0 0
(16) JOHN F RICCI
TRUSTEE
 3.0 X           0 0 0
(17) MICHAEL L SOMERSTEIN MD
TRUSTEE
 3.0 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) TELECHERY SUDHAKAR MD
TRUSTEE
 3.0 X           0 0 0
(19) JOHN P THURBER
TRUSTEE
 3.0 X           0 0 0
(20) RONALD L WARREN MD
TRUSTEE
 3.0 X           0 0 0
(21) MARK S WHITMAN MD
TRUSTEE - PRES, MEDICAL STAFF
 3.0 X           112,152 0 0
(22) RONALD J GUY
CHIEF FINANCIAL OFFICER
 55.0     X       1,556,960 0 408,922
(23) EUGENE W GROCHALA
CHIEF INFORMATION OFFICER
 55.0     X       405,277 0 151,026
(24) STEPHEN A MILLER JD
CHIEF COMPLIANCE OFFICER
 55.0     X       251,148 0 128,537
(25) LARRY DISANTO
EXECUTIVE VICE PRESIDENT
 55.0     X       773,726 0 569,550
(26) JAN GABIN ESQ
GENERAL COUNSEL
 55.0     X       425,162 0 168,573
(27) ROBERT REMSTEIN DO
VP, MEDICAL AFFAIRS
 55.0     X       484,594 0 145,380
(28) PATRICIA V CAVANAUGH RN MSN
VP, PATIENT SERVICES/CNO
 55.0     X       473,937 0 125,682
(29) NATHAN BOSK FACHE
VP, AMBULATORY SERVICES
 55.0     X       385,541 0 143,113
(30) TIMOTHY M GRAHAM
VP, FINAN SVCS (TERM 10/28/10)
 55.0     X       361,816 0 72,213
(31) J SCOTT CLEMMENSEN
VP, HUMAN RESOURCES
 55.0     X       326,225 0 154,119
(32) GREGORY N DADAMO
VP, SUPPORT SERVICES
 55.0     X       306,160 0 134,800
(33) MARGARET SULLIVAN
VP, QUALITY RESOURCE MGMT.
 55.0     X       296,785 0 134,473
(34) DENNIS DOOLEY
VP, PLANNING AND DEVELOPMENT
 55.0     X       290,597 0 167,047
(35) LINDA DITE
VP, CLINICAL SERVICES
 55.0     X       278,108 0 119,747
(36) EILEEN M HORTON
VP, STRATEGIC TRANSFORMATION
 55.0     X       224,215 0 111,794
(37) ARLENE WALSH
VP, NEUROSCIENCES
 55.0     X       202,515 0 17,206
(38) ARLINE M STEPHAN
EXECUTIVE DIRECTOR, FOUNDATION
 3.0       X     183,337 0 14,767
(39) EROL VEZNEDAROGLU MD
PHYSICIAN
 55.0         X   3,310,662 0 9,988
(40) KENNETH M LIEBMAN MD
PHYSICIAN
 55.0         X   3,279,655 0 26,625
(41) ARIEL F ABUD MD
PHYSICIAN
 55.0         X   996,816 0 23,207
(42) JOHN D LIPANI MD
PHYSICIAN
 55.0         X   896,998 0 16,623
(43) DOMINICK EBOLI MD
PHYSICIAN
 55.0         X   482,319 0 12,892
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 18,656,296 0 3,509,718
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet340
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SKANSKA USA BUILDING INC
516 EAST TOWNSHIP LINE ROAD
BLUE BELL,PA19422 		CONSTRUCTION 127,585,150
BARR AND BARR BUILDERS INC
460 WEST 34TH STREET 16TH FLOOR
NEW YORK,NY10001 		CONSTRUCTION 12,758,773
TARGET BUILDING CONSTRUCTION
1124 CHESTER PIKE
CRUM LYNNE,PA19022 		CONSTRUCTION 12,020,941
TRENTON ANESTHESIOLOGY
PO BOX 15321
NEWARK,NJ07192 		PHYSICIAN 6,558,039
SODEXHO MANAGEMENT INC
PO BOX 360170
PITTSBURGH,PA152516170 		MANAGEMENT 4,915,519
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet130
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 8,500
e Government grants (contributions)1e 4,793,391
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 4,801,891
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 541,900 483,897,693 483,897,693    
b 911 COUNTY SUPPORT & FIRE DISPATCH 541,900 36,709 36,709    
c SCHOOL OF NURSING 541,900 488,197 488,197    
d OTHER HEALTHCARE RELATED REVENUE 541,900 8,659,292 8,659,292    
e AUXILIARY REVENUE 541,900 679,614 679,614    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 493,761,505
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 7,522,029     7,522,029
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 1,941,439  
b Less: rental expenses 1,919,649  
c Rental income or (loss) 21,790  
d Net rental income or (loss).......MediumBullet 21,790     21,790
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   7,530
b Less: cost or other basis and sales expenses   0
c Gain or (loss)   7,530
d Net gain or (loss)..........MediumBullet 7,530     7,530
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CHILD DAY CARE 624,410 1,246,129   1,246,129  
b PATIENT/EMPLOYEE CONVENIENCE 722,210 1,741,057     1,741,057
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 2,987,186
12 Total revenue. See Instructions....MediumBullet 509,101,931 493,761,505 1,246,129 9,292,406
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 202,000 202,000
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. 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 .... 13,110,232 11,799,210 1,311,022 0
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 211,427,361 190,284,626 21,142,735  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 1,335,105 1,201,594 133,511  
9 Other employee benefits ....... 24,391,543 21,952,388 2,439,155  
10 Payroll taxes ........... 14,229,471 12,806,524 1,422,947  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 431,522 388,370 43,152  
c Accounting ........... 349,998 314,998 35,000  
d Lobbying ........... 189,343 170,409 18,934  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 737,384 663,646 73,738  
g Other .......... 0      
12 Advertising and promotion .... 4,271,472 3,844,325 427,147  
13 Office expenses ....... 64,520,657 58,068,591 6,452,066  
14 Information technology ...... 1,110,898 999,808 111,090  
15 Royalties .. 0      
16 Occupancy ........... 0      
17 Travel ............ 0      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 391,389 352,250 39,139  
20 Interest ........... 7,249,934 6,524,941 724,993  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 32,236,315 29,012,683 3,223,632  
23 Insurance .............. 7,912,928 7,121,635 791,293  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PROVISION FOR BAD DEBT 31,634,319 28,470,888 3,163,431 0
b CONTRACTED OUTSIDE SERVICES 24,417,186 21,975,467 2,441,719 0
c PHYSICIAN FEES 19,880,612 17,892,551 1,988,061 0
d UTILITIES, TRASH & DISPOSAL 9,054,523 8,149,071 905,452 0
e CONSULTING FEES 6,785,476 6,106,928 678,548 0
f All other expenses 13,134,641 11,810,985 1,323,656 0
25 Total functional expenses. Add lines 1 through 24f 489,004,309 440,113,888 48,890,421 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 16,509,861 2 24,781,552
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 49,348,186 4 49,596,322
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 3,368,625 7 2,709,346
8 Inventories for sale or use .............. 2,152,909 8 2,658,890
9 Prepaid expenses and deferred charges ............ 4,414,351 9 5,382,293
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 945,740,973
b Less: accumulated depreciation. ..... 10b 362,219,250 404,758,498 10c 583,521,723
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 247,515,097 13 267,855,492
14 Intangible assets ......... 13,105,973 14 15,991,969
15 Other assets. See Part IV, line 11 ........... 14,718,010 15 12,768,833
16 Total assets. Add lines 1 through 15 (must equal line 34)... 755,891,510 16 965,266,420
Liabilities 17 Accounts payable and accrued expenses . 57,769,728 17 66,464,639
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 328,797,566 23 500,750,016
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 84,472,630 25 70,265,862
26 Total liabilities. Add lines 17 through 25..... 471,039,924 26 637,480,517
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 284,851,586 27 327,785,903
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 284,851,586 33 327,785,903
34 Total liabilities and net assets/fund balances ..... 755,891,510 34 965,266,420
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
509,101,931
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
489,004,309
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
20,097,622
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
284,851,586
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
22,836,695
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
327,785,903
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
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 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 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 fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
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) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 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) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (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) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not 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 in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
CAPITAL HEALTH SYSTEM INC
  		Employer identification number

22-3548695
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
CAPITAL HEALTH SYSTEM INC
  		Employer identification number

22-3548695
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
CAPITAL HEALTH SYSTEM INC
  		Employer identification number

22-3548695
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (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.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to 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,” to 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,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
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
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(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? ......................................

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 instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
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)).
(a)
Yes
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
138,140
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
51,203
i
Other activities? If "Yes," describe in Part IV ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
189,343
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITIES SCHEDULE C, PART II-B; LINES 1G AND 1H DURING 2010, THE ORGANIZATION PAID TWO OUTSIDE LOBBYING FIRMS A TOTAL OF $138,140 FOR LOBBYING ON A FEDERAL AND STATE LEVEL RELATED TO MEDICARE, MEDICAID AND OTHER HEALTHCARE LEGISLATIVE MATTERS. IN ADDITION, THE ORGANIZATION IS A MEMBER OF THE NEW JERSEY HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WHICH BOTH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $51,203.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may 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. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the 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 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, 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" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, 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 XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, 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)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
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 SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV 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  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to 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 ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   49,382,285 49,382,285
b Buildings ................   150,017,799 78,159,252 71,858,547
c Leasehold improvements ............        
d Equipment ................   328,454,244 280,034,506 48,419,738
e Other .................   417,886,645 4,025,492 413,861,153
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 583,521,723
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. 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    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) SECURITIES 126,822,247 F
(2) SECURITIES 102,361,647 F
(3) INVESTMENT IN SUBSIDIARIES 16,014,514 F
(4) ACCRUED INTEREST 244,711 F
(5) CERTIFICATES OF DEPOSIT 53,988 F
(6) LIMITED USE -689,916 F
(7) SUPPLEMENTAL RETIREMENT PLAN 3,266,225 F
(8) ALTERNATIVE INVESTMENTS 17,072,730 F
(9) GUARANTEES 2,709,346 F
Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet 267,855,492
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
NON-CURRENT 2,464,001
OTHER LIABILITIES 34,025,182
CONSTRUCTION AND RETAINAGE PAYABLE 33,776,679






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 70,265,862
2. Fin 48 (ASC 740) Footnote. In Part XIV, 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 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
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 on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 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 XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
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 XIV): ............ 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 XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to 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; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X THE ORGANIZATION IS THE PARENT ORGANIZATION OF THE CAPITAL HEALTH SYSTEM ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM ISSUES CONSOLIDATED AUDITED FINANCIAL STATEMENTS WHICH INCLUDE ALL RELATED ENTITIES; INCLUDING THIS ORGANIZATION. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ALSO CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE FIN 48 FOOTNOTE BELOW IS FROM THE SYSTEM'S 2007 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IN JULY 2006, FASB INTERPRETATION NO. 48 (FIN 48), ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AN INTERPRETATION OF FASB STATEMENT NO. 109, ACCOUNTING FOR INCOME TAXES, WAS ISSUED. FIN 48 CREATES A SINGLE MODEL TO ADDRESS UNCERTAINTY IN TAX POSITIONS AND CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING THE MINIMUM RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. UNDER THE REQUIREMENTS OF FIN 48, TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. PRIOR TO FIN 48, THE DETERMINATION OF WHEN TO RECORD A LIABILITY FOR A TAX EXPOSURE WAS BASED ON WHETHER A LIABILITY WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE IN ACCORDANCE WITH FASB STATEMENT NO. 5, ACCOUNTING FOR CONTINGENCIES. ON JANUARY 1, 2007, THE SYSTEM'S ADOPTED FIN 48. THE IMPACT OF THE ADOPTION OF FIN 48 ON THE SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS IS NOT SIGNIFICANT.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 1 1 Program Services FINANCIAL VEHICLE 5,105,331
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 1 1 5,105,331
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 1 1 5,105,331
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
 
No
6b
If "Yes," does the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    46,713,629 32,563,000 14,150,629 3.090 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    27,444,132 18,699,444 8,744,688 1.910 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    74,157,761 51,262,444 22,895,317 5.000 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		364 70,249 250,426 2,207 248,219 0.050 %
f Health professions education
(from Worksheet 5) .. 		    8,720,799 6,350,061 2,370,738 0.520 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     139,829 0 139,829 0.030 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		156   1,227,156 2,953 1,224,203 0.270 %
jTotal Other Benefits ... 520 70,249 10,338,210 6,355,221 3,982,989 0.870 %
kTotal. Add lines 7d and 7j. .. 520 70,249 84,495,971 57,617,665 26,878,306 5.870 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
31,634,319
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
91,316,084
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
115,660,177
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-24,344,093
8
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:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(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) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?2
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 REGIONAL MEDICAL CENTER
750 BRUNSWICK AVENUE
TRENTON,NJ08638 		X X   X     X    
2 MERCER MEDICAL CENTER
446 BELLEVUE AVENUE
TRENTON,NJ08618 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:REGIONAL MEDICAL CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and 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?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:MERCER MEDICAL CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and 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?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?19
Name and address Type of Facility (Describe)
1 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
2 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
3 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
4 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
5 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
6 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
7 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
8 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
9 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
10 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
11 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
12 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
13 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
14 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
15 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
16 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
17 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
18 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
19 CAPITAL HEALTH SYSTEM IN HAMILTON
1401-1445 WHITEHORSE-MERCERVILLE RO
HAMILTON,NJ08619 		OUTPATIENT FACILITY
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments 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.
Identifier ReturnReference Explanation
FINANCIAL ASSISTANCE ELIGIBILITY SCHEDULE H, PART I, LINE 3C THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2010 POVERTY GUIDELINES (DEPARTMENT OF HEALTH AND SENIOR SERVICES). FPG ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE.
COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A NOT APPLICABLE.
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $31,634,319.
COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II Beginning in June, 2008, Capital Health undertook two major construction projects in Mercer County-the construction of a new hospital in Hopewell Township and extensive renovations at its hospital in Trenton. Capital Health felt strongly that local community residents, small businesses and women and minority owned businesses should benefit from the construction projects, so it hired Qualified Women/Minorities in Construction (QWIC) to recruit such companies and to train them in the skills necessary to get work on the projects. A longer term goal is that the skills and connections that are learned on the Capital Health projects can be used to gain future work. A feature of the success of this initiative was that we took the extraordinary step of breaking the bids down into small enough packages that the smaller companies could have a chance to bid on them. This enabled many companies to participate on the project who otherwise would not have been able to. It is important to note that Capital Health was not obligated in any way to undertake this initiative and, in a time of poor economic conditions in this country, its two construction projects were the only major construction projects taking place in Mercer County. WHEN THE QWIC CONTRACT ENDED IN JANUARY 2010, $110 million in contracts hAD been awarded to Mercer County businesses, 75% of the workers on the site WERE NJ residents and 15% WERE Mercer County residents. CAPITAL HEALTH SAW STRONG PARTICIPATION IN THE AREAS OF WOMEN-OWNED BUSINESSES AND LOCAL PARTICIPATION WITH 24% AND 17%, RESPECTIVELY.
BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM ITS AUDITED FINANCIAL STATEMENTS, MULTIPLIED BY ITS COST TO CHARGE RATIO. THE CAPITAL HEALTH SYSTEM, INC. AND ITS AFFILIATES, INCLUDING ITS HOSPITALS AND SUBSIDIARIES, PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM'S ALLOWANCE FOR DOUBTFUL ACCOUNTS (BAD DEBT EXPENSE) METHODOLOGY AND CHARITY CARE POLICIES ARE CONSISTENTLY APPLIED ACROSS ALL HOSPITAL AFFILIATES. THE ATTACHED TEXT WAS OBTAINED FROM THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS OF THE CAPITAL HEALTH SYSTEM. CHARITY CARE CAPITAL HEALTH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA DEFINED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE CAPITAL HEALTH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. CAPITAL HEALTH MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED. CHARGES FORGONE FOR CHARITY CARE PROVIDED DURING THE YEARS ENDED DECEMBER 31, 2010 AND 2009 WERE APPROXIMATELY $282,247,000 AND $269,667,000, RESPECTIVELY. CAPITAL HEALTH RECEIVES PARTIAL REIMBURSEMENT FOR THE UNCOMPENSATED CARE IT PROVIDES.
MEDICARE SHORTFALL SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE DERIVED FROM THE 2009 MEDICARE COST REPORT. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "[T]HE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE," AND PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY, AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVE[D]" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED "DUAL ELIGIBLES." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE;
DEBT COLLECTION POLICY SCHEDULE H, PART III, LINE 9B ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE, BUT RATHER, ACCOUNTED FOR AS AN ALLOWANCE. IT IS THE POLICY OF THE CAPITAL HEALTH SYSTEM, AND ALL ITS HOSPITAL AFFILIATES, TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. FOR ACCOUNTS DETERMINED TO BE 'SELF-PAY" AND/OR ACCOUNTS WITH BALANCE AFTER PRIMARY INSURANCE PAYMENTS, THE COLLECTION POLICY REQUIRES: SENDING THREE STATEMENTS, A MINIMUM OF ONE PRE-COLLECTION LETTER, TELEPHONE CONTACT FOR ANY ACCOUNT OVER $5,000.00 OR AT THE DISCRETION OF THE ACCOUNT REPRESENTATIVE AND/OR SUPERVISOR. THE FACILITY ALSO HAS A CHARITY CARE ACCESS POLICY TO ASSURE PATIENTS ARE PROVIDED WITH CHARITY CARE ASSISTANCE DETERMINED BY STATE AND FEDERAL REGULATIONS. IT IS THE POLICY TO INFORM ALL PATIENTS DEEMED SELF-PAY OF THE APPROPRIATE ASSISTANCE PROGRAMS AVAILABLE. PATIENTS APPLYING FOR CHARITY CARE ASSISTANCE WILL BE FINANCIALLY SCREENED BY A RESOURCE ADVISOR TO DETERMINE ELIGIBILITY ACCORDING TO STATE AND FEDERAL GUIDELINES AND WILL BE INFORMED OF DOCUMENTATION NEED TO COMPLETE A CHARITY CARE APPLICATION. PATIENTS NOT ELIGIBLE FOR CHARITY CARE WILL BE FINANCIALLY COUNSELED FOR ALL OTHER OPTIONS. QUALIFIED PATIENTS WILL BE REFERRED TO ALL APPROPRIATE AGENCIES OR PROGRAMS TO MEET OTHER FINANCIAL NEEDS. AT THE TIME OF THE PATIENT VISIT AND PART OF THE REGISTRATION PROCESS AT THE FACILITY, THE FOLLOWING OPTIONS ARE MADE AVAILABLE TO PATIENTS: - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR MEDICAL ASSISTANCE INCLUDING MEDICAID AND SSI; - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR THE NEW JERSEY HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM; AND, - FINANCIAL ARRANGEMENTS INCLUDING: 1. CASH/CREDIT CARD (AMERICAN EXPRESS, DISCOVER, VISA, MASTERCARD), 2. LOW INTEREST LOAN PROGRAM, OR 3. FLEXIBLE PAYMENT PLANS. IN ADDITION TO THE ABOVE OPTIONS, THE FACILITY HAS ESTABLISHED A SELF-PAY ASSISTANCE PROGRAM FOR OUR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR MEDICAID OR THE NEW JERSEY HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM. THE SELF-PAY ASSISTANCE PROGRAM RATES ARE REFLECTIVE OF MEDICARE REIMBURSEMENT, AS REFERRED BY THE STATE OF NEW JERSEY.
FACILITY POLICIES AND PRACTICES SCHEDULE H, PART V; SECTION B NOT APPLICABLE.
NEEDS ASSESSMENT SCHEDULE H, PART VI; QUESTION 2 Capital Health routinely monitors demand for the services it provides while simultaneously utilizing a variety of information sources to determine unmet or underserved needs of the communities it serves. Capital Health meets at least monthly with the other healthcare providers in its service area as well as a community health department director to discuss unmet needs and collaboratively strategize the prioritization of needs and develop programs to address them in a coordinated way. We also routinely review available data regarding incidence of health issues and propose programs to address these issues and ultimately implement those which will have the greatest impact. Additionally, we retain a full time Community Relations Coordinator whose task it is to be out in the community interacting with community leaders and receiving feedback on their satisfaction with our services. We believe this comprehensive approach of monitoring and analyzing both objective data and subjective feedback gives us a current understanding of how we are addressing community needs and what we need to do to optimize our impact upon the healthcare status of our region.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI; QUESTION 3 CHS EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE WITH THEIR BILLS IN NUMEROUS WAYS. INSURANCE INFORMATION IS OBTAINED AT ALL REGISTRATION POINTS AT EACH VISIT. IF A PATIENT IS FOUND NOT TO HAVE INSURANCE, OR IS UNDERINSURED THE FOLLOWING PROCEDURE IS FOLLOWED; 1. WHEN A PATIENT IS FOUND TO BE UNINSURED AND IN NEED OF FINANCIAL ASSISTANCE, A NEW JERSEY CARE PAYMENT FACT SHEET IS REVIEWED WITH THE PATIENT, AND A WRITTEN COPY IS PROVIDED TO THE PATIENT BY THE HEALTH ACCESS STAFF. THE FACT SHEET EXPLAINS WHO IS ELIGIBLE, HOW TO APPLY WITH THE PHONE NUMBER OF EACH CAMPUS CHARITY CARE OFFICE, AND WHAT DOCUMENTS ARE NEEDED TO DETERMINE ELIGIBILITY. 2. WHEN A PATIENT IS ADMITTED TO THE HOSPITAL, A CHARITY CARE WORKER WILL VISIT THE PATIENT'S BEDSIDE TO START THE CHARITY CARE PROCESS. IF A PATIENT IS FINANCIALLY SCREENED AND FOUND TO BE ELIGIBLE FOR MEDICAID, A REFERRAL IS GIVEN TO THE HOSPITAL'S MEDICAID OUTSTATION WORKER. THE OUTSTATION WORKER WILL VISIT THE PATIENT, AND BEGAN THE MEDICAID PROCESS. 3. WHEN A PATIENT IS FOUND TO BE UNDERINSURED, (EXAMPLE IS A PATIENT WHO HAS MEDICARE ONLY) A REFERRAL IS MADE TO THE CHARITY CARE WORKER, AND THE SAME PROCESS IS FOLLOWED ABOVE. 4. THE PATIENT IS MONITORED FOR COMPLIANCE IN COMPLETING THE APPLICATION INCLUDING VISITING THE PATIENT'S HOME IF NECESSARY TO OBTAIN NECESSARY DOCUMENTATION TO COMPLETE THE APPLICATION. 5. ONCE THE PATIENT HAS BEEN APPROVED, THE CHARITY CARE DETERMINATION INFORMATION IS DOCUMENTED IN THE PATIENT'S REGISTRATION RECORD. PATIENT ACCESS MONITORS AND INSTRUCTS THE PATIENT WHEN THEIR CHARITY CARE APPLICATION IS DUE FOR RENEWAL. ASIDE FROM INFORMING PATIENTS DURING THEIR REGISTRATION PROCESS, ALL OF CAPITAL HEALTH'S DUNNING STATEMENTS CONTAIN THE FOLLOWING LANGUAGE: CAPITAL HEALTH SYSTEM OFFERS FINANCIAL ASSISTANCE TO ALL OF ITS PATIENTS WHO ARE UNINSURED OR DO NOT HAVE FULL INSURANCE COVERAGE, AND WHO MEET CERTAIN INCOME AND ASSET CRITERIA. CAPITAL HEALTH SYSTEM PROVIDES THIS ASSISTANCE THROUGH THE MEDICAID PROGRAM WHICH IS SPONSORED BY THE STATE OF NEW JERSEY AND FEDERAL GOVERNMENT AND THROUGH THE STATE OF NEW JERSEY'S HEALTHCARE FOR THE UNINSURED PROGRAM. IN ADDITION, IF YOU DO NOT QUALIFY FOR EITHER OF THESE PROGRAMS, CAPITAL HEALTH SYSTEM CAN OFFER PROMPT PAYMENT DISCOUNTS AND DISCOUNTS FOR PATIENTS WHO HAVE BILLS THAT ARE A SIGNIFICANT FINANCIAL BURDEN TO THEM. IF YOU CAN NOT AFFORD TO PAY YOUR BILL AND WOULD LIKE TO APPLY FOR FINANCIAL ASSISTANCE PLEASE CALL US AT 609-394-6023. EN ESPANOL: LLAME 609-394-6169 SIU USTED NO PUEDE PERMITIRSE A PAGAR SU CUENTA Y LE GUSTARA SOLICITAR LA AYUDA FINANCIERA. LASTLY, THE HOSPITAL HAS A RECORDED MESSAGE THAT IS PLAYED WHILE A CUSTOMER IS ON HOLD THAT SAYS THE FOLLOWING: CAPITAL HEALTH SYSTEM OFFERS FINANCIAL ASSISTANCE TO ALL OF ITS PATIENTS WHO ARE UN-INSURED OR DO NOT HAVE FULL INSURANCE COVERAGE, AND WHO MEET CERTAIN INCOME AND ASSET CRITERIA. CAPITAL HEALTH SYSTEM PROVIDES THIS ASSISTANCE THROUGH THE MEDICAID PROGRAM WHICH IS SPONSORED BY THE STATE OF NEW JERSEY AND FEDERAL GOVERNMENT AND THROUGH NEW JERSEY'S HEALTHCARE FOR THE UNINSURED PROGRAM. IN ADDITION, IF YOU DO NOT QUALIFY FOR ANY OF THESE PROGRAMS, CAPITAL HEALTH SYSTEM CAN OFFER PROMPT PAYMENT DISCOUNTS AND DISCOUNTS FOR PATIENTS WHO HAVE BILLS THAT ARE A SIGNIFICANT BURDEN TO THEM. IF YOU CANNOT AFFORD TO PAY YOUR BILL AND WOULD LIKE TO APPLY FOR FINANCIAL ASSISTANCE PLEASE CALL US AT 609-394-6023.
COMMUNITY INFORMATION SCHEDULE H, PART VI; QUESTION 4 CAPITAL HEALTH SERVES THE COMMUNITIES IN MERCER AND BURLINGTON COUNTIES IN NEW JERSEY AND BUCK COUNTY IN PENNSYLVANIA. THERE ARE APPROXIMATELY 400,000 RESIDENTS WITHIN THE DEFINED PRIMARY AND SECONDARY SERVICE AREA. THE RACIAL MAKEUP OF MERCER COUNTY, WHICH INCLUDES TRENTON, THE STATE CAPITAL, IS 61.4% WHITE, 20.3% BLACK, AND 15.1% HISPANIC OR LATINO. NEARLY 87% OF THE COUNTY'S RESIDENTS WHO ARE 25 YEARS OR OLDER GRADUATED HIGH SCHOOL AND 38% HAVE A BACHELOR'S DEGREE. MEDIAN HOUSEHOLD INCOME IN THE COUNTY WAS $70,570 ACCORDING TO THE US CENSUS. THE RACIAL MAKEUP OF BURLINGTON COUNTY IS 73.8% WHITE, 16.6% BLACK, AND 6.4% HISPANIC OR LATINO. MORE THAN 90.6% OF BURLINGTON COUNTY RESIDENTS WHO ARE 25 YEARS OR OLDER GRADUATED HIGH SCHOOL AND 33% HAVE A BACHELOR'S DEGREE. MEDIAN HOUSEHOLD INCOME IN BURLINGTON COUNTY WAS $74,481, ACCORDING TO THE US CENSUS. THE RACIAL MAKEUP OF BUCKS COUNTY, PENNSYLVANIA IS 89.2% WHITE, 3.6% BLACK AND 4.3% HISPANIC OR LATINO. OF THOSE, 91.3% OF BUCKS COUNTY RESIDENTS WHO ARE 25 YEARS OR OLDER GRADUATED HIGH SCHOOL AND 34.1% HAVE A BACHELOR'S DEGREE. MEDIAN HOUSEHOLD INCOME IN BUCKS COUNTY WAS $75,895 ACCORDING TO THE US CENSUS.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI; QUESTION 5 THIS ORGANIZATION OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. THE ORGANIZATION OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. THE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF THE ORGANIZATION RESTS WITH ITS BOARD OF GOVERNORS; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW THE ORGANIZATION PROMOTES COMMUNITY HEALTH.
AFFILIATED HEALTHCARE SYSTEM SCHEDULE H, PART VI; QUESTION 6 OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE CAPITAL HEALTH SYSTEM AND AFFILIATES. NOT FOR PROFIT CAPITAL HEALTH SYSTEM AND AFFILIATES ENTITIES CAPITAL HEALTH SYSTEM, INC. CAPITAL HEALTH SYSTEM, INC. ("CHS") IS THE TAX-EXEMPT PARENT OF THE CAPITAL HEALTH SYSTEM AND AFFILIATES ("SYSTEM"). THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER CHS OR ANOTHER SYSTEM AFFILIATE CONTROLLED BY CHS. THE SYSTEM IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS IN THE STATE OF NEW JERSEY. CAPITAL HEALTH SYSTEM IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A HOSPITAL. AS THE PARENT ORGANIZATION OF A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM IN MERCER COUNTY NEW JERSEY. CAPITAL HEALTH SYSTEM STRIVES TO CONTINUALLY DEVELOP AND OPERATE A MULTI-HOSPITAL HEALTH CARE SYSTEM WHICH PROVIDES SUBSTANTIAL COMMUNITY BENEFIT THROUGH THE PROVISION OF A COMPREHENSIVE SPECTRUM OF HEALTH CARE SERVICES TO THE RESIDENTS OF NEW JERSEY AND SURROUNDING COMMUNITIES. CAPITAL HEALTH SYSTEM ENSURES THAT ITS SYSTEM PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGINS OR ABILITY TO PAY. NO INDIVIDUALS ARE DENIED NECESSARY MEDICAL CARE, TREATMENT OR SERVICES. CAPITAL HEALTH SYSTEM ACTIVE HOSPITAL IS CAPITAL HEALTH SYSTEM, INC. THE HOSPITAL OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF- PAY, MEDICARE AND MEDICAID PATIENTS; 2. OPERATE AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. MAINTAIN AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; AND 4. CONTROL RESTS WITH ITS BOARD OF TRUSTEES AND THE BOARD OF TRUSTEES OF CAPITAL HEALTH SYSTEM, INC. BOTH BOARDS ARE COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY. 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. CAPITAL HEALTH SYSTEM FOUNDATION CAPITAL HEALTH SYSTEM FOUNDATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THROUGH FUNDRAISING ACTIVITIES THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF CAPITAL HEALTH SYSTEM, INC.; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. FOR PROFIT CAPITAL HEALTH SYSTEM AND AFFILIATES ENTITIES BELLEVUE AVENUE MANAGEMENT, INC. A FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS MERCER HOLDING CORPORATION. THE ORGANIZATION IS LOCATED IN TRENTON, MERCER COUNTY, NEW JERSEY. THE ORGANIZATION PROVIDES MANAGERIAL ADMINISTRATION AND SUPPORT. CAPITAL REGION INSURANCE COMPANY A CONTROLLED FOREIGN CORPORATION BY CAPITAL HEALTH SYSTEM, INC.. THE ORGANIZATION WAS FORMED AND OPERATES SOLELY IN THE CAYMAN ISLANDS. MERCER HOLDING CORPORATION A FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS CAPITAL HEALTH SYSTEM, INC. THIS ENTITY IS THE SOLE OWNER OF ALL THE OUSTANDING COMMON STOCK OF BELLEVUE AVENUE MANAGEMENT, INC. AND IS INVOLVED IN VARIOUS ANCILLARY HEALTHCARE RELATED ACTIVITIES.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI; QUESTION 7 NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. THE STATE OF NEW JERSEY DOES NOT REQUIRE HOSPITALS TO ANNUALLY FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW JERSEY.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number
22-3548695
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) CAPITAL HEALTH SYSTEM FOUNDATION750 BRUNSWICK AVENUE
TRENTON,NJ08638 		22-2230681 501(C)(3) 100,000       PROGRAM SUPPORT
(2) ISLES INC10 WOOD STREET
TRENTON,NJ08618 		22-2350832 501(C)(3) 10,000       GENERAL SUPPORT
(3) AMERICAN CANCER SOCIETY3076 PRINCETON PIKE
LAWRENCEVILLE,NJ08648 		16-0743902 501(C)(3) 12,000       GENERAL SUPPORT
(4) MARCH OF DIMES5 CEDAR BROOK DR
CRANBURY,NJ08512 		22-2383132 501(C)(3) 15,000       GENERAL SUPPORT
(5) BOY SCOUTS OF AMERICA1325 WEST WALNUT HILL LANE
IRVING,TX75038 		22-1576300 501(C)(3) 7,500       GENERAL SUPPORT
(6) AMERICAN HEART ASSOCIATION2550 US HGHWY 1
NORTH BRUNSWICK,NJ08902 		13-5613797 501(C)(3) 15,000       GENERAL SUPPORT
(7) NATIONAL KIDNEY FOUNDATION30 EAST 33RD STREET
NEW YORK,NY10016 		13-1673104 501(C)(3) 7,500       GENERAL SUPPORT










2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
14
3
Enter total number of other organizations ................................ . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
GRANT FUND MONITORING SCHEDULE D, PART I; QUESTION 2 GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.
Schedule I (Form 990) 2010


Additional Data


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Software Version:  


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" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in 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) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) LOUIS DAMELIO MD (i)
(ii)		 749,623
0 		2,500
0 		1,311
0 		13,844
0 		18,764
0 		786,042
0 		0
0
(2) AL MAGHAZEHE PHD FACHE (i)
(ii)		 1,047,702
0 		420,787
0 		28,207
0 		605,666
0 		15,160
0 		2,117,522
0 		0
0
(3) RONALD J GUY (i)
(ii)		 594,194
0 		238,447
0 		724,319
0 		392,476
0 		16,446
0 		1,965,882
0 		705,014
0
(4) EUGENE W GROCHALA (i)
(ii)		 294,274
0 		91,292
0 		19,711
0 		146,481
0 		4,545
0 		556,303
0 		0
0
(5) STEPHEN A MILLER JD (i)
(ii)		 192,079
0 		57,845
0 		1,224
0 		108,102
0 		20,435
0 		379,685
0 		0
0
(6) LARRY DISANTO (i)
(ii)		 649,202
0 		103,362
0 		21,162
0 		552,390
0 		17,160
0 		1,343,276
0 		0
0
(7) JAN GABIN ESQ (i)
(ii)		 326,056
0 		96,170
0 		2,936
0 		149,597
0 		18,976
0 		593,735
0 		0
0
(8) ROBERT REMSTEIN DO (i)
(ii)		 371,447
0 		109,796
0 		3,351
0 		136,425
0 		8,955
0 		629,974
0 		0
0
(9) PATRICIA V CAVANAUGH RN MSN (i)
(ii)		 247,011
0 		72,283
0 		154,643
0 		122,993
0 		2,689
0 		599,619
0 		131,587
0
(10) NATHAN BOSK FACHE (i)
(ii)		 281,283
0 		87,513
0 		16,745
0 		125,063
0 		18,050
0 		528,654
0 		0
0
(11) TIMOTHY M GRAHAM (i)
(ii)		 280,062
0 		80,558
0 		1,196
0 		56,929
0 		15,284
0 		434,029
0 		0
0
(12) J SCOTT CLEMMENSEN (i)
(ii)		 232,897
0 		74,099
0 		19,229
0 		137,820
0 		16,299
0 		480,344
0 		0
0
(13) GREGORY N DADAMO (i)
(ii)		 235,010
0 		69,343
0 		1,807
0 		133,337
0 		1,463
0 		440,960
0 		0
0
(14) MARGARET SULLIVAN (i)
(ii)		 213,175
0 		65,214
0 		18,396
0 		130,795
0 		3,678
0 		431,258
0 		0
0
(15) DENNIS DOOLEY (i)
(ii)		 222,402
0 		65,697
0 		2,498
0 		148,867
0 		18,180
0 		457,644
0 		0
0
(16) LINDA DITE (i)
(ii)		 213,925
0 		62,293
0 		1,890
0 		118,648
0 		1,099
0 		397,855
0 		0
0
(17) EILEEN M HORTON (i)
(ii)		 179,638
0 		42,428
0 		2,149
0 		97,300
0 		14,494
0 		336,009
0 		0
0
(18) ARLENE WALSH (i)
(ii)		 171,737
0 		29,667
0 		1,111
0 		9,764
0 		7,442
0 		219,721
0 		0
0
(19) ARLINE M STEPHAN (i)
(ii)		 155,251
0 		27,810
0 		276
0 		7,440
0 		7,327
0 		198,104
0 		0
0
(20) EROL VEZNEDAROGLU MD (i)
(ii)		 1,450,009
0 		1,860,503
0 		150
0 		8,575
0 		1,413
0 		3,320,650
0 		0
0
(21) KENNETH M LIEBMAN MD (i)
(ii)		 1,446,927
0 		1,832,503
0 		225
0 		8,575
0 		18,050
0 		3,306,280
0 		0
0
(22) ARIEL F ABUD MD (i)
(ii)		 994,911
0 		0
0 		1,905
0 		8,761
0 		14,446
0 		1,020,023
0 		0
0
(23) JOHN D LIPANI MD (i)
(ii)		 799,165
0 		96,663
0 		1,170
0 		8,761
0 		7,862
0 		913,621
0 		0
0
(24) DOMINICK EBOLI MD (i)
(ii)		 482,033
0 		0
0 		286
0 		11,129
0 		1,763
0 		495,211
0 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 1A THE ORGANIZATION PAID FOR CERTAIN HEALTH CLUB DUES FOR EUGENE W. GROCHALA IN THE AMOUNT OF $40 DURING 2010. THIS AMOUNT WAS FULLY INCLUDED IN TAXABLE INCOME AND REPORTED ON HIS 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 4B THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THESE AMOUNTS WERE REPORTED AS EMPLOYEE BENEFIT PLAN CONTRIBUTIONS ON PRIOR YEARS FORMS 990. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2010 FORM W-2, AS TAXABLE WAGES: RONALD J. GUY, $705,014 AND PATRICIA V. CAVANAUGH, RN, MSN, $131,587. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN THESE INDIVIDUAL'S 2010 FORM W-2, AS TAXABLE WAGES: AL MAGHAZEHE, PH.D., FACHE, $380,525; RONALD J. GUY, $224,632; EUGENE W. GROCHALA, $60,861; STEPHEN A. MILLER, J.D., $30,851; LARRY DISANTO, $382,175; JAN GABIN, ESQ., $51,291; ROBERT REMSTEIN, D.O., $58,558; PATRICIA V. CAVANAUGH, RN, MSN, $41,453; NATHAN BOSK, FACHE, $46,674; TIMOTHY M. GRAHAM, $42,964; J. SCOTT CLEMMENSEN, $49,399; GREGORY N. D'ADAMO, $46,229; MARGARET SULLIVAN, $43,476; DENNIS DOOLEY, $43,798; LINDA DITE, $33,223 AND EILEEN M. HORTON, $18,135. THE ORGANIZATION HAS IMPLEMENTED AN AT RISK DEFERRED COMPENSATION PROGRAM WITH RESPECT TO THE CONSTRUCTION AND OPENING OF ITS NEW HOPEWELL HOSPITAL FACILITY. THE PROGRAM MAY PAY THESE INDIVIDUALS BASED UPON SPECIFIC CRITERIA BEING SATISFIED WITH RESPECT TO THE HOPEWELL HOSPITAL FACILITY BEING ON TIME AND UNDER BUDGET ("HOTUB"). ACCORDINGLY, THESE HOTUB AMOUNTS AS OUTLINED BELOW ARE ACCRUALS ONLY AND ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. AS A RESULT THESE INDIVIDUAL'S MAY NEVER RECEIVE THIS MONEY. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN THESE INDIVIDUAL'S 2010 FORM W-2, AS TAXABLE WAGES: AL MAGHAZEHE, PH.D., FACHE, $202,500; RONALD J. GUY, $148,500; EUGENE W. GROCHALA, $67,500; STEPHEN A. MILLER, J.D., $67,500; LARRY DISANTO, $148,500; JAN GABIN, ESQ., $84,375; ROBERT REMSTEIN, D.O., $67,500; PATRICIA V. CAVANAUGH, RN, MSN, $67,500; NATHAN BOSK, FACHE, $67,500; J. SCOTT CLEMMENSEN, $67,500; GREGORY N. D'ADAMO, $67,500; MARGARET SULLIVAN, $67,500; DENNIS DOOLEY, $84,375; LINDA DITE, $67,500 AND EILEEN M. HORTON, $67,500.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 5A THE FOLLOWING INDIVIDUALS RECEIVED INCENTIVE COMPENSATION PAYMENTS DURING CALENDAR YEAR 2010 WHICH INCENTIVE COMPENSATION PAYMENTS WERE INCLUDED IN COLUMN B (II) HEREIN AND IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. THESE INCENTIVE COMPENSATION PAYMENTS WERE BASED UPON A NUMBER OF FACTORS INCLUDING PRODUCTIVITY, PERFORMANCE AND REVENUES COLLECTED BY THE ORGANIZATION FOR PROFESSIONAL PHYSICIAN SERVICES RENDERED BY THESE INDIVIDUALS: EROL VEZNEDAROGLU, M.D., $1,860,503; KENNETH M. LIEBMAN, M.D., $1,832,503 AND JOHN D LIPANI, M.D., $96,663.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 7 THE FOLLOWING INDIVIDUALS RECEIVED INCENTIVE AWARDS DURING CALENDAR YEAR 2010 WHICH INCENTIVE AWARDS WERE INCLUDED IN COLUMN B (II) HEREIN AND IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. THESE INCENTIVE AWARDS WERE GIVEN PURSUANT TO THE ORGANIZATION'S 2010 INCENTIVE COMPENSATION PLAN (ICP), APPROVED BY THE BOARD COMPENSATION COMMITTEE, BASED ON ACHIEVEMENT OF PRE-ESTABLISHED SYSTEM-WIDE AND BUSINESS UNIT PERFORMANCE CRITERIA AND METRICS, AS WELL AS MEETING OR EXCEEDING SPECIFIC PERFORMANCE ON "CIRCUIT BREAKERS": LOUIS DAMELIO, M.D., $2,500; AL MAGHAZEHE, PH.D., FACHE, $420,787; RONALD J. GUY, $238,447; EUGENE W. GROCHALA, $91,292; STEPHEN A. MILLER, J.D., $57,845; LARRY DISANTO, $103,362; JAN GABIN, ESQ., $96,170; ROBERT REMSTEIN, D.O., $109,796; PATRICIA V. CAVANAUGH, RN, MSN, $72,283; NATHAN BOSK, FACHE, $87,513; TIMOTHY M. GRAHAM, $80,558; J. SCOTT CLEMMENSEN, $74,099; GREGORY N. D'ADAMO, $69,343; MARGARET SULLIVAN, $65,214; DENNIS DOOLEY, $65,697; LINDA DITE, $62,293; EILEEN M. HORTON, $42,428; ARLENE WALSH, $29,667 AND ARLINE M. STEPHAN, $27,810.
COMPENSATION INFORMATION SCHEDULE J, PART II; COLUMN F THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN F REPRESENTS AMOUNTS THAT WERE RECEIVED IN 2010 FOR SERVICES RENDERED IN PRIOR YEARS, AND REPORTED ON PRIOR FORMS 990. THESE AMOUNTS WERE TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5 MEDICARE WAGES AS FOLLOWS: RONALD J. GUY, $705,014 AND PATRICIA V. CAVANAUGH, RN, MSN, $131,587.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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 lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) 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 (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
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, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting 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 grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
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?
Yes No
(1) PRINCETON PIKE OFFICE PARK LLC TRUSTEE, JINGOLI 559,473 RENT   No
(2) MERCER MEDICAL ASSOCIATES PA TRUSTEE, SUDHAKAR 255,033 MEDICAL SERVICES   No
(3) WILLIS OF NEW YORK INC TRUSTEE, FAM MEMBER CO. 987,078 INSURANCE SERVICES   No
(4) RONA H REMSTEIN SPOUSE OF OFFICER 126,297 EMPLOYEE   No
(5) BAHRAM MAGHAZEHE BROTHER OF OFFICER 83,671 EMPLOYEE   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Identifier Return Reference Explanation
COMMUNITY BENEFIT STATEMENT CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS BACKGROUND ========== CAPITAL HEALTH SYSTEM, INC ("CAPITAL HEALTH") IS A GENERAL MEDICAL AND SURGICAL HOSPITAL. CAPITAL HEALTH IS RECOGNIZED BY THE IRS AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CAPITAL HEALTH PROVIDES MEDICALLY NECESSARY HEALTH CARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CAPITAL HEALTH OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1) CAPITAL HEALTH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S REGARDLESS OF ABILITY TO PAY; 2) CAPITAL HEALTH OPERATES EMERGENCY ROOMS AT BOTH OF ITS HOSPITAL CAMPUSES; REGIONAL AND MERCER; WHICH ARE OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3) CAPITAL HEALTH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4) CONTROL OF CAPITAL HEALTH RESTS WITH ITS BOARD OF DIRECTORS; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5) SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. WITH OVER A CENTURY OF SERVICE TO MERCER AND BUCKS COUNTIES, BOTH HELENE FULD AND MERCER MEDICAL CENTERS SHARED TRADITIONS OF CARING. WITH THE VISION OF BUILDING ON THAT SERVICE INTO THE MILLENNIUM, THEY CAME TOGETHER IN DECEMBER 1997 TO FORM CAPITAL HEALTH. THE NEW ORGANIZATION IS COMPRISED OF 621 BEDS, EMPLOYS NEARLY 3,700 INDIVIDUALS, AND GENERATES OVER 480 MILLION DOLLARS IN ANNUAL NET PATIENT SERVICE REVENUE. CAPITAL HEALTH REGIONAL AND MERCER CAMPUSES ARE SEPARATELY LICENSED ACUTE CARE HOSPITALS WITH 271 AND 350 BEDS; RESPECTIVELY. CAPITAL HEALTH BUILT A NEW KIND OF HEALTHCARE CENTER THAT PUTS FAMILY PHYSICIANS AND SPECIALISTS, STATE-OF-THE-ART TECHNOLOGIES, AND SAME-DAY SURGICAL SERVICES ALL IN ONE LOCATION. CAPITAL HEALTH IN HAMILTON, LOCATED AT 1445 WHITEHORSE-MERCERVILLE ROAD, AND SPANNING 46,293 SQUARE FEET, CREATES A "MEDICAL MALL" WHERE PATIENTS CAN SEEK A HOST OF SERVICES SUCH AS OUTPATIENT SURGERY, RADIOLOGICAL TESTING AND SPECIALIZED CARE. MOREOVER, IT IS AESTHETICALLY DESIGNED TO MAKE PATIENTS FEEL BETTER EVEN BEFORE SEEING A PHYSICIAN. THE FAMILY HEALTH CENTER AT CAPITAL HEALTH IS LOCATED AT 433 BELLEVUE AVENUE JUST ACROSS THE STREET FROM THE CAPITAL HEALTH MERCER CAMPUS. THE NEW 14,000 SQUARE FOOT LOCATION HELPS TO REDUCE PATIENT WAIT TIME AND EXPEDITE THE REGISTRATION PROCESS. THE $2.5 MILLION EXPANSION HAS ENABLED THE FAMILY HEALTH CENTER TO INCREASE FROM NINE TO 22 EXAM ROOMS, ALLOWING PATIENTS MORE PRIVACY AND CONFIDENTIALITY WHEN MEETING WITH THEIR DOCTORS. CAPITAL HEALTH IS GUIDED BY ITS DEDICATION TO THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES. THAT LEVEL OF DETERMINATION AND COMMITMENT IS THE VERY SOUL OF CAPITAL HEALTH. CAPITAL HEALTH PROVIDES HEALTH CARE SERVICES TO ALL PERSONS IN A NON-DISCRIMINATORY MANNER, REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGINS OR ABILITY TO PAY. MOREOVER, CAPITAL HEALTH PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY, AS DEFINED BY THE NEW JERSEY STATE ATTORNEY GENERAL, WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. CAPITAL HEALTH MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE AMOUNT OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. MISSION STATEMENT ================= THE MISSION OF CAPITAL HEALTH IS TO SERVE THE COMMUNITY BY PROVIDING THE HIGHEST QUALITY AND MOST COST EFFECTIVE HEALTH CARE TO ALL. CAPITAL HEALTH IS COMMITTED TO PROVIDING COMPREHENSIVE, QUALITY HEALTH CARE SERVICES, WHICH IMPROVE AND SUSTAIN THE HEALTH STATUS OF THE RESIDENTS PRIMARILY IN CENTRAL NEW JERSEY AND LOWER BUCKS COUNTY, PENNSYLVANIA. CAPITAL HEALTH ASSURES ACCESSIBLE, COMPASSIONATE HEALTH CARE SERVICES THAT HONOR THE DIGNITY OF EVERY PERSON. CAPITAL HEALTH WILL BE A LEADER IN DEFINING THE COMMUNITY'S HEALTH CARE NEEDS, IN PROVIDING APPROPRIATE SOLUTIONS, AND DEVELOPING A COMPREHENSIVE CONTINUUM OF CARE INCLUDING EDUCATION, PREVENTION, DISEASE MANAGEMENT AND RESTORATIVE PROGRAMS. AWARDS AND RECOGNITION ====================== CAPITAL HEALTH HAS RECENTLY RECEIVED THE FOLLOWING AWARDS AND RECOGNITIONS: AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES GOLD PLUS AWARD JOINT COMMISSION DISEASE SPECIFIC CERTIFICATION FOR HIV/AIDS JOINT COMMISSION DISEASE SPECIFIC CERTIFICATION FOR RESPIRATORY DISTRESS IN PRETERM INFANTS HEALTHCARE HEROES "HOSPITAL OF THE YEAR" ---------------------------------------- ACCORDING TO SURVEY SCORES SHOWING INCREASED PATIENT SATISFACTION IN THE FIRST TWO YEARS OF THE SURVEYS, PRESS GANEY ASSOCIATES HAS NAMED THE CAPITAL HEALTH MERCER CAMPUS AS A RECIPIENT OF THE 2007 PRESS GANEY COMPASS AWARD. CAPITAL HEALTH IS ONE OF ONLY TWELVE HEALTHCARE PROVIDERS IN THE COUNTRY WHO PARTICIPATE IN THE PRESS GANEY INPATIENT SURVEY TO RECEIVE THIS HONOR. AMONG HOSPITALS OF SIMILAR SIZE (300-449 BEDS) THAT PARTNER WITH PRESS GANEY, CAPITAL HEALTH IS ONE OF ONLY THREE HOSPITALS IN THE COUNTRY TO RECEIVE THE COMPASS AWARD IN 2007. MAGNET RE-DESIGNATION --------------------- IN 2006, THE AMERICAN NURSES CREDENTIALING CENTER (ANCC) HAS RECOGNIZED CAPITAL HEALTH'S EXEMPLARY NURSING LEADERSHIP AND QUALITY PATIENT CARE BY AWARDING ITS MAGNET RECOGNITION FOR EXCELLENCE IN NURSING SERVICE. MAGNET STATUS IS THE HIGHEST LEVEL OF RECOGNITION THE ANCC CAN EXTEND TO A HEALTHCARE ORGANIZATION. CAPITAL HEALTH HOSTED TWO ANCC APPRAISERS FOR A SITE VISIT AND THEIR RESULTS FOUND CAPITAL HEALTH TO BE THE DEFINITION OF EXCELLENCE SET FORTH BY THE SCOPE AND STANDARDS FOR NURSE ADMINISTRATORS AND OUTLINED BY THE CONGRESS OF NURSING PRACTICE OF THE AMERICAN NURSES ASSOCIATION (ANA). JOINT COMMISSION'S GOLD SEAL OF APPROVAL ---------------------------------------- THE JOINT COMMISSION IS AN INDEPENDENT, NOT-FOR-PROFIT, NATIONAL BODY THAT OVERSEES THE SAFETY AND QUALITY OF HEALTH CARE AND OTHER SERVICES PROVIDED IN ACCREDITED ORGANIZATIONS. BY AWARDING CAPITAL HEALTH THEIR GOLD SEAL OF APPROVAL, THE JOINT COMMISSION CONFIRMED THAT CAPITAL HEALTH IMPROVED THE ACCURACY OF PATIENT IDENTIFICATION, IMPROVED THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS, AND IMPROVED THE SAFETY OF USING MEDICATIONS. IN ADDITION, THE JOINT COMMISSION CONFIRMED THAT CAPITAL HEALTH REDUCED THE RISK OF HEALTH CARE-ASSOCIATED INFECTIONS, ACCURATELY AND COMPLETELY RECONCILE MEDICATIONS ACROSS THE CONTINUUM OF CARE, REDUCED THE RISK OF PATIENT HARM RESULTING FROM FALLS, ENCOURAGED PATIENTS' ACTIVE INVOLVEMENT IN THEIR OWN CARE AS A PATIENT SAFETY STRATEGY, AND CAPITAL HEALTH IDENTIFIED SAFETY RISKS INHERENT IN THE PATIENT POPULATION. STATEMENT FOR COMMUNITY HEALTH IMPROVEMENT & BENEFITS ===================================================== TO PROMOTE WELLNESS, PREVENT ILLNESS, AND REMOVE BARRIERS THAT HINDER ACCESS TO HEALTH CARE BY WORKING HAND-IN-HAND WITH THE COMMUNITIES SERVED. PRINCIPLES ---------- - CAPITAL HEALTH BELIEVES THAT COMMUNITY HEALTH IMPROVEMENT IS ESSENTIAL TO THE CAPITAL HEALTH MISSION. - CAPITAL HEALTH BELIEVES COMMUNITY-BASED COALITIONS ARE UNIQUELY QUALIFIED TO ACHIEVE COMMUNITY HEALTH GOALS, AND CAPITAL HEALTH VALUES PARTNERSHIPS WITH THEM. - CAPITAL HEALTH VALUES EVIDENCE-BASED PRACTICES AND SEEKS TO MODEL EXCELLENCE IN COMMUNITY HEALTH PRACTICE BASED ON EVIDENCE. - CAPITAL HEALTH BELIEVES IN APPLYING CONTINUOUS QUALITY IMPROVEMENT TO COMMUNITY HEALTH: MEASURING NEED, MATCHING RESOURCES TO NEED, MEASURING OUTCOMES, AND MAKING ADJUSTMENTS IN PROCESSES. OPERATIONAL VALUES ------------------ - INTEGRITY: ADHERES TO AN APPROPRIATE AND EFFECTIVE SET OF CORE BELIEFS INCLUDING HONESTY AND SERVING THE GREATER GOOD. DOES NOT BLAME OTHERS FOR HIS OR HER OWN MISTAKES OR MISREPRESENT HIM OR HER FOR PERSONAL GAIN OR PROTECTION. PERCEIVED BY OTHERS AS A DIRECT, TRUTHFUL INDIVIDUAL AND IS WIDELY TRUSTED, WITH THE ABILITY TO PRESENT THE TRUTH IN AN APPROPRIATE AND HELPFUL MANNER. - EXCELLENCE: PROVIDES THE MOST EFFICIENT AND EFFECTIVE WORK PROCESSES TO MEET THE NEEDS OF PATIENTS AND OTHER CUSTOMERS, WHICH LEADS TO THE HIGHEST QUALITY SERVICES. MAKES SOUND DECISIONS BASED UPON KNOWLEDGE, JUDGMENT, AND EXPERIENCE, AND IS SOUGHT OUT BY OTHERS FOR ADVICE AND SOLUTIONS TO ISSUES AND PROBLEMS. - COMPASSION: DEMONSTRATES CARING AND CONCERN FOR THE WELFARE OF OTHERS, ASSISTING WHEREVER NECESSARY. USES UNDERSTANDING AND INSIGHT WHEN DEALING WITH PATIENTS OR OTHER CUSTOMERS IN ALL ASPECTS OF CARE OR SERVICE DELIVERY.
COMMUNITY BENEFIT STATEMENT (CONTINUED) CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - TEAMWORK: DISPLAYS A PROFESSIONAL AND COLLABORATIVE SPIRIT IN FULFILLING RESPONSIBILITIES AND ASSISTING OTHERS. HELPS TO CREATE AND MAINTAIN POSITIVE MORALE WITH HIS OR HER TEAM, SHARING IN SUCCESSES, WORKING THROUGH PROBLEMS. FOSTERS OPEN DIALOGUE, AND WORKS TOWARDS CREATING AN ATMOSPHERE WHERE OUTCOMES AND SUCCESS ARE BENEFICIAL TO THE TEAM AND/OR THE ORGANIZATION AT LARGE. VISION ------ CAPITAL HEALTH WILL BE THE PREMIER COMMUNITY-BASED HEALTH CARE PROVIDER IN NEW JERSEY. CAPITAL HEALTH WILL CONSTANTLY STRIVE TO SUSTAIN THE HIGHEST PROFESSIONAL QUALITY STANDARDS, TO EXCEED EXPECTATIONS OF THOSE SERVED AND TO PROMOTE A POSITIVE WORK ENVIRONMENT. CAPITAL HEALTH'S SUCCESS WILL BE BUILT UPON CARING, COMPASSION, CREATIVITY, INTEGRITY, RESPECT, SERVICE, AND TEAMWORK. SERVICE CULTURE INITIATIVE -------------------------- CAPITAL HEALTH IS DEDICATED TO HIGH QUALITY PERFORMANCE AND TO EXCEEDING CUSTOMER EXPECTATIONS WITHIN A SUPPORTIVE AND FRIENDLY ENVIRONMENT. EACH EMPLOYEE HAS A RESPONSIBILITY AND IS ACCOUNTABLE FOR PROVIDING OPTIMUM SATISFACTION TO THE PATIENTS AND THEIR FAMILIES, PHYSICIANS AND COWORKERS. SERVICE CULTURE INITIATIVE VISION STATEMENT ------------------------------------------- - CAPITAL HEALTH COMMITS TO THE NEEDS OF THE COMMUNITY SERVED. THROUGH EXCELLENT SERVICE AND CARE, CAPITAL HEALTH ACHIEVES SUCCESSFUL PATIENT OUTCOMES. - CAPITAL HEALTH ADHERES TO A STANDARD OR POSITIVE BEHAVIOR. THIS MUST INCLUDE POSITIVE FIRST IMPRESSIONS, APPROPRIATE COMMUNICATION, PROFESSIONAL APPEARANCE AND THE REALIZATION THAT THEY ARE DEALING WITH PEOPLE'S LIVES. - CAPITAL HEALTH CREATES AN ENVIRONMENT CONDUCIVE TO POSITIVE RELATIONSHIPS. BY HAVING EFFICIENT AND EFFECTIVE SYSTEMS, CAPITAL HEALTH IMPROVES QUALITY CARE AND SERVICE DELIVERY. - CAPITAL HEALTH ACCEPTS THE CHALLENGE OF SERVICE CULTURE IMPROVEMENT AS A BUSINESS STRATEGY. IT IS NOT ONLY THE NICE THING TO DO, BUT THE RIGHT THING TO DO TO ASSURE THE GROWTH OF CAPITAL HEALTH. - CAPITAL HEALTH RECOGNIZES EXCELLENT SERVICE CULTURE PERFORMANCE. AFFILIATIONS/ COLLABORATION --------------------------- CENTERS OF EXCELLENCE ===================== BEHAVIORAL HEALTH ----------------- CAPITAL HEALTH HAS BEEN DESIGNATED THE REGIONAL EMERGENCY MENTAL HEALTH SERVICES CENTER IN MERCER COUNTY, NEW JERSEY. CAPITAL HEALTH IS AVAILABLE 24-HOURS-A-DAY, SEVEN DAYS A WEEK FOR ANYONE EXPERIENCING AN URGENT MENTAL HEALTH PROBLEM. CAPITAL HEALTH ALSO MAINTAINS A MOBILE OUTREACH PROGRAM TO PROVIDE SERVICES TO CLIENTS AT HOME OR AT THE SITE OF THE CRISIS. CAPITAL HEALTH OFFERS Y.E.S., A YOUTH EMERGENCY SERVICE PROGRAM. Y.E.S. IS A FULL-SERVICE PSYCHIATRIC INTERVENTION AND SUICIDE PREVENTION PROGRAM. SERVICES INCLUDE CRISIS INTERVENTION, EMERGENCY ASSESSMENT, PSYCHIATRIC EVALUATION AND TREATMENT BY A BOARD-CERTIFIED CHILD PSYCHIATRIST AS NEEDED, HOME OR SCHOOL VISITS, REFERRAL FOR ONGOING TREATMENT AND ADMISSION TO A PRIVATE PSYCHIATRIC HOSPITAL. CYBERKNIFE ---------- CAPITAL HEALTH IS OFFERING CYBERKNIFE RADIOSURGERY SYSTEM, THE WORLD'S MOST ACCURATE RADIOSURGERY DEVICE THAT ALLOWS PHYSICIANS TO TREAT TUMORS AND LESIONS ANYWHERE IN THE BODY WITH SUB-MILLIMETER ACCURACY. USED AS A NONINVASIVE ALTERNATIVE TO CONVENTIONAL SURGERY IN CANCER PATIENTS AS WELL AS OTHER MEDICAL CONDITIONS, CYBERKNIFE ENSURES THE MOST ACCURATE TARGETING OF TUMORS, ALLOWING FOR LESS TRAUMA TO HEALTHY TISSUE AND QUICKER RECOVERY TIME FOR PATIENTS. THE CYBERKNIFE CENTER AT CAPITAL HEALTH IS THE ONLY HOSPITAL IN MERCER AND BUCKS COUNTIES TO OFFER THIS TECHNOLOGICAL BREAKTHROUGH. DA VINCI SURGICAL SYSTEM ------------------------ THE DA VINCI SURGICAL SYSTEM COMBINES SUPERIOR 3D VISUALIZATION ALONG WITH GREATLY ENHANCED DEXTERITY, PRECISION AND CONTROL IN AN INTUITIVE, ERGONOMIC INTERFACE WITH BREAKTHROUGH SURGICAL CAPABILITIES. THE DA VINCI SURGICAL SYSTEM AT CAPITAL HEALTH'S REGIONAL MEDICAL CENTER IS CURRENTLY BEING USED AS A MINIMALLY INVASIVE OPTION FOR PATIENTS IN NEED OF PROSTATE CANCER TREATMENT (PROSTATECTOMY) OR GYNECOLOGY PROCEDURES. THE FIRST PROCEDURES AT CAPITAL HEALTH WERE RECENTLY PERFORMED SUCCESSFULLY AT THE REGIONAL CAMPUS. THE DA VINCI SURGICAL SYSTEM IS IMPROVING PATIENT EXPERIENCES AND OUTCOMES BY FUNDAMENTALLY CHANGING SURGERY BY SIMPLIFYING MANY EXISTING MINIMALLY INVASIVE SURGICAL (MIS) PROCEDURES, MAKING DIFFICULT MIS OPERATIONS ROUTINE, MAKING NEW MIS PROCEDURES POSSIBLE, AND IMPROVING PATIENT OUTCOMES. DIABETES SERVICES ----------------- DIABETES CARE AT CAPITAL HEALTH IS AN OUTPATIENT COMPREHENSIVE REFERRAL BASED DIABETES EDUCATION PROGRAM THAT EMPOWERS PATIENTS TO TAKE CONTROL IN THE SUCCESSFUL MANAGEMENT OF THEIR DISEASE. CAPITAL HEALTH'S EDUCATION MODEL, WHERE THE PATIENT IS THE CENTRAL PLAYER, IS WIDELY RECOGNIZED AS THE BEST MODEL TO USE TO HELP THE PATIENT ACHIEVE OPTIMAL HEALTH RELATED OUTCOMES.CAPITAL HEALTH WORKS CLOSELY WITH PRIMARY CARE PHYSICIANS WHO CONTINUE TO MONITOR EACH INDIVIDUAL'S MEDICAL PROBLEMS. EMERGENCY SERVICES ------------------ THE CAPITAL AREA REGIONAL TRAUMA CENTER, THE LEVEL II TRAUMA CENTER AT CAPITAL HEALTH - REGIONAL MEDICAL CENTER, IS ONE OF ONLY 10 DESIGNATED TRAUMA CENTERS IN NEW JERSEY. CAPITAL HEALTH PROVIDES COMPREHENSIVE CARE FROM THE TIME OF INJURY THROUGH REHABILITATION. THE CAPITAL HEALTH CENTER MEETS HIGH NATIONAL STANDARDS FOR PATIENT CARE AND TEACHING. THE CAPITAL AREA REGIONAL TRAUMA CENTER IS A NEW JERSEY STATE DESIGNATED TRAUMA CENTER. THE DESIGNATION PROCESS INVOLVES DETAILED REGULAR INSPECTIONS BY NATIONAL AND STATE ORGANIZATIONS TO ASSURE HIGH STANDARDS OF CARE. CAPITAL HEALTH IS THE REGIONAL REFERRAL CENTER FOR INJURED PATIENTS IN MERCER COUNTY AND ADJACENT PARTS OF SOMERSET, HUNTERDON, BURLINGTON, AND MIDDLESEX COUNTIES AS WELL AS NEARBY AREAS OF PENNSYLVANIA. DESIGNATED TRAUMA CENTERS CARE FOR SEVERELY INJURED PATIENTS AS WELL AS VICTIMS OF ACCIDENT TYPES KNOWN TO BE ASSOCIATED WITH A HIGH RISK FOR INJURY. TRAUMA PATIENTS INCLUDE PERSONS INVOLVED IN MOTOR VEHICLE CRASHES, FALLS, AND ASSAULTS WITH KNIVES, GUNS, OR BLUNT OBJECTS. TRAUMA CENTERS HAVE THE LATEST TECHNOLOGY AND EXPERIENCED STAFF AVAILABLE TO CARE FOR YOUR FAMILY MEMBER. BESIDES PROVIDING CARE TO THE INJURED, TRAUMA CENTERS ARE ALSO ACTIVE PARTNERS WITH THE COMMUNITY IN INJURY PREVENTION AND PUBLIC EDUCATION. MATERNITY --------- FROM ROUTINE DELIVERIES TO HIGH-RISK NEEDS, CAPITAL HEALTH'S GREAT EXPECTATIONS PROGRAM PROVIDES A FULL RANGE OF PRENATAL, OBSTETRICAL, POSTPARTUM, AND NEONATAL CARE OPTIONS TO MAKE SURE YOUR NEW FAMILY HAS THE GREATEST CHANCE FOR A HEALTHY BEGINNING. THE MATERNITY UNIT ON THE MERCER CAMPUS IS MERCER COUNTY'S ONLY REGIONAL PERINATAL CENTER AND THE ONLY LEVEL III NEONATAL INTENSIVE CARE UNIT. CAPITAL HEALTH IS THE ONLY HEALTHCARE PROVIDER IN THE REGION TO HAVE IN-HOUSE COVERAGE BY OBSTETRICIANS, MIDWIVES, NEONATOLOGISTS, AND ANESTHESIOLOGISTS 24 HOURS A DAY, SEVEN DAYS A WEEK. AND, CAPITAL HEALTH WAS CHOSEN AS NEW JERSEY'S FIRST SITE TO HOUSE A NEW PROGRAM CALLED MARCH OF DIMES FAMILY SUPPORT. THE PROGRAM PROVIDES INFORMATION AND EMOTIONAL SUPPORT TO FAMILIES OF CRITICALLY ILL NEWBORNS BEING CARED FOR IN THE NEONATAL INTENSIVE CARE UNIT. ALSO, THE COMPREHENSIVE CHILDBIRTH AND PARENT EDUCATION SERVICES HELPS PREPARE INDIVIDUALS TO BE THE BEST PARENT POSSIBLE BY TEACHING ABOUT THE PROCESS OF BIRTH AND HOW TO CARE FOR YOUR INFANT. THE INSTITUTE FOR NEUROSCIENCES ------------------------------- AT THE INSTITUTE, PATIENTS FIND EXPERT PHYSICIANS WHO PRACTICE MEDICINE IN A BROAD ARRAY OF SPECIALTIES, LEADING-EDGE TECHNOLOGY, AND MUCH MORE, ALL WITHIN A CAREFULLY COORDINATED CARE PLAN CREATED FOR THE PATIENTS. WITHIN THE INSTITUTE FOR NEUROSCIENCES, THE CENTERS OF EXCELLENCE INCLUDE: - THE SPINE WELLNESS CENTER - THE CENTER FOR SPINAL DIAGNOSTICS AND INTERVENTIONAL PAIN MANAGEMENT - THE CYBERKNIFE CENTER - THE CEREBROVASCULAR CENTER - THE NEUROSURGERY CENTER - THE NEURO-ONCOLOGY CENTER - THE EPILEPSY CENTER ONCOLOGY -------- CAPITAL HEALTH HAS CONSISTENTLY OFFERED PATIENTS A CLOSELY INTEGRATED TEAM OF MEDICAL, SURGICAL, RADIATION, AND ALLIED CANCER SPECIALISTS WHO USE THEIR KNOWLEDGE AND EXPERIENCE TO PROVIDE CUTTING-EDGE CANCER TREATMENT CLOSE TO HOME. WHEN ONE CHOOSES CAPITAL HEALTH FOR CANCER CARE, ONE SELECTS BOARD CERTIFIED PHYSICIANS WHO REMAIN WITH THE PATIENT FROM DIAGNOSIS THROUGH TREATMENT. WORKING TOGETHER, CAPITAL HEALTH OFFERS A COMPASSIONATE APPROACH TO ASSIST PATIENTS WITH EVERY ASPECT OF CANCER CARE, INCLUDING SCREENING, DIAGNOSIS, TREATMENT, RECOVERY, AND SURVIVORSHIP.
COMMUNITY BENEFIT STATEMENT (CONTINUED) CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS THE REGIONAL CANCER CENTER (RCC) AT CAPITAL HEALTH IS COMMITTED TO PROVIDING COMPREHENSIVE QUALITY ONCOLOGY HEALTH CARE SERVICES, TO HELP IMPROVE AND SUSTAIN THE HEALTH STATUS OF RESIDENTS LIVING PRIMARILY IN CENTRAL NEW JERSEY AND LOWER BUCKS COUNTY. CAPITAL HEALTH STRIVES TO IMPROVE AND EXTEND THE QUALITY OF LIFE FOR THE PATIENT WITH CANCER. THE RCC WILL BE A LEADER IN DEFINING THE COMMUNITY'S CANCER CARE NEEDS BY PROVIDING APPROPRIATE PLANS THROUGH A COMPREHENSIVE CONTINUUM OF CARE, WHICH INCLUDES EDUCATION, PREVENTION, SCREENING, DIAGNOSIS, TREATMENT, SYMPTOM MANAGEMENT, SUPPORTIVE CARE AND SURVIVORSHIP PROGRAMS. CAPITAL HEALTH'S SUCCESS WILL BE BUILT UPON CARE, COMPASSION, CREATIVITY, INTEGRITY, RESPECT, SERVICE, STATE-OF-THE-ART TECHNOLOGY AND MULTIDISCIPLINARY TEAMWORK. PEDIATRICS ---------- CAPITAL HEALTH'S MERCER CAMPUS IS HOME TO THE ONLY LEVEL III NEONATAL INTENSIVE CARE UNIT (NICU) AND IN-PATIENT PEDIATRIC UNIT IN MERCER COUNTY. CAPITAL HEALTH'S PEDIATRIC EMERGENCY SERVICES ENSURES NO CHILD WILL WAIT FOR EMERGENCY CARE. THE PEDIATRIC HOSPITALIST PROGRAM GIVES PEDIATRIC PATIENTS AND THEIR PHYSICIANS AROUND-THE-CLOCK ACCESS TO IN-HOUSE PEDIATRICIANS. RADIOLOGY SERVICES ------------------ CAPITAL HEALTH HAS AN ARSENAL OF THE MOST STATE-OF-THE-ART TECHNOLOGY TOOLS THAN ANY OTHER HEALTHCARE SYSTEM IN THE REGION. AS THE REGION'S TECHNOLOGY LEADER, CAPITAL HEALTH IS THE FIRST TO OFFER FULL-TIME, ONSITE PET SCAN TECHNOLOGY. THE FULL-SERVICE IMAGING SUITE BOASTS A NEW GENERATION SPIRAL CT ULTRA SCANNER EQUIPPED TO PERFORM COMPUTERIZED TOMOGRAPHY(CAT SCANS) AND A MAGNETIC RESONANCE IMAGING(MRI) MACHINE THAT FEATURES THE SHORTEST HIGH-FIELD MAGNET IN THE INDUSTRY. SLEEP CENTER ------------ CAPITAL HEALTH HAS BEEN PROVIDING COMPREHENSIVE EVALUATION AND TREATMENT FOR SLEEP RELATED PROBLEMS FOR MORE THAN 20 YEARS AND CAPITAL HEALTH WAS THE FIRST IN MERCER COUNTY. AT THE PRESENT TIME, CAPITAL HEALTH IS THE LARGEST FULLY ACCREDITED SLEEP CENTER IN MERCER AND BUCKS COUNTIES. BETWEEN BOTH CAMPUSES, CAPITAL HEALTH OFFERS FOURTEEN PRIVATE ROOMS DEDICATED TO SLEEP TESTING FOR PATIENTS WHO HAVE A WIDE VARIETY OF PROBLEMS RELATED TO SLEEP AND WAKEFULNESS. AS SLEEP CENTERS FULLY ACCREDITED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE, CAPITAL HEALTH ENSURES THAT ALL PATIENTS TREATED AT CAPITAL HEALTH BENEFIT FROM A COMPLETE SLEEP EVALUATION AND INDIVIDUALIZED TREATMENT PLAN. DEFINITION OF COMMUNITY AND POPULATION SERVED --------------------------------------------- CAPITAL HEALTH DEFINES ITS COMMUNITY AS THE CITY OF TRENTON, MERCER COUNTY AND BUCKS COUNTY. TRENTON, N.J. IS LOCATED IN MERCER COUNTY ACROSS THE DELAWARE RIVER FROM BUCKS COUNTY, PA. TRENTON WAS ONCE A CENTER FOR INDUSTRY IN THE LATE 1800'S AND EARLY 1900'S, BUT HAS SEEN DRAMATIC ECONOMIC DEVELOPMENT CHALLENGES FOR MOST OF THE 20TH CENTURY. ACCORDING TO THE 2000 U.S. CENSUS, ITS 1999 MEDIAN HOUSEHOLD INCOME WAS $31,074, BY FAR THE LOWEST IN MERCER COUNTY, WHERE THE OVERALL MEDIAN HOUSEHOLD INCOME WAS $56,612. TRENTON WAS THE ONLY MUNICIPALITY IN THE COUNTY TO EXPERIENCE A DECREASE IN ITS POPULATION BETWEEN 1990 AND 2000 AS ITS NUMBER OF RESIDENTS FELL 3.7 PERCENT TO 85,403. TRENTON ALSO HAS THE HIGHEST NUMBER AND PERCENTAGE OF MINORITIES IN MERCER COUNTY WITH A PREDOMINANTLY AFRICAN-AMERICAN POPULATION OF 44,465 RESIDENTS OR 52.1 PERCENT. HISPANICS OR LATINOS OF ANY RACE CONSTITUTED 18,391 RESIDENTS OR 21.5 PERCENT, WHILE CAUCASIANS WERE NUMBERED AT 27,802 OR 32.6 PERCENT. COMMUNITY BENEFITS FOR FY 2008 ============================== OUTLINED BELOW ARE A NUMBER OF CAPITAL HEALTH COMMUNITY BENEFIT PROGRAMS. THE INFORMATION IS NOT INTENDED TO BE ALL-INCLUSIVE BUT RATHER PROVIDES ADDITIONAL INFORMATION THAT FURTHER DEMONSTRATES HOW CAPITAL HEALTH BENEFITS THE SURROUNDING COMMUNITY IN FURTHERANCE OF ITS CHARITABLE TAX-EXEMPT PURPOSES. CAPITAL HEALTH CHILDBIRTH AND PARENT EDUCATION PROGRAM ------------------------------------------------------ BENEFIT ACTIVITY: PREPARED CHILDBIRTH CLASSES IN SPANISH LANGUAGE THE CHILDBIRTH AND PARENT EDUCATION PROGRAM PROVIDES, FREE OF CHARGE, A FULL-DAY PREPARED CHILDBIRTH CLASS TO SPANISH-SPEAKING EXPECTANT PARENTS FROM THEIR COMMUNITY. THE CLASS IS HELD EVERY OTHER MONTH AND IS TAUGHT BY A CAPITAL HEALTH CERTIFIED CHILDBIRTH AND PARENT EDUCATOR WHO IS FLUENT IN SPANISH. CULTURALLY APPROPRIATE METHODS AND AUDIO-VISUAL MATERIALS ARE UTILIZED IN THE TEACHING OF THIS CLASS. PARTICIPANTS RECEIVE FREE BREAKFAST AND LUNCH. PARTICIPANTS RECEIVE SPANISH LANGUAGE REFERENCE MATERIALS AND AN EXTENSIVE HANDBOOK. REFERRALS TO THIS CLASS COME FROM THE CAPITAL HEALTH HEALTH START PRENATAL CLINIC, A COMMUNITY PARTNERSHIP WITH CUNA, AND BY WORD-OF-MOUTH. LACTATION SERVICES ------------------ IN 2000, THE BREASTFEEDING RATE AT CAPITAL HEALTH START CLINIC FOR ANY BREASTFEEDING WAS 40 PERCENT. EXCLUSIVE BREASTFEEDING WAS ONLY 14 PERCENT. THROUGH EDUCATIONAL PROGRAMS AND ONE-TO-ONE SUPPORT WITH INCREASES IN SERVICES, THE CAPITAL HEALTH HEALTH START CLINIC AS OF 2005 DEMONSTRATED A 69 PERCENT BREASTFEEDING INITIATION RATE AND A 34 PERCENT EXCLUSIVE BREASTFEEDING RATE. SUPPORT PROGRAMS FOR THIS VULNERABLE POPULATION HAVE BEEN INSTRUMENTAL IN THESE DRAMATIC INCREASES. THESE RATES EXCEED THOSE OF OTHER CITIES SUCH AS NEWARK, PHILADELPHIA AND BALTIMORE. MERCER AREA EARLY INTERVENTION SERVICES --------------------------------------- CAPITAL HEALTH MERCER AREA EARLY INTERVENTION SERVICES PROVIDE AT-RISK MINORITY ADULTS/ADOLESCENTS IN THE CITY OF TRENTON AND ITS SURROUNDING COMMUNITIES WITH HIV/AIDS OUTREACH. THEIR OUTREACH INCLUDES HIV EDUCATION, HIV TESTING AND COUNSELING, AND IMMEDIATE ACCESS TO TREATMENT AND SUPPORT SERVICES FOR INDIVIDUALS IDENTIFIED WITH HIV INFECTION. CAPITAL HEALTH COLLABORATES WITH OTHER LOCAL ORGANIZATIONS, SCHOOLS, AND CHURCHES THROUGH A MINIMUM OF SIX COMMUNITY AWARENESS/EDUCATION EVENTS THROUGHOUT THE YEAR. TRAUMA EDUCATION ---------------- THE CAPITAL AREA REGIONAL TRAUMA CENTER AT CAPITAL HEALTH OFFERS FREE IN.J.URY PREVENTION PROGRAMS TO MEMBERS OF THE COMMUNITY THAT INCLUDE PEDESTRIAN SAFETY, BICYCLE SAFETY, SEAT BELT SAFETY, PROPER USE OF CHILD SAFETY SEATS, AND HOME SAFETY. CAPITAL HEALTH SCHOOL OF NURSING -------------------------------- THE CAPITAL HEALTH SCHOOL OF NURSING WAS ESTABLISHED IN 2000 AND COMBINES A RICH HISTORY OF BOTH MERCER MEDICAL CENTER (1895) AND HELENE FULD (1890) SCHOOLS OF NURSING. IT CARRIES OVER A CENTURY OF EXCELLENCE IN EDUCATING HEALTH CARE PROFESSIONALS. THE CAPITAL HEALTH SCHOOL OF NURSING IS A TWO-YEAR COOPERATIVE PROGRAM WITH MERCER COUNTY COMMUNITY COLLEGE (MCCC). EVERY CANDIDATE WHO IS ACCEPTED TO THE CAPITAL HEALTH SCHOOL OF NURSING IS A RECIPIENT OF THE HELENE FULD TRENTON TRUST SCHOLARSHIP THAT PROVIDES TUITION FOR ALL NURSING COURSES TAUGHT AT THE CAPITAL HEALTH SCHOOL OF NURSING. IN ADDITION, STUDENTS MAY APPLY FOR VARIOUS SCHOLARSHIPS PROVIDED THROUGH THE CAPITAL HEALTH FOUNDATION. THE MAIN CAMPUS IS LOCATED IN AN URBAN AREA RICH IN HISTORY AND WITHIN EASY REACH OF PRINCETON, PHILADELPHIA, AND BUCKS COUNTY. MCCC IS LOCATED IN A BEAUTIFUL SUBURBAN LOCATION IN WEST WINDSOR TOWNSHIP APPROXIMATELY SIX MILES FROM THE SCHOOL. ALL NURSING COURSES ARE OFFERED AT THE NURSING SCHOOL, WHILE BASIC HUMANITIES AND SCIENCE COURSES ARE TAUGHT AT THE COLLEGE. UPON COMPLETION OF THIS PROGRAM, GRADUATES ARE AWARDED A DIPLOMA FROM CAPITAL HEALTH AND AN ASSOCIATE IN SCIENCE DEGREE FROM MCCC. GRADUATES ARE ELIGIBLE TO MATRICULATE WITH INSTITUTIONS OF HIGHER LEARNING FOR A BACHELOR OF SCIENCE IN NURSING DEGREE. GRADUATES HAVE PROVEN THEIR COMPETENCY WITH CONSISTENTLY HIGH PASSING RATES ON THE NATIONAL COUNCIL LICENSING EXAMINATION FOR REGISTERED NURSES. THE NEW JERSEY BOARD OF NURSING AND THE NATIONAL LEAGUE FOR NURSING ACCREDITING COMMISSION ACCREDIT THE CAPITAL HEALTH SCHOOL OF NURSING. CONNECTING WITH THE LATINO COMMUNITY ------------------------------------ ENLACE ("LINK" IN SPANISH) IS A NAME FOR AN INNOVATIVE CAPITAL HEALTH PROGRAM DESIGNED TO CREATE CONTACTS AND CONNECTIONS WITHIN THE LATINO COMMUNITY. THROUGH ENLACE, CAPITAL HEALTH PROVIDES MEDICAL INTERPRETING AND HAS TRANSLATED ALL VITAL MEDICAL DOCUMENTS AND ARE NOW DOING THE SAME WITH PATIENT EDUCATION MATERIALS. ENLACE ALSO HELPS EDUCATE THE LATINO COMMUNITY ABOUT AMERICAN CUSTOMS AND HEALTHCARE PRACTICES AND PROVIDES CAPITAL HEALTH STAFF WITH INFORMATION ABOUT LATINO CULTURES. ANOTHER PROGRAM, CUNA (WHICH IS SPANISH FOR "CRIB"), CONNECTS LATINO WOMEN WITH PRE- AND POST-NATAL CARE, AND HELPS NEW MOTHERS OVERCOME LANGUAGE BARRIERS TO BETTER UNDERSTAND HEALTH ISSUES. CUNA ALSO OFFERS HELP WITH NUTRITION, COPING SKILLS AND EVEN BABYSITTING FOR OLDER CHILDREN.
COMMUNITY BENEFIT STATEMENT (CONTINUED) CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS COMMUNITY HEALTH EDUCATION -------------------------- CAPITAL HEALTH'S COMMUNITY HEALTH EDUCATION DEPARTMENT (CHE) IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITY, AS WELL AS TO THE PREVENTION AND EARLY DETECTION OF DISEASE AMONG PEOPLE LIVING IN OUR COMMUNITY. THESE GOALS ARE ACCOMPLISHED BY PROVIDING HEALTH EDUCATION AND OTHER RELATED SERVICES TO THE GENERAL PUBLIC, AS WELL AS TO BUSINESS ORGANIZATIONS. THESE SERVICES CONSIST OF THE SPEAKER'S BUREAU, HEALTH FAIRS/HEALTH SCREENINGS, HEALTH EDUCATION LECTURE SERIES AND SUPPORT GROUPS, WALKING CLUBS, HEALTH INFORMATION CENTER, WELLNESS SPA, AND A PARTNERSHIP WITH THE MERCER COUNTY TOBACCO QUIT CENTER. PROGRAMS ARE HELD IN VARIOUS LOCATIONS THROUGHOUT MERCER AND BUCKS COUNTIES, WITH TOPICS INCLUDING DIABETES EDUCATION, PERIPHERAL VASCULAR DISEASE AWARENESS, HEALTHY EATING, CANCER GENETICS, WOMEN'S HEALTH AND INTEGRATIVE MODALITIES, MODALITIES SUCH AS YOGA. THE CHE DEPARTMENT PROVIDES A SERIES OF DIVERSE HEALTH EDUCATION PROGRAMS, RELATED TO HEALTH MAINTENANCE, DISEASE PREVENTION, EARLY DETECTION, GENERAL WELLNESS AND PERSONAL DEVELOPMENT. A SCHEDULE OF THE PROGRAMS, SCREENINGS AND SUPPORT GROUPS MAY BE VIEWED ONLINE AT: WWW.CAPITALHEALTH.ORG/MEDICAL_SERVICES/CHED.HTML OR IN THE COMMUNITY HEALTH EDUCATION PUBLICATION, "REGARDING YOUR HEALTH." THIS PUBLICATION IS MAILED TO 80,000 HOMES IN THE SURROUNDING MERCER AND BUCKS COUNTY AREAS. CALL CENTER & WEBSITE --------------------- IMMEDIATE ACCESS TO CAPITAL HEALTH IS PROVIDED THROUGH A FREE CALL CENTER, WHICH OFFERS PHYSICIAN REFERRALS TO OVER 700 PHYSICIANS IN MORE THAN 40 SPECIALTIES, REGISTRATION FOR COMMUNITY HEALTH PROGRAMS, DIRECTIONS, AND INFORMATION ABOUT CAPITAL HEALTH PROGRAMS AND SERVICES. CAPITAL HEALTH'S WEBSITE (WWW.CAPITALHEALTH.ORG) BRINGS A WEALTH OF HEALTHCARE INFORMATION TO YOU WITH JUST THE CLICK OF A MOUSE. THE HOMEPAGE IS DESIGNED FOR EASY NAVIGATION, AND CAPITAL HEALTH OFFERS EASY ACCESS TO MEDLINE PLUS HEALTH RESOURCES, INTERACTIVE FEATURES SUCH AS "ASK THE EXPERTS," QUIZZES, POLLS, AND SURVEYS, ONLINE PHYSICIAN DIRECTORY WITH PHYSICIAN PHOTOS AND BIOS, AND LINKS TO NUMEROUS PATIENT RESOURCES. COMMUNITY SPONSORSHIPS ---------------------- CAPITAL HEALTH IS PROUD TO SPONSOR MANY LOCAL ORGANIZATIONS IN MERCER AND BUCKS COUNTY THROUGH IN-KIND AND MONETARY DONATIONS. CAPITAL HEALTH SUPPORTS A VARIETY OF CIVIC AND CULTURAL ORGANIZATIONS THAT WORK TO IMPROVE THE WELL BEING OF THE COMMUNITY. LOCAL CHAPTERS OF NATIONAL ORGANIZATIONS ---------------------------------------- THE NATIONAL ORGANIZATION OF WOMEN, NAACP TRENTON BRANCH, BOY SCOUTS OF AMERICA, GIRL SCOUTS OF DELAWARE, NATIONAL CONGRESS OF BLACK WOMEN, AMERICAN HEART ASSOCIATION, MARCH OF DIMES, AMERICAN CANCER SOCIETY, AMERICAN RED CROSS, UNITED NEGRO COLLEGE FUND. NON-PROFIT, CIVIC AND CULTURAL ORGANIZATIONS -------------------------------------------- TRENTON COUNCIL OF CIVIC ASSOCIATION, EGGERS CROSSING COMMUNITY DEVELOPMENT CORPORATION, SHILOH COMMUNITY DEVELOPMENT CORPORATION, WOMAN SPACE, INC., MENTOR POWER OF LAWRENCE TOWNSHIP, LIFE TIES, ENABLE, INC., SERVE, MERCER COUNTY IMPROVEMENT AUTHORITY, TRENTON HISTORICAL SOCIETY, THE CRISIS MINISTRY, NAMI MERCER N.J., CATHOLIC CHARITIES, CYO, MERCER ALLIANCE TO END HOMELESSNESS, ISLES, INC., TRENTON EDUCATION DANCE INSTITUTE, TRENTON ALUMNAE FORTITUDE CORPORATION, YWCA OF PRINCETON, ARC MERCER, GREATER TRENTON YMCA, CHILDREN HOME SOCIETY, MOBILE MEALS OF TRENTON/EWING, BUCKS COUNTY PERFORMING ARTS CENTER, SUCCESS LINKS, LLC, TRENTON FILM FESTIVAL, BOHEME OPERA, PASSAGE THEATRE COMPANY, TRENTON DOWNTOWN ASSOCIATION, KIDSBRIDGE KID'S MUSEUM EDUCATION --------- TRENTON CENTRAL HIGH SCHOOL, STEINER HIGH SCHOOL, EWING HIGH SCHOOL, THE COLLEGE OF NEW JERSEY, RIDER COLLEGE. FOUNDATIONS ----------- TRENTON PUBLIC EDUCATION FOUNDATION, MERCER COUNTY COMMUNITY COLLEGE FOUNDATION, WOMEN'S HEART FOUNDATION, ANCHOR HOUSE FOUNDATION, SUNSHINE FOUNDATION, THE MILL HILL FOUNDATION, THOMAS EDISON STATE COLLEGE FOUNDATION CHAMBERS OF COMMERCE'S ---------------------- MERCER REGIONAL CHAMBER OF COMMERCE, PRINCETON CHAMBER OF COMMERCE ATHLETIC -------- NATIONAL JUNIOR TENNIS LEAGUE, EWING TOWNSHIP LITTLE LEAGUE, HAMILTON POLICE ATHLETIC LEAGUE, WEST END LITTLE LEAGUE, NORTH TRENTON LITTLE LEAGUE, GREATER TRENTON JUNIOR GOLF LEAGUE, ROBERTO CLEMENTE SOFTBALL LEAGUE, 2006 BABE RUTH WORLD SERIES MUNICIPALITY ------------ CITY OF TRENTON, EWING TOWNSHIP, HOPEWELL TOWNSHIP, LAWRENCE TOWNSHIP, HAMILTON TOWNSHIP, MORRISVILLE, PA, YARDLEY, PA CONCLUSION ---------- CAPITAL HEALTH IS A NON-PROFIT ORGANIZATION THAT HAS AN "OPEN DOOR" POLICY. THIS POLICY MEANS THAT CAPITAL HEALTH PROVIDES NECESSARY BASIC HOSPITAL CARE TO EVERYONE, REGARDLESS OF THEIR ABILITY TO PAY FOR THEIR CARE. CAPITAL HEALTH IS COMMITTED TO COMMUNITY OUTREACH AND EDUCATION, OFFERING NUMEROUS HEATH CARE RELATED PROGRAMS AND ACTIVITIES, INCLUDING COMMUNITY HEALTH FAIRS, HEALTH SCREENINGS, HEALTH EDUCATION AND MEDICAL LECTURES AND SEMINARS ANNUALLY. CAPITAL HEALTH IS PROUD OF THEIR MANY PARTNERSHIPS WITH LOCAL ORGANIZATIONS SUCH AS CHILDREN'S FUTURES, CHILDREN'S HOME SOCIETY OF N.J., AND HENRY J. AUSTIN HEALTH CENTER. TO FURTHER SHOW HOW CAPITAL HEALTH IS COMMITTED TO BENEFITING ITS COMMUNITY, CAPITAL HEALTH, IN ITS LARGEST SINGLE TRANSACTION OF ITS 75 YEAR HISTORY, BROKE GROUND IN AUGUST, 2008, TO CONSTRUCT A $530 MILLION 223-BED HOSPITAL IN HOPEWELL TOWNSHIP, NEW JERSEY TO REPLACE ITS EXISTING FACILITY, MERCER HOSPITAL, IN TRENTON, NEW JERSEY. IN ADDITION, CAPITAL HEALTH FULD HOSPITAL, NOW KNOWN AS CAPITAL HEALTH REGIONAL MEDICAL CENTER, IN TRENTON IS CREATING TWO NEW MEDICAL-SURGICAL UNITS AND PROVIDING SPACE TO ACCOMMODATE SERVICES TRANSFERRED FROM MERCER, WHEN THE NEW HOSPITAL OPENEND.. CAPITAL HEALTH OBTAINED A MORTGAGE LOAN THROUGH THE FEDERAL HOUSING ADMINISTRATION WHICH ENABLED IT TO LOWER ITS COST OF CREDIT. THIS WILL ALLOW CAPITAL HEALTH TO USE MORE OF ITS RESOURCES TO SERVE THE MEDICAL NEEDS OF ITS COMMUNITY. THE CONSTRUCTION PROJECTS WILL CREATE APPROXIMATELY 4,700 FULL-TIME JOBS AND PROVIDE AN ECONOMIC STIMULUS OF NEARLY $1.7 BILLION DURING THE CONSTRUCTION PERIOD. ONCE CONSTRUCTION IS COMPLETED, THE PROJECT WILL SUPPORT AN ADDITIONAL 2,200 JOBS IN THE COMMUNITY AND PROVIDE AN ANNUAL ECONOMIC BENEFIT OF APPROXIMATELY $425 MILLION.
OTHER PROGRAM SERVICES CORE FORM, PART III; QUESTION 4D EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11A THE ORGANIZATION IS THE PARENT ENTITY OF CAPITAL HEALTH SYSTEM AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE ORGANIZATION'S FEDERAL FORM 990 WAS MADE AVAILABLE TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION THE CAPITAL HEALTH SYSTEM, INC. COMPENSATION COMMITTEE ALSO PERFORMED A DETAILED REVIEW OF THE FEDERAL FORM 990 PRIOR TO MAKING IT AVAILABLE TO ITS BOARD OF TRUSTEES. THE CAPITAL HEALTH SYSTEM, INC. BOARD OF TRUSTEES HAS DELEGATED TO THE COMPENSATION COMMITTEE THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION AND FILING PROCESS FOR THE TAX-EXEMPT AFFILIATES OF THE SYSTEM. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S GENERAL COUNSEL, VICE-PRESIDENT OF FINANCE, CHIEF COMPLIANCE OFFICER AND VARIOUS OTHER INDIVIDUALS OF THE SYSTEM TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S INTERNAL WORKING GROUP, INCLUDING, BUT NOT LIMITED TO, THOSE INDIVIDUALS OUTLINED ABOVE FOR THEIR REVIEW. THE ORGANIZATION'S INTERNAL WORKING GROUP AND OTHER INDIVIDUALS REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S INTERNAL WORKING GROUP AND VARIOUS OTHER INDIVIDUALS FOR FINAL REVIEW AND APPROVAL PRIOR TO PRESENTATION OF THE FEDERAL FORM 990 TO THE MEMBERS OF THE CAPITAL HEALTH SYSTEM, INC. COMPENSATION COMMITTEE. FOLLOWING THE COMPENSATION COMMITTEE'S REVIEW THE FINAL FEDERAL FORM 990 WAS MADE AVAILABLE TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO THE FILING WITH THE IRS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 12 THE ORGANIZATION IS THE PARENT ENTITY IN THE CAPITAL HEALTH SYSTEM AND AFFILIATES ("SYSTEM"). THE ORGANIZATION AND THE SYSTEM REGULARLY MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO THE ORGANIZATION AND BOTH THE SYSTEM'S GENERAL COUNSEL AND CHIEF COMPLIANCE OFFICER FOR REVIEW. THEREAFTER THE CHIEF COMPLIANCE OFFICER PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS. THEREAFTER, THE SYSTEMS CHIEF COMPLIANCE OFFICER PRESENTS THIS SUMMARY TO THE SYSTEM'S FULL BOARD OF TRUSTEES FOR ITS REVIEW AND DISCUSSION. THIS SUMMARY IS UPDATED BY THE CHIEF COMPLIANCE OFFICER ON A QUARTERLY BASIS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 15 THE ORGANIZATION'S BOARD OF TRUSTEES HAS A BOARD COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF ALL OF THE ORGANIZATION'S SENIOR MANAGEMENT AND OTHERS, INCLUDING THE CEO, CFO AND COO, OTHER OFFICERS OF CHS, PHYSICIANS, AND ANY OTHER DISINTERESTED PERSONS. IT ALSO REVIEWS AND APPROVES EMPLOYMENT AGREEMENTS FOR THE COVERED EMPLOYEES AND DISINTERESTED PERSONS. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF THE SENIOR MANAGEMENT TEAM. REBUTTAL PRESUMPTION REQUIREMENTS HAVE GUIDED THE ACTIVITIES OF THE COMMITTEE IN ALL OF ITS REVIEWS, DELIBERATIONS AND APPROVAL OF EXECUTIVE COMPENSATION ACTIONS FOR ALL OF THE COVERED EMPLOYEES AND DISINTERESTED PERSONS. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON DATA FROM COMPARABLE HEALTHCARE AND HOSPITAL PEERS IN NEW JERSEY AS WELL AS NEIGHBORING STATES BASED ON APPROPRIATE REVENUE, SERVICES, AND OVERALL FINANCIAL PERFORMANCE. IN ADDITION, SPECIFIC SALARY SURVEYS COVERING SIMILAR, REPRESENTATIVE HOSPITAL COMPENSATION DATA WAS USED. ALL DATA WAS WEIGHTED IN ARRIVING AT MARKET CONSENSUS FOR COVERED EMPLOYEE POSITIONS, IN ORDER TO ACCURATELY REFLECT THE RELEVANT LABOR MARKET. CONTEMPORANEOUS MINUTES ARE COMPILED AND APPROVED OF ALL COMMITTEE DELIBERATIONS. THESE ARE SUPPORTED BY THE WRITTEN DOCUMENTATION COVERING ALL COMPENSATION STUDIES AND PLAN DOCUMENTS, AS WELL AS DETAILED PERFORMANCE JUSTIFICATION USED AS THE BASIS FOR AWARDING OF ALL INCENTIVE PROGRAMS. REBUTTAL PRESUMPTION ACTIVITIES OF THE COMMITTEE COVER ALL MEMBERS OF SENIOR MANAGEMENT, AS WELL AS THE COMPENSATION AND CONTRACTS COVERING PHYSICIANS AND OTHER DISINTERESTED PERSONS, ALL OF WHICH ARE SUBJECT TO THE REVIEW AND APPROVAL OF THE COMMITTEE. RECOGNIZING THE NEED TO CONSIDER RETIREMENT PLANNING FOR ITS SENIOR MANAGEMENT AS A MEANS TO AID IN THEIR RETENTION, THE COMMITTEE UNDERTOOK AN EXTENSIVE RESEARCH AND ANALYSIS OF ALTERNATIVE PROGRAMS, AND CREATED AND APPROVED A FORM OF LONG-TERM NON-QUALIFIED DEFERRED COMPENSATION (REFERRED TO AS THE "PERFORMANCE-BASED CAPITAL ACCUMULATION PLAN", OR "PBCAP"). THIS PLAN ALSO PROVIDES CHS WITH AN ADDITIONAL TOOL TO ASSIST IN THE RECRUITING OF SENIOR MANAGEMENT WITHIN THE HIGHLY COMPETITIVE HEALTHCARE LABOR MARKET. THE PLAN PROVIDES SENIOR MANAGEMENT WITH THE OPPORTUNITY TO QUALIFY FOR ANNUAL DEFERRED CONTRIBUTIONS TO BE PAID AT RETIREMENT, BASED ON ACHIEVING SPECIFIED FINANCIAL PERFORMANCE TARGETS AND MEETING ESTABLISHED CIRCUIT BEAKERS. THIS PLAN COMPLIES WITH AND ADHERES TO ALL RELATED REGULATIONS, WITH AN EMPHASIS ON IRC SECTIONS 409A AND 457(F). WITH THE DECISION IN MAY 2004 TO CONSTRUCT A NEW HOSPITAL CAMPUS IN HOPEWELL, NJ, THE COMMITTEE WAS CHALLENGED TO PROVIDE THE MOTIVATION TO MEET THE CONSTRUCTION TIMETABLE AND GUARANTEED MAXIMUM PRICE (GMP). THIS WAS NECESSARY TO ENSURE THAT THE PROJECT, INCLUDING THE RETROFIT OF THE REGIONAL CAMPUS, WAS COMPLETED ON A TIMELY AND ECONOMICAL BASIS. THEY RECOGNIZED THAT TRANSACTIONAL BONUSES, INCLUDED IN MOST STATE CONSTRUCTION CONTRACTS, PROVIDE THE INCENTIVE TOOLS NECESSARY TO KEEP PROJECTS ON TIME AND WITHIN BUDGET. THE RESULTING INCENTIVE PLAN, REFERRED TO AS THE "HOSPITAL ON TIME AND UNDER BUDGET PLAN" OR "HOTUB", CONTAINS THE METHODOLOGY TO REWARD MEMBERS OF SENIOR MANAGEMENT AND OTHER IDENTIFIED KEY MANAGEMENT FOR ACHIEVING THOSE GOALS, WHILE REDUCING AND/OR ELIMINATING AWARDS IF THE PROJECT IS NOT ON SCHEDULE AND/OR OVER BUDGET. SINCE THIS TYPE OF PLAN IS RELATIVELY UNIQUE IN THE NOT-FOR-PROFIT ENVIRONMENT, THE COMPENSATION COMMITTEE SPENT CONSIDERABLE TIME IN ITS DEVELOPMENT AND ENGAGED BOTH AN EXTERNAL COMPENSATION CONSULTANT TO DEVELOP THE PLAN, AS WELL AS A NOT-FOR-PROFIT LEGAL COMPENSATION AUTHORITY TO REVIEW THE PLAN. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION C; QUESTION 19 THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY SECRETARY OF STATE.
COMPENSATION INFORMATION DISCLOSURE CORE FORM, PART VII AND SCHEDULE J PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION OR A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THE ORGANIZATION OR A RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES.
INDEPENDENT CONTRACTORS CORE FORM, PART VII; SECTION B THE AMOUNTS REPORTED FOR SERVICES PROVIDED BY SKANSKA USA BUILDING, INC., BARR & BARR BUILDERS, INC. AND TARGET BUILDING CONSTRUCTION INCLUDE BOTH SERVICES AND CONSTRUCTION GOODS AND SUPPLIES.
OTHER CHANGES IN NET ASSETS CORE FORM, PART XI; QUESTION 5 OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - NET CHANGE IN UNREALIZED GAINS AND LOSSES ON INVESTMENTS; $15,860,142 - PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST; $6,976,553
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 THE TAXPAYER IS THE PARENT ENTITY IN A TAX-EXEMPT, INTEGRATED HEALTHCARE DELIVERY SYSTEM. A BIG FOUR INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE TAXPAYER AND ALL AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2010 AND DECEMBER 31, 2009; RESPECTIVELY AND ISSUED A CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES BY ENTITY. AN UNQUALIFIED OPINION WAS ISSUED EACH YEAR BY THE INDEPENDENT CPA FIRM. THE TAXPAYER'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.
CHS DEPARTMENTAL EIN LISTING   THE ORGANIZATION'S FEDERAL FORM 990 INCLUDES CERTAIN REVENUE RECEIVED AND EXPENSES INCURRED BY VARIOUS CAPITAL HEALTH SYSTEM, INC. RELATED PROGRAMS, DEPARTMENTS, ACTIVITIES AND CAPITAL HEALTH SYSTEM, INC. EMPLOYEES. REVENUE EARNED FROM THESE PROGRAMS AND ACTIVITES WAS RECEIVED BY CAPITAL HEALTH SYSTEM, INC. UTILIZING DIFFERENT FEDERAL IDENTIFICATION NUMBERS OTHER THAN 22-3548695. BELOW IS A LIST OUTLINING THE VARIOUS CAPITAL HEALTH SYSTEM, INC. PROGRAMS, DIVISIONS, DEPARTMENTS AND PHYSICIAN EMPLOYEES AND THEIR RESPECTIVE FEDERAL IDENTIFICATION NUMBERS: CAPITAL ENDOCRINOLOGY 20-1730017 CAPITAL HEALTH CLINICAL CARDIOLOGY 26-3519972 CAPITAL SURGICAL ASSOCIATES 22-3680051 CHS INSTITUTE FOR NEUROSCIENCES 26-0346624 EWING INTERNAL MED ASSOC 27-0192330 FAMILY HEALTH CENTER 22-3796256 HAMILTON PHYSICIANS GROUP 22-3502175 HPG AT BORDENTOWN FAMILY MEDICAL 22-3502175 HEART CARE SPECIALISTS AT CH 27-0309548 MERCER MATERNAL FETAL SPECIALTY GROUP 20-2886402 MULTISPECIALTY PROVIDER GROUP 22-3628075 STROKE & CEREBROVASCULAR CENTER OF NEW JERSEY 26-3519824 TRENTON NEUROSURGEONS ASSOCIATES 22-2035924 WEST TRENTON MEDICAL ASSOCIATES 20-4643360 PEDIATRIC HOSPITALIST 27-2627834 EMERGENCY PHYSICIANS 27-2232524 REHABILITATION MEDICINE 27-3421189 SPINE CENTER 27-3421008 PLASTIC SURGERY 27-4510784 PRIMARY CARE PENNINGTON 27-3945093
COMPENSATION AND BENEFITS DISCLOSURE SCHEDULE J-2, PART I THE ORGANIZATION DOES NOT COMPENSATE ITS BOARD MEMBERS FOR THEIR SERVICES PERFORMED AS A TRUSTEE. ALL TRUSTEES ARE VOLUNTEERS. COMPENSATION AND BENEFITS, WHERE APPLICABLE FOR CERTAIN MEMBERS, IS RELATED TO THE BOARD MEMBER'S SERVICES PERFORMED AS A FULL-TIME EMPLOYEE OR INDEPENDENT CONTRACTOR OF THE ORGANIZATION.
DOCUMENT CORRECTION   THE FOLLOWING INFORMATION IS PROVIDED IN ACCORDANCE WITH SECTION XII OF NOTICE 2010-6: NAME OF THE SERVICE PROVIDERS: NAME ---- AL MAGHAZEHE, PH.D., FACHE LARRY DISANTO J. SCOTT CLEMMENSEN EUGENE W. GROCHALA MARGARET SULLIVAN IDENTIFICATION OF PLAN OR AGREEMENT: CAPITAL HEALTH SYSTEM NON-QUALIFIED 457(F) DEFERRED COMPENSATION PLAN (THE "PLAN"). DOCUMENT FAILURE AND CORRECTION UNDER THE NOTICE: THE DOCUMENT FAILURE IS ELIGIBLE FOR CORRECTION UNDER NOTICE 2010-6 AND WAS CORRECTED PURSUANT TO SECTIONS V.B AND V.C AND THE TRANSITION RELIEF IN SECTION XI.A FOR CORRECTIONS COMPLETED PRIOR TO DECEMBER 31, 2010. THE DEFINITIONS OF CHANGE IN CONTROL AND DISABILITY WERE CORRECTED IN ACCORDANCE WITH SECTION V.B AND V.C RESPECTIVELY OF NOTICE 2010-6. DATE OF CORRECTION: CAPITAL HEALTH SYSTEM HAS TAKEN ALL ACTIONS REQUIRED AND OTHERWISE MET ALL REQUIREMENTS FOR SUCH CORRECTION PRIOR TO DECEMBER 31, 2010, THE LAST DAY OF THE 2010 FISCAL YEAR OF CAPITAL HEALTH SYSTEM. CORRECTION WAS ACCOMPLISHED PURSUANT TO AN AMENDMENT AND RESTATEMENT OF THE PLAN EXECUTED ON DECEMBER 15, 2010, EFFECTIVE AS OF THE DATE OF EXECUTION. DATE OF EVENT CAUSING INCOME INCLUSION: NOT APPLICABLE. NO AMOUNTS ARE REQUIRED TO BE INCLUDED IN INCOME UNDER NOTICE 2010-6 FOR THIS DOCUMENT CORRECTION. AMOUNT INVOLVED IN THE DOCUMENT FAILURE: THE AMOUNT INVOLVED WITH RESPECT TO EACH FAILURE IS $1,987,731.76. AMOUNT REPORTED AS INCLUDIBLE IN INCOME: NOT APPLICABLE. NO AMOUNTS ARE REQUIRED TO BE INCLUDED IN INCOME UNDER NOTICE 2010-6 FOR THIS DOCUMENT CORRECTION IN ACCORDANCE WITH THE TRANSITION RELIEF PROVIDED UNDER SECTION XI.A OF NOTICE 2010-6.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SAMUEL J PLUMERI JR TITLE:CHAIRMAN - TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NANCY H BECKER TITLE:VICE CHAIR - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GILBERT W LUGOSSY TITLE:SECRETARY - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MILES W TRUESDELL JR TITLE:TREASURER - TRUSTEE HOURS:8
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CARMEN M GARCIA ESQ TITLE:ASSISTANT SECRETARY - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUDGE GERALD J COUNCIL JSC TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOUIS DAMELIO MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANTHONY C HOOPER TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH R JINGOLI TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARTIN P JOHNSON TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RAMAN KAPUR TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL J LEE MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AL MAGHAZEHE PHD FACHE TITLE:TRUSTEE - PRESIDENT/CEO HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SEAN S MURRAY TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CLINTON OGOLO MD TITLE:TRUSTEE - VP, MEDICAL STAFF HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN F RICCI TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL L SOMERSTEIN MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TELECHERY SUDHAKAR MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN P THURBER TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD L WARREN MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK S WHITMAN MD TITLE:TRUSTEE - PRES, MEDICAL STAFF HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD J GUY TITLE:CHIEF FINANCIAL OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EUGENE W GROCHALA TITLE:CHIEF INFORMATION OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHEN A MILLER JD TITLE:CHIEF COMPLIANCE OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY DISANTO TITLE:EXECUTIVE VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAN GABIN ESQ TITLE:GENERAL COUNSEL HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT REMSTEIN DO TITLE:VP, MEDICAL AFFAIRS HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICIA V CAVANAUGH RN MSN TITLE:VP, PATIENT SERVICES/CNO HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NATHAN BOSK FACHE TITLE:VP, AMBULATORY SERVICES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIMOTHY M GRAHAM TITLE:VP, FINAN SVCS (TERM 10/28/10) HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J SCOTT CLEMMENSEN TITLE:VP, HUMAN RESOURCES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GREGORY N DADAMO TITLE:VP, SUPPORT SERVICES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARGARET SULLIVAN TITLE:VP, QUALITY RESOURCE MGMT. HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENNIS DOOLEY TITLE:VP, PLANNING AND DEVELOPMENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA DITE TITLE:VP, CLINICAL SERVICES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EILEEN M HORTON TITLE:VP, STRATEGIC TRANSFORMATION HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARLINE M STEPHAN TITLE:EXECUTIVE DIRECTOR, FOUNDATION HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EROL VEZNEDAROGLU MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KENNETH M LIEBMAN MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARIEL F ABUD MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN D LIPANI MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOMINICK EBOLI MD TITLE:PHYSICIAN HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CAPITAL HEALTH SYSTEM INC
 
Employer identification number

22-3548695
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN 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 organization
Yes No
(1) CAPITAL HEALTH SYSTEM FOUNDATION

750 BRUNSWICK AVENUE

TRENTON,NJ08638
22-2230681 		SUPPORT CHS NJ 501(C)(3) 509(A)(1) CH SYSTEM
 
 
 












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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
Yes No Yes No












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



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) BELLEVUE AVENUE MANAGEMENT INC
446 BELLEVUE AVENUE
TRENTON,NJ08618
22-2775694 		MANAGEMENT NJ N/A
 C CORP.      
(2) CAPITAL REGION INSURANCE COMPANY
P O BOX 10073 APO
GRAND CAYMAN    
CJ
98-0656385 		FINANCIAL VEHICLE CJ CH SYSTEM
  		FOREIGN CORP. 7,855,789 32,998,084 100.000 %
(3) MERCER HOLDING CORPORATION
446 BELLEVUE AVENUE
TRENTON,NJ08618
22-2778535 		HOLDING CO. NJ CH SYSTEM
  		C CORP. 2,571,579 12,428,465 100.000 %








Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
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 (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
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 other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CAPITAL HEALTH SYSTEM FOUNDATION

 N 401,291  
(2) MERCER HOLDING CORPORATION

 E 659,279  
(3) CAPITAL HEALTH SYSTEM FOUNDATION

 B 100,000  
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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