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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2 STONE HARBOR BOULEVARD
Suite
Room/suite
City or town, state or country, and ZIP + 4
CAPE MAY COURT HOUSE, NJ08210
D Employer identification number

22-2629594
E Telephone number

G Gross receipts $ 885,673
F Name and address of principal officer:
JOANNE CARROCINO FACHE
2 STONE HARBOR BLVD
CAPE MAY COURT HOUSE,NJ08210
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CAPEREGIONAL.COM
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: 1984
M State of legal domicile: NJ
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO CONTINUALLY DEVELOP AND OPERATE A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 10,515
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 9,514
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 354 0
9 Program service revenue (Part VIII, line 2g) ......... 0 500
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 42,993 32,453
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 127,382 10,515
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 170,729 43,468
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
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–24e).... 32,144 65,279
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 32,144 65,279
19 Revenue less expenses. Subtract line 18 from line 12....... 138,585 -21,811
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 11,391,715 14,219,503
21 Total liabilities (Part X, line 26)............. 8,192,524 8,976,882
22 Net assets or fund balances. Subtract line 21 from line 20..... 3,199,191 5,242,621
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 Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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 MISSION OF CAPE REGIONAL HEALTH SYSTEM, INC. IS TO CONTINUALLY DEVELOP AND OPERATE A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC.; AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS 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.
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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 58,752 including grants of $ 0 ) (Revenue $ 11,015 )
EXPENSES INCURRED IN FUNCTIONING AS THE PARENT ORGANIZATION OF A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC.; AN INTERNAL REVENUE CODE SECTION 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. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet58,752
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? ...
2
 
No
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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
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
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 for escrow or custodial account liability; 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 temporarily restricted endowments, permanent endowments, 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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick 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 XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII 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 and XII 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
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
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........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 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........
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...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
.....................
28b
 
No
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
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
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
0
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
 
 
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
0
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
 
 
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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
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 as charitable contributions?...
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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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
 
No
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.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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
14
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
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
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletMARK R GILL2 STONE HARBOR BOULEVARDCAPE MAY COURT HOUSENJ08210 (609) 463-2471
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(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) HENRY S BRZYSKI........................................................................
CHAIRMAN - TRUSTEE
1.0
.......................  
X   X       0 0 0
(2) ELLEN KRAVET BURKE........................................................................
VICE CHAIR - TRUSTEE
1.0
.......................  
X   X       0 0 0
(3) GARRY GILBERT........................................................................
SECRETARY/TREASURER - TRUSTEE
1.0
.......................  
X   X       0 0 0
(4) RALPH AUTUORE........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(5) GENE BRAGA MD........................................................................
TRUSTEE (1/1/12-6/30/12)
1.0
.......................  
X           0 0 0
(6) WILLIAM R BRADWAY DO........................................................................
TRUSTEE
1.0
.......................  
X           0 4,000 0
(7) JOANNE CARROCINO FACHE........................................................................
TRUSTEE - PRESIDENT/CEO
50.0
.......................  
X   X       0 500,836 66,025
(8) ARTHUR L CHILDS DO........................................................................
TRUSTEE - VP MEDICAL STAFF
1.0
.......................  
X           0 10,000 0
(9) THOMAS DIERKES DO........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(10) ROBERT A FINEBERG ESQ........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(11) RAYMOND HANER CPA........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(12) HERBERT L HORNSBY JR........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(13) ART JOBLIN........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(14) ARLENE MACDONALD........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(15) RICHARD A MICHNER MD........................................................................
TRUSTEE - PRES MEDICAL STAFF
50.0
.......................  
X   X       0 2,500 0
(16) MARK R GILL........................................................................
CFO
50.0
.......................  
    X       0 299,598 100,065


Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 816,934 166,090
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(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  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
 
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 0
 Program Service Revenue Business Code
2a OTHER PROGRAM RELATED REVENUE 900099 500 500    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 500
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 31,520     31,520
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 842,503  
b Less: rental expenses 831,988  
c Rental income or (loss) 10,515 0
d Net rental income or (loss).......MediumBullet 10,515   10,515  
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 11,150  
b Less: cost or other basis and sales expenses 10,217  
c Gain or (loss) 933  
d Net gain or (loss)..........MediumBullet 933     933
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            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 43,468 500 10,515 32,453
Form 990 (2012)
Form 990 (2012)
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).Check if Schedule O contains a response to any question in this Part IX ...............
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 United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 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 0      
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 0      
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 12,000 10,800 1,200 0
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 7,588 6,830 758  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 80 72 8  
12 Advertising and promotion .... 0      
13 Office expenses ....... 0      
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 33,358 30,022 3,336  
17 Travel ............ 0      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 11,953 10,758 1,195  
23 Insurance .............. 300 270 30  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 65,279 58,752 6,527 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 324,886 2 75,790
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 0 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 49,841 9 3,690
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 8,559,824
b Less: accumulated depreciation ..... 10b 455,248 7,412,314 10c 8,104,576
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 1,596,943 13 1,710,515
14 Intangible assets ............... 147,731 14 130,858
15 Other assets. See Part IV, line 11 ........... 1,860,000 15 4,194,074
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 11,391,715 16 14,219,503
Liabilities 17 Accounts payable and accrued expenses ......... 73,886 17 415,048
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 5,208,868 23 5,083,898
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 2,909,770 25 3,477,936
26 Total liabilities. Add lines 17 through 25......... 8,192,524 26 8,976,882
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 3,199,191 27 5,242,621
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 3,199,191 33 5,242,621
34 Total liabilities and net assets/fund balances ........ 11,391,715 34 14,219,503
Form 990 (2012)
Form 990 (2012)
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
43,468
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
65,279
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-21,811
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
3,199,191
5
Net unrealized gains (losses) on investments ...............
5
65,241
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
2,000,000
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
5,242,621
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
 
No
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
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Employer identification number

22-2629594
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 supported organization? ................
11g(i)
 
No
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
(A) CAPE REGIONAL MEDICAL CENTER
 
210662542 03 Yes   Yes   Yes   0
Total                 0

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
THE ORGANIZATION HAS FILED WITH THE IRS EXEMPT ORGANIZATION DIVISION A REQUEST FOR RECLASSIFICATION OF PUBLIC CHARITY STATUS FROM IRC 509(A)(2) TO IRC 509(A)(3), TYPE III. THE ORGANIZATION IS FUNCTIONALLY INTEGRATED WITH AND SUPPORTS CAPE REGIONAL MEDICAL CENTER; AN IRC 501(C)(3) TAX-EXEMPT CHARITABLE HOSPITAL. THE ORGANIZATION'S REQUEST FOR RECLASSIFICATION OF PUBLIC CHARITY STATUS ASKED THE IRS FOR RETROACTIVE APPROVAL TO JANUARY 1, 2010. THUS, THIS FORM 990 AND SCHEDULE A HAS BEEN PREPARED BASED UPON THIS FAVORABLE RECLASSIFICATION.
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Employer identification number

22-2629594
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 can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
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 through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
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 XIII.
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 XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and 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 current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 0 1,398,000 1,398,000
b Buildings ................ 0 6,727,610 452,085 6,275,525
c Leasehold improvements ............        
d Equipment ................   52,843 3,163 49,680
e Other .................   381,371   381,371
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 8,104,576
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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) must 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) CASH AND CASH EQUIVALENTS;   F
(2) LIMITED USE 149,299 F
(3) MUTUAL FUNDS; LIMITED USE 797,979 F
(4) EQUITY SECURITIES; LIMITED USE 753,493 F
(5) FIXED INCOME SECURITIES;   F
(6) LIMITED USE 9,744 F



Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 1,710,515
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 4,130,480
(2) RENT RECEIVABLE 61,104
(3) OTHER ASSETS 2,490






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 4,194,074
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
OTHER LIABILITIES 905,199
DUE TO AFFILIATES 2,572,737







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 3,477,936
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, 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 tax-exempt PARENT ENTITY OF THE CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE SYSTEM FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY. THE FOOTNOTE BELOW IS FROM THE SYSTEM'S 2012 AUDITED FINANCIAL STATEMENTS AND REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48: THE SYSTEM FOLLOWS THE ACCOUNTING GUIDANCE FOR UNCERTAINTIES IN INCOME TAX POSITIONS WHICH REQUIRES THAT A TAX POSITION BE RECOGNIZED OR DERECOGNIZED BASED ON A "MORE LIKELY THAN NOT" THRESHOLD. THIS APPLIES TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
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
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Employer identification number

22-2629594
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 or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
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
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
 
No
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 Regulations 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)JOANNE CARROCINO FACHETRUSTEE - PRESIDENT/CEO (i)
(ii)
0
413,267
0
49,733
0
37,836
0
52,315
0
13,710
0
566,861
0
0
(2)MARK R GILLCFO (i)
(ii)
0
261,149
0
22,539
0
15,910
0
66,606
0
33,459
0
399,663
0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 4B 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 EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: JOANNE CARROCINO, FACHE, $28,030 AND MARK R. GILL, $17,270.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 7 CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2012 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Employer identification number

22-2629594
Identifier Return Reference Explanation
COMMUNITY BENEFIT STATEMENT CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS CAPE REGIONAL HEALTH SYSTEM, INC. ("CRHS")IS A NOT FOR-PROFIT HOLDING COMPANY BASED IN CAPE MAY COURT HOUSE, NEW JERSEY. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF VARIOUS NOT FOR-PROFIT ENTITIES. THE INTERNAL REVENUE SERVICE HAS RECOGNIZED CAPE REGIONAL HEALTH SYSTEM, INC. AS BEING A TAX-EXEMPT ORGANIZATION UNDER INTERNAL REVENUE CODE 501(C)(3). AS THE tax-exempt PARENT ORGANIZATION OF A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM, CAPE REGIONAL HEALTH SYSTEM, INC. STRIVES TO CONTINUALLY DEVELOP AND OPERATE AN INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH PROVIDES A COMPREHENSIVE SPECTRUM OF MEDICALLY NECESSARY HEALTHCARE SERVICES TO THE RESIDENTS OF NEW JERSEY AND SURROUNDING COMMUNITY. CAPE REGIONAL HEALTH SYSTEM, INC. ENSURES THAT ITS SYSTEM PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF CAPE REGIONAL MEDICAL CENTER ("CRMC"), A NATIONALLY ACCREDITED 242-BED ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE EMERGENCY, MEDICAL/SURGICAL AND REHABILITATIVE SERVICES TO SOUTHERN NEW JERSEY RESIDENTS. IN ADDITION TO INPATIENT, SAME-DAY AND OUTPATIENT CARE, THE MEDICAL CENTER IS CURRENTLY AN AFFILIATE OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM. BACKGROUND ========== CAPE REGIONAL MEDICAL CENTER, INC. ("CRMC") IS A GENERAL MEDICAL AND SURGICAL HOSPITAL. CRMC IS RECOGNIZED BY THE IRS AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CRMC 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. MOREOVER, CRMC OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1) CRMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2) CRMC OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3) CRMC MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4) CONTROL OF CRMC RESTS WITH ITS BOARD OF TRUSTEES; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS, OTHER PROMINENT MEMBERS OF THE COMMUNITY, MEDICAL STAFF MEMBERS AND THE CHIEF EXECUTIVE OFFICER; AND 5) SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. CRMC IS THE 242-BED ACUTE-CARE MEDICAL CENTER OF THE SOUTH JERSEY CAPE. LOCATED IN THE COUNTY SEAT OF CAPE MAY COURT HOUSE, CRMC IS THE SOUTHERN-MOST GATEWAY TO ADVANCED CARE IN THE STATE OF NEW JERSEY. CRMC SERVES AN EXPANDING LOCAL POPULATION AND MORE THAN ONE MILLION SEASONAL VISITORS WITH A VARIETY OF INPATIENT AND OUTPATIENT SERVICES. CRMC IS FULLY ACCREDITED BY THE JOINT COMMISSION. OUTLINED BELOW ARE THE 2012 PATIENT STATISTICS OF CRMC: - ADMISSIONS - 9,804 - PATIENT DAYS (INCLUDING NEWBORNS) - 36,015 - NEWBORN DELIVERIES - 533 - SURGICAL PROCEDURES - 6,556 - OUTPATIENT VISITS (INCLUDING ER) - 151,846 - EMERGENCY DEPARTMENT VISITS - 47,206 CRMC IS GUIDED BY ITS DEDICATION TO THE HEALTHCARE NEEDS OF THE COMMUNITIES THAT IT SERVES. THAT LEVEL OF DETERMINATION AND COMMITMENT IS THE VERY SOUL OF CRMC. CRMC ALSO PROVIDES HEALTHCARE 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. CRMC 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 CRMC IS TO SERVE ITS COMMUNITY BY PROVIDING THE HIGHEST QUALITY AND MOST COST EFFECTIVE HEALTHCARE TO ALL. CRMC IS COMMITTED TO PROVIDING COMPREHENSIVE, QUALITY HEALTHCARE SERVICES, WHICH IMPROVE AND SUSTAIN THE HEALTH STATUS OF THE RESIDENTS PRIMARILY IN SOUTHERN NEW JERSEY. CRMC ASSURES ACCESSIBLE, COMPASSIONATE HEALTHCARE SERVICES THAT HONOR THE DIGNITY OF EVERY PERSON. CRMC WILL BE A LEADER IN DEFINING THE COMMUNITY'S HEALTHCARE NEEDS, IN PROVIDING APPROPRIATE SOLUTIONS, AND DEVELOPING A COMPREHENSIVE CONTINUUM OF CARE INCLUDING EDUCATION, PREVENTION, DISEASE MANAGEMENT AND RESTORATIVE PROGRAMS. CRMC STATEMENT FOR COMMUNITY HEALTH IMPROVEMENT & BENEFITS ========================================================== TO PROMOTE WELLNESS, PREVENT ILLNESS, AND REMOVE BARRIERS THAT HINDER ACCESS TO HEALTHCARE BY WORKING HAND-IN-HAND WITH THE COMMUNITIES THAT CRMC SERVES. CRMC PRINCIPLES =============== CRMC IS GUIDED BY THE FOLLOWING PRINCIPLES IN PERFORMING ITS CHARITABLE TAX-EXEMPT PURPOSES: 1. CRMC BELIEVES THAT COMMUNITY HEALTH IMPROVEMENT IS ESSENTIAL TO THE CRMC MISSION. 2. CRMC BELIEVES COMMUNITY-BASED COALITIONS ARE UNIQUELY QUALIFIED TO ACHIEVE COMMUNITY HEALTH GOALS, AND CRMC VALUES PARTNERSHIPS WITH THEM. 3. CRMC VALUES EVIDENCE-BASED PRACTICES AND SEEKS TO MODEL EXCELLENCE IN COMMUNITY HEALTH PRACTICE BASED ON EVIDENCE. 4. CRMC BELIEVES IN APPLYING CONTINUOUS QUALITY IMPROVEMENT TO COMMUNITY HEALTH: MEASURING NEED, MATCHING RESOURCES TO NEED, MEASURING OUTCOMES, AND MAKING ADJUSTMENTS IN PROCESSES. CRMC OPERATIONAL VALUES ======================= QUALITY: CRMC STRIVES TO PROVIDE THE HIGHEST QUALITY OF CARE AND CONTINUALLY LOOKS FOR WAYS TO IMPROVE THE SERVICES IT PROVIDES. SERVICE: CRMC IS COMMITTED TO EXCEEDING THE EXPECTATIONS OF ITS PATIENTS, THEIR FAMILIES, ITS PHYSICIANS AND STAFF. EFFICIENCY: CRMC WILL UTILIZE ITS RESOURCES WISELY AND EFFICIENTLY TO ACHIEVE ITS GOALS. INTEGRITY: CRMC PERFORMS ITS JOBS IN AN ETHICAL MANNER, WITH HONESTY, SINCERITY AND RESPECT FOR OTHERS. SAFETY: CRMC PROMOTES A SAFE AND HEALTHY ENVIRONMENT FOR ITS PATIENTS, THEIR FAMILIES, ITS STAFF, PHYSICIANS, VOLUNTEERS, AND VISITORS. PROFESSIONALISM: CRMC IS DEDICATED TO ENHANCING ITS PROFESSIONAL AND PERSONAL KNOWLEDGE AND SKILLS THROUGH ONGOING PROFESSIONAL DEVELOPMENT EFFORTS. TEAMWORK: CRMC WILL WORK TOGETHER AS A TEAM TO ACHIEVE THE BEST POSSIBLE RESULTS. COMPASSION: CRMC SEEKS TO OFFER A COMPASSIONATE AND CARING ENVIRONMENT TO PROMOTE THE HEALING AND WELL-BEING OF ITS PATIENTS AND THEIR FAMILIES. VISION ====== CRMC WILL BE THE PREMIER COMMUNITY-BASED HEALTHCARE PROVIDER IN NEW JERSEY. CRMC WILL CONSTANTLY STRIVE TO BE THE HEALTHCARE LEADER AND PROVIDER OF CHOICE BY DEVELOPING A COMPREHENSIVE, INDEPENDENT AND HIGH QUALITY HEALTHCARE SYSTEM. RECOGNITION AND AWARDS ====================== - JOINT COMMISSION'S GOLD SEAL OF APPROVAL - AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER THREE YEAR ACCREDITATION - THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES (ICA) GRANTED A THREE YEAR ACCREDITATION TO OUR ECHOCARDIOGRAPHY LABORATORY. AFFILIATIONS ============ - UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM - UNIVERSITY OF PENNSYLVANIA CANCER NETWORK (PROVIDES INDIVIDUALS WITH ACCESS TO OVER 200 CLINICAL TRIALS) - PENN CARDIAC CARE CENTERS OF EXCELLENCE ===================== CANCER CARE ----------- COMPREHENSIVE, STATE-OF-THE-ART CANCER CARE CLOSE TO HOME IS WHAT CRMC PROVIDES THE PATIENTS AND FAMILIES IN CAPE MAY COUNTY. CRMC'S CANCER CARE CENTER IS A MEMBER OF THE UNIVERSITY OF PENNSYLVANIA CANCER NETWORK. THIS JOINT AFFILIATION STRENGTHENS CRMC'S MISSION TO PROVIDE THE HIGHEST QUALITY HEALTHCARE IN ITS COMMUNITY BY OFFERING AN INTEGRATED SYSTEM OF CARE THROUGH THE UNIVERSITY OF PENNSYLVANIA. PENN'S CANCER NETWORK HOSPITALS, INCLUDING CRMC, WERE CHOSEN FOR THEIR COMMITMENT TO EXCELLENCE IN PATIENT CARE AND IMPROVING THE HEALTH OF THE COMMUNITIES THEY SERVE. IN ADDITION, CRMC'S CANCER CARE PROGRAM HAS RECEIVED THE RECOGNITION OF THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS BY BEING AWARDED ACCREDITATION. ONCOLOGY PROGRAMS EARNING RECOGNITION FROM THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS OFFER HIGH-QUALITY CANCER CARE. ONLY ONE IN FOUR HOSPITALS THAT TREAT CANCER RECEIVES THIS SPECIAL APPROVAL. IT RECOGNIZES THE QUALITY OF COMPREHENSIVE CANCER CARE AVAILABLE AT A FACILITY AND OFFERS A COMMITMENT THAT PATIENTS WILL HAVE ACCESS TO ALL OF THE VARIOUS MEDICAL SPECIALISTS WHO ARE INVOLVED IN THE DIAGNOSIS AND TREATMENT OF CANCER.
COMMUNITY BENEFIT STATEMENT (CONTINUED) CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS IMAGING SERVICES ---------------- CAPE RADIOLOGY, A DIVISION OF CAPE REGIONAL HEALTH ENTERPRISES, PREVIOUSLY RAN THE HEALTH SYSTEM'S MAGNETIC RESONANCE IMAGING (OR MRI) SITE AT 11 VILLAGE DRIVE IN CAPE MAY COURT HOUSE. IN 2008 THIS LOCATION WAS CLOSED AND A NEW CONVENIENT FACILITY WAS OPENED ON THE MEDICAL CENTER CAMPUS, THIS NEW SITE INCLUDES A NEW STATE OF THE ART MRI SYSTEM. THE NEW SYSTEM DELIVERS HIGH RESOLUTION IMAGES ACROSS THE ENTIRE BODY WITH FASTER IMAGING TIMES AND ALLOWS CLINICIANS TO PERFORM MULTIPLE EXAMS WITHOUT REPOSITIONING THE PATIENT. THE SYSTEM IS ABLE TO PROVIDE HIGH RESOLUTION IMAGES WITH LESS CONTRAST THAN PREVIOUS SYTEMS AND IS 75% QUIETER. ALL OF THESE FEATURES PROVIDE THE PATIENT A MORE COMFORTABLE EXPERIENCE WHILE PROVIDING THE MOST ADVANCED MRI APPLICATIONS IN THE INDUSTRY. THE MRI STAFF INCLUDES BOARD-CERTIFIED RADIOLOGISTS AND NATIONALLY CERTIFIED RADIOLOGIC TECHNOLOGISTS WHO DELIVER HUNDREDS OF SAFE AND ACCURATE TESTS EVERY YEAR. CRMC'S MRI UNIT IS AMONG THE FASTEST AND MOST ADVANCED AVAILABLE, PROVIDING IMAGES OF THE ENTIRE BODY IN UNPRECEDENTED DETAIL AND WITHOUT THE USE OF X-RAYS. MRI WORKS USING A COMBINATION OF MAGNETIC ENERGY AND RADIO WAVES TO CREATE PICTURES OF THE INSIDE OF THE BODY. IN DECEMBER OF 2011 CAPE RADIOLOGY INSTALLED A NEW ADVANCED CT SCANNER THAT CAN REDUCE RADIATION UP TO 50 PERCENT WITHOUT COMPROMISING IMAGE QUALITY. THIS NEW CT SCANNER IS A PREMIUM 16-SLICE SYSTEM THAT ENABLES THE USE OF LESS RADIATION WHILE MAINTAINING HIGH QUALITY IMAGES CAPE REGIONAL HEALTH ENTERPRISES' OUTPATIENT FACILITY IS LOCATED AT 4011 ROUTE 9 SOUTH IN RIO GRANDE, NEW JERSEY. THIS CONVENIENT LOCATION BRINGS A VARIETY OF ADVANCED DIAGNOSTIC IMAGING SERVICES TO SOUTHERN CAPE MAY COUNTY. CRMC UTILIZES THE PICTURE ARCHIVING AND COMMUNICATION SYSTEM (PACS) FOR RADIOLOGY IMAGES TAKEN SINCE 2006. THIS SYSTEM ALLOWS PHYSICIANS AND RADIOLOGISTS TO ACCESS THESE IMAGES 24 HOURS A DAY, 7 DAYS A WEEK IN A SECURE COMPUTER NETWORK WITHOUT WAITING FOR FILMS TO BE DELIVERED. PATIENTS REQUESTING COPIES OF THOSE IMAGES ARE PROVIDED ON A COMPACT COMPUTER DISK. CARDIAC CARE ------------ CRMC IS A CHEST PAIN CENTER ACCREDITED BY THE SOCIETY OF CHEST PAIN CENTERS. CRMC OFFERS THE FIRST AND ONLY CARDIAC CATHETERIZATION LABORATORY IN CAPE MAY COUNTY. ALL CARDIAC SERVICES ARE AFFILIATED WITH THE UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM AND ARE STAFFED WITH BOARD CERTIFIED CARDIOLOGISTS AND INTERVENTIONAL CARDIOLOGISTS. THE CARDIAC CATHETERIZATION LABORATORY'S MEDICAL DIRECTOR IS GENE CHANG, M.D. DR. CHANG IS AN ASSOCIATE PROFESSOR OF MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE. DR. CHANG IS A GRADUATE OF TUFTS UNIVERSITY SCHOOL OF MEDICINE AND IS BOARD CERTIFIED IN CARDIOVASCULAR DISEASE, INTERNAL MEDICINE AND INTERVENTIONAL CARDIOLOGY. CRMC HAS PARTNERED WITH PENN PRESBYTERIAN MEDICAL CENTER IN PHILADELPHIA IN THE PENN HEART RESCUE PROGRAM. WHEN A PATIENT COMES TO THE EMERGENCY DEPARTMENT AT CRMC SEEKING EMERGENCY MEDICAL SERVICES FOR CHEST PAIN, THEY ARE EVALUATED TO DETERMINE IF THEY ARE HAVING A HEART ATTACK. IF THEY ARE DETERMINED TO HAVE AN ST ELEVATION MYOCARDIAL INFARCTION, THEY ARE TRANSPORTED ABOARD THE PENN STAR HELICOPTER TO PENN PRESBYTERIAN'S CARDIAC CATHETERIZATION LABORATORY. THE PATIENT IS MET BY A TEAM OF SKILLED HEALTHCARE PROFESSIONALS WAITING TO EVALUATE AND TREAT THEM. THE PENN PRESBYTERIAN EXPERT CARDIAC CARE TEAM IS ON HAND 24 HOURS A DAY, SEVEN DAYS A WEEK. CRMC OFFERS A VARIETY OF SUPPORT PROGRAMS TO OPTIMIZE YOUR CARDIOPULMONARY HEALTH. THESE SERVICES INCLUDE: - CARDIAC REHABILITATION - CENTER FOR LIFESTYLE MANAGEMENT - EECP PROGRAM FOR REFRACTORY ANGINA PATIENTS - OUTPATIENT NUTRITIONAL COUNSELING - SLEEPCARE AT CRMC (SLEEP DISORDERS LABORATORY) MATERNAL AND NEWBORN CARE ------------------------- WHEN PLANNING A FAMILY, REMEMBER THAT CRMC IS HOME TO COMPREHENSIVE MATERNITY AND PEDIATRIC SERVICES, ALL CONVENIENTLY LOCATED IN CAPE MAY COUNTY. CRMC'S STATE-OF-THE-ART LDRP SUITES ALLOW LABOR, DELIVERY, RECOVERY AND POSTPARTUM CARE TO OCCUR IN ONE COMFORTABLE, HOME-LIKE SETTING. CRMC'S HIGHLY EXPERIENCED MATERNITY STAFF INCLUDES PHYSICIANS, MIDWIVES, RNS, SURGEONS AND TEACHERS. TOGETHER THEY OFFER A FULL ARRAY OF EDUCATIONAL AND PREVENTATIVE SERVICES LIKE GENETIC COUNSELING, PRENATAL CARE, BREAST-FEEDING GUIDANCE AND ULTRASOUND. CRMC'S SERVICE ALSO PROVIDES HIGH-RISK NEONATAL CARE, A SPECIALIZED CARDIAC CLINIC AND PERINATOLOGY SERVICES THROUGH ITS AFFILIATIONS WITH THE COOPER AND OUR LADY OF LOURDES HEALTH SYSTEMS. SLEEPCARE --------- THE SLEEPCARE CENTER AT CRMC IS STAFFED BY HIGHLY SPECIALIZED SLEEP EXPERTS. THE SERVICE HELPS PATIENTS AND THEIR LOVED ONES GET A SOUND, RESTFUL SLEEP. THE SPECIALISTS IDENTIFY AND DIAGNOSE SLEEP DISORDERS, LIKE SNORING AND SLEEP APNEA, SO THAT PATIENTS CAN RECEIVE RELIEF FROM THE SYMPTOMS. LABORATORY MEDICINE ------------------- CRMC'S DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE, ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS AND THE AMERICAN ASSOCIATION OF BLOOD BANKS, BRINGS TOGETHER BOARD CERTIFIED PATHOLOGISTS AND NATIONALLY CERTIFIED TECHNOLOGISTS TO OFFER A WIDE ARRAY OF LABORATORY TESTING AND TEST INTERPRETATION 24 HOURS A DAY, 7 DAYS A WEEK. IN ADDITION TO HISTOPATHOLOGY AND CYTOPATHOLOGY, THE LABORATORY SPECIALISTS PROVIDE CONSULTATION IN COAGULATION, HEMATOLOGY, IMMUNOLOGY, URINALYSIS, MICROBIOLOGY AND CLINICAL CHEMISTRY, INCLUDING TOXICOLOGY AND ENDOCRINOLOGY. CRMC UTILIZES STATE-OF-THE-ART TECHNOLOGY, INCLUDING A TUBE TRANSPORT SYSTEM, AUTOMATED ANALYTICAL SYSTEMS, DNA-PROBES, LASER AND ROBOTIC TECHNOLOGY, COUPLED WITH SPECIALIZED INFORMATION MANAGEMENT, PROVIDING ACCURATE AND RAPID SERVICES TO CRMC PATIENTS. - ADVANCED COMPUTER NETWORK TO SEND TEST RESULTS DIRECTLY TO A PATIENT'S PHYSICIAN'S OFFICE IN ADDITION TO CRMC'S NURSES' STATIONS. THE SYSTEM CAN AUTOMATICALLY FAX TEST RESULTS ANYWHERE IN THE COUNTRY. - FOR A PATIENT'S CONVENIENCE, CRMC OFFERS BLOOD-DRAWING SERVICES IN ITS OUTPATIENT DEPARTMENT FROM 7A.M. - 8P.M. - SEVEN DAYS A WEEK AS WELL AS IN A PATIENT'S PHYSICIAN'S OFFICE, AT HOME AND CRMC'S SATELLITE BLOOD-DRAW STATION IN NEARBY RIO GRANDE. - CRMC OFFERS PHYSICIANS A HUGE ARRAY OF TESTS INCLUDING CHEMISTRY, THERAPEUTIC DRUG MONITORING, HEMATOLOGY, URINALYSIS, MICROBIOLOGY, TUBERCULOSIS, HISTOPATHOLOGY AND CYTOPATHOLOGY. - CRMC'S IMMUNOCYTOCHEMISTRY PROCEDURES AID IN THE EARLY DIAGNOSIS OF CERTAIN DISEASES INCLUDING CANCERS. - CRMC OFFERS A DIRECT-DONOR PROGRAM TO ALLOW A PATIENT OR A FAMILY MEMBER TO GIVE BLOOD TO YOURSELF OR A RELATIVE. SAME DAY CARE CENTER -------------------- THE SAME DAY CARE CENTER IS THE OUTPATIENT SURGERY CENTER AT CRMC. THE COMPLETE SAME-DAY SURGERY EXPERIENCE AT CRMC HAS BEEN DESIGNED AS A CENTER OF EXCELLENCE, WITH PATIENTS AND THEIR FAMILIES IN MIND. THIS TRANSLATES INTO CONVENIENT PARKING, STREAMLINED ADMISSIONS PROCEDURES AND FOLLOW-UP PHONE CALLS MADE TO A PATIENT'S HOME A DAY AFTER THE PROCEDURE. THE STAFF COMMUNICATES CLOSELY WITH A PATIENT'S PRIMARY CARE PHYSICIAN, SO THAT HE OR SHE CAN STAY APPRISED OF A PATIENT'S CONDITION. UNLIKE MANY STAND-ALONE SURGERY CENTERS, CRMC IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION, THE NEW JERSEY HOSPITAL ASSOCIATION AND IS LICENSED BY THE NEW JERSEY STATE DEPARTMENT OF HEALTH AND SENIOR SERVICES. CRMC IS ALSO ACCREDITED BY THE JOINT COMMISSION, AND THE COLLEGE OF AMERICAN PATHOLOGISTS. NEW DIAGNOSTIC & TREATMENT TECHNIQUES FOR FASTER, LESS PAINFUL RECOVERIES: TODAY, REMARKABLE ADVANCES IN SURGERY HAVE TRANSFORMED THE FIELD, MAKING MINIMALLY INVASIVE ALTERNATIVES TO TRADITIONAL "OPEN" SURGERY MORE READILY AVAILABLE. WHO WOULD HAVE THOUGHT 25 YEARS AGO THAT SURGERY WOULD BE DONE WITHOUT LENGTHY MEDICAL CENTER STAYS, SEVERE PAIN OR NOTICEABLE SCARRING? MANY PROCEDURES CAN NOW BE PERFORMED ON AN OUTPATIENT BASIS, GETTING PATIENTS OR THEIR FAMILY MEMBERS HOME THE SAME DAY. AN EXAMPLE OF THIS IS THE NEW LITHOTRIPSY PROCEDURE WHICH ALLOWS A LESS INVASIVE PROCEDURE FOR THE REMOVAL OF KIDNEY STONES. SPECIAL CARE FOR KIDS: CHILD PATIENTS AT THE SAME DAY CARE CENTER UNDERGO A SPECIAL ADMISSION, SURGICAL AND POST-OPERATIVE EXPERIENCE WHICH HAS BEEN CREATED ESPECIALLY FOR THEM. CRMC'S STAFF WORKS CLOSELY WITH THE MEDICAL CENTER'S DEPARTMENT OF PEDIATRICS TO MAINTAIN EXCELLENCE IN A CHILD'S PATIENT CARE AND MEET THEIR SPECIAL NEEDS.
COMMUNITY BENEFIT STATEMENT (CONTINUED) CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS SOCIAL WORK/CASE MANAGEMENT --------------------------- THE SOCIAL WORK/CASE MANAGEMENT DEPARTMENT AT CRMC HELPS PATIENTS AND FAMILIES COORDINATE HOSPITAL AND COMMUNITY SERVICES ON BEHALF OF PATIENTS. THEY HELP FAMILIES COPE WITH ILLNESS, HOSPITALIZATION, DISCHARGE PLANNING, COMMUNITY OUTREACH, PERINATAL SERVICES, AND OTHERWISE HELP FAMILIES WITH SOCIAL AND EMOTIONAL CONCERNS RELATED TO AN ILLNESS. CRMC'S CARING SOCIAL WORKERS AND CASE MANAGERS HELP PATIENTS AND THEIR FAMILIES PLAN AT-HOME HEALTH SERVICES INCLUDING SKILLED NURSING AND REHABILITATIVE THERAPY. THE TEAM ALSO HELPS LOCATE THE RIGHT MEDICAL EQUIPMENT, REFERRAL SOURCES, NURSING HOMES OR AFTER-CARE FACILITIES. HELP WITH LIVING WILLS AND ADVANCE DIRECTIVES MAY ALSO BE PROVIDED FOR YOUR FAMILY'S SPECIAL SITUATIONS. OUTPATIENT REHABILITATION ------------------------- CRMC OFFERS A VARIETY OF CONVENIENT SERVICES TO RESTORE PATIENTS TO THEIR HIGHEST LEVEL OF INDEPENDENCE AND FUNCTION. ALL OF CRMC'S SERVICES ARE CONDUCTED IN STATE-OF-THE-ART FACILITIES WITH A PATIENT'S CARE SUPERVISED BY HIGHLY QUALIFIED, LICENSED AND TRAINED REHAB EXPERTS. - PHYSICAL THERAPY - MANY PATIENTS OF ALL AGES MAY BENEFIT FROM PT AFTER AN ACCIDENT, ILLNESS, INJURY OR SURGERY. - WOUND CARE SERVICES - UPON REFERRAL BY A PATIENT'S PRIMARY CARE PHYSICIAN, OUR WOUND CARE PROGRAM IS DESIGNED TO HEAL AND PREVENT CHRONIC WOUNDS. - OCCUPATIONAL THERAPY - TREATING PEOPLE OF ALL AGES WHO, BECAUSE OF PHYSICAL, DEVELOPMENTAL, SOCIAL OR EMOTIONAL NEEDS, REQUIRE SPECIALIZED ASSISTANCE TO LEAD INDEPENDENT LIVES. - PRE-DRIVING PROGRAM UTILIZING ENHANCED DRIVING SIMULATOR AS PART OF OCCUPATIONAL THERAPY DEPARTMENT IN ORDER TO ACCESS THE PATIENT'S DRIVING SKILLS. THIS PROGRAM IS DESIGNED TO AID THE ELDERLY, STROKE PATIENTS, OR ANYONE WITH WHOSE DRIVING ABILITIES MAY BE COMPROMISED. - LYMPHEDEMA MANAGEMENT - CANCER-SURGERY PATIENTS WHO HAVE EXPERIENCED LOSS OF FUNCTION DUE TO LYMPHEDEMA MAY BENEFIT FROM TREATMENT. - SPEECH THERAPY- STROKE AND OTHER PATIENTS WITH SPEECH, LANGUAGE OR COGNITIVE DEFICITS LEARN TO COMMUNICATE BETTER WITH THOSE AROUND THEM. SPEECH THERAPY ALSO HELPS THOSE WITH COMPROMISED SWALLOWING. - CARDIOPULMONARY REHABILITATION - OPEN TO THOSE WHO HAVE EXPERIENCED HEART ATTACK, STABLE ANGINA, OPEN-HEART SURGERY, HEART TRANSPLANTATION, ASTHMA, EMPHYSEMA, LUNG-VOLUME REDUCTION SURGERY, AND OTHER CARDIOPULMONARY DISORDERS. SUPERVISED FIT-FOR-LIFE EXERCISE PROGRAMS AND FITNESS CENTER ARE ALSO AVAILABLE. - SMOKING CESSATION - NEW FOUR-WEEK PROGRAM DEVELOPED FOR THOSE WILLING TO QUIT SMOKING. DIABETES CARE CENTER -------------------- THE CRMC DIABETES CARE CENTER IS ACCREDITED BY THE AMERICAN DIABETES ASSOCIATION FOR QUALITY SELF-MANAGEMENT EDUCATION. SELF-MANAGEMENT EDUCATION IS AN ESSENTIAL COMPONENT OF DIABETES TREATMENT. ONE BENEFIT OF COMPLIANCE WITH THE NATIONAL STANDARDS IS GREATER CONSISTENCY IN THE QUALITY AND QUANTITY OF EDUCATION OFFERED TO PEOPLE WITH DIABETES. PROGRAM PARTICIPANTS ARE TAUGHT, AS NEEDED, SELF-CARE SKILLS THAT ALLOW BETTER MANAGEMENT OF THEIR DIABETES TREATMENT PROGRAM. HOSPITALIST PROGRAM ------------------- IN 2007, CRMC ADDED A HOSPITALIST PROGRAM TO THE SERVICES AVAILABLE FOR PATIENTS ADMITTED TO THE MEDICAL CENTER. THE HOSPITALIST IS ABLE TO COORDINATE THE PATIENT'S CARE WITH THE PATIENT'S PHYSICIAN AND A HOSPITALIST IS AT THE MEDICAL CENTER 24 HOURS A DAY, 7 DAYS A WEEK. PASTORAL CARE ------------- CRMC'S CHAPEL IS LOCATED NEAR BISTRO 10 AND THE EAST LOBBY OF THE MEDICAL CENTER. CRMC'S INTERFAITH CHAPLAINS AND PASTORAL CARE VOLUNTEERS OFFER SPIRITUAL AND EMOTIONAL SUPPORT TO PATIENTS AND THEIR FAMILIES DURING HOSPITALIZATION. PRAYER, BIBLES AND SACRAMENTAL MINISTRY SERVICES ARE AVAILABLE TO PATIENTS UPON REQUEST. CLERGY WILL BE GUIDED BY A PATIENT'S SPIRITUAL PREFERENCES. COMMUNITY BENEFIT ================= CRMC IS COMMITTED TO COMMUNITY OUTREACH AND EDUCATION, OFFERING NUMEROUS HEATHCARE RELATED PROGRAMS AND ACTIVITIES. CRMC WORKS IN COLLABORATION WITH VOLUNTEERS IN MEDICINE (VIM) AND A FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC), WHICH IS RUN BY COMMUNITY HEALTHCARE. CAPE REGIONAL HEALTH SYSTEM PROVIDES THE VIM OUTPATIENT FACILITY ON A RENT FREE BASIS. IN ADDITION, CRMC PROVIDES MUCH OF THE ANCILLARY SERVICES FOR THESE TWO PROVIDERS OF PRIMARY AND SPECIALTY CARE TO CHARITY AND STATE MEDICAID PATIENTS. CRMC'S CENTER FOR LIFESTYLE MANAGEMENT OFFERS A BROAD VARIETY OF SUPPORT GROUPS, HEALTH EDUCATION CLASSES, WELLNESS PROGRAMS AND INFORMATION ABOUT HEALTHCARE SERVICES IN CAPE MAY COUNTY. OUTLINED BELOW ARE A NUMBER OF CRMC COMMUNITY BENEFIT PROGRAMS. THE INFORMATION IS NOT INTENDED TO BE ALL-INCLUSIVE BUT RATHER PROVIDES ADDITIONAL INFORMATION DEMONSTRATING HOW CRMC BENEFITS THE SURROUNDING COMMUNITY IN FURTHERANCE OF ITS CHARITABLE TAX-EXEMPT PURPOSES. SUPPORT GROUPS -------------- THE CENTER FOR LIFESTYLE MANAGEMENT PROVIDES ONGOING SUPPORT GROUPS FOR THOSE COPING WITH FOLLOWING: - DIABETES - CANCER - GRIEF - CAREGIVER - PULMONARY REHABILITATION - FIBROMYALGIA - GASTRIC BYPASS - LYMPHEDEMA ADDITIONAL GROUP MEETINGS ------------------------- - AA AND ALANON - WEIGHT WATCHERS - OVEREATERS ANONYMOUS - LIFE MAKEOVERS FOR WOMEN HEALTH EDUCATION ---------------- CRMC'S HEALTH EDUCATION SERIES COVER A VARIETY OF TOPICS WITH PROGRAMS AVAILABLE AT CRMC AND IN THE COMMUNITY INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING: - DIABETES MANAGEMENT - STRESS MANAGEMENT FOR HEART AND LUNG PATIENTS - FITNESS WORKSHOPS - HEART HEALTH INFORMATION - CHRONIC DISEASE SELF MANAGEMENT - EXERCISE AND GETTING FIT - SERVING UP GOOD NUTRITION - BONE UP ON YOUR HEALTH - BE WISE ABOUT YOUR MEDICATION - KEEP UP THE BEAT - MAXIMIZING MEMORY HEALTH SCREENINGS ----------------- CRMC PROVIDES OPPORTUNITIES FOR THE COMMUNITY TO MONITOR THEIR HEALTH WITH THE FOLLOWING SCREENINGS AVAILABLE AT CRMC AND THROUGHOUT CAPE MAY COUNTY: - BLOOD PRESSURE - BLOOD SUGAR - CHOLESTEROL - FRACTURE RISK - PERIPHERAL ARTERY DISEASE CERTIFICATION PROGRAMS ---------------------- - CPR CERTIFICATION AND RE-CERTIFICATION - SAFE SITTER - 55 ALIVE SAFE DRIVING - SMOKING CESSATION OTHER COMMUNITY BENEFIT PROGRAMS -------------------------------- - PARISH NURSING GRANT TO KEEP SENIORS HEALTHY & ACTIVE WHICH PROVIDES FREE SCREENINGS, HEALTH EDUCATION TO PUBLIC, AND TRAINS OTHER HEALTHCARE PROFESSIONALS TO GO BACK TO THEIR COMMUNITIES AND PROVIDE THE SAME PROGRAM IN THEIR AREA - PARISH NURSING COMMUNITY HEALTH FAIR WHICH PROVIDES VARIOUS SCREENINGS INCLUDING BLOOD PRESSURE, BLOOD SUGAR, CHOLESTEROL, FRACTURE RISK FOR OSTEOPOROSIS, EYE TESTING, & MOBILE MAMMOGRAPHY (FREE FOR WOMEN WITHOUT INSURANCE) - ANNUAL MEN'S HEALTH DAY - CANCER SCREENINGS; PROSTATE, COLORECTAL, & TESTICULAR - ANNUAL WOMEN'S HEALTH DAY - CANCER SCREENINGS - PERIPHERAL ARTERY DISEASE - FREE SCREENINGS EVERY FRIDAY - NATIONAL LUNG HEALTH DAY - ANNUAL HOME & HEALTH SHOW; FUNDRAISER FROM TOURS OF HOMES AND PROVIDES FREE HEALTH SCREENINGS - MEDICAL EXPLORER PROGRAM FOR HIGH SCHOOL STUDENTS IN THE LOCAL COMMUNITY - ANNUAL DIABETES UPDATE OPEN TO THE PUBLIC AND CERTIFIED BY THE AMERICAN DIABETES ASSOCIATION - FREE FLU SHOTS PROVIDED IN PARTNERSHIP WITH THE CAPE MAY COUNTY DEPARTMENT OF HEALTH AND A LEADING COMMUNITY BUSINESS - EMPLOYEE HEALTH SHARP CONTAINER EXCHANGES FOR INDIVIDUALS WITH CHRONIC DISEASE MANAGEMENT APPROXIMATELY 21,000 INDIVIDUALS BENEFITED FROM THE COMMUNITY BENEFIT PROGRAMS OFFERED BY CRMC DURING 2012.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11B THE ORGANIZATION IS THE TAX-EXEMPT PARENT ENTITY OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC. THE ORGANIZATION'S FEDERAL FORM 990 WAS MADE AVAILABLE TO EACH VOTING MEMBER OF ITS GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION, EACH MEMBER OF THE CAPE REGIONAL HEALTH SYSTEM, INC. EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE PERFORMED A DETAILed REVIEW OF THIS ORGANIZATION'S FORM 990 PRIOR TO FILING WITH THE IRS. THE CAPE REGIONAL HEALTH SYSTEM INC. EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE HAS ASSUMED THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION, REVIEW AND FILING PROCESS FOR BOTH 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 FINANCE PERSONNEL AND SYSTEM INDIVIDUALS INCLUDING THE CHIEF FINANCIAL OFFICER, VICE-PRESIDENT OF FINANCE AND VARIOUS OTHER INDIVIDUALS 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 FINANCE PERSONNEL AND OTHER INDIVIDUALS FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL 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 FINANCE PERSONNEL AND VARIOUS OTHER INDIVIDUALS FOR FINAL REVIEW AND APPROVAL PRIOR TO THE PRESENTATION OF THE FEDERAL FORM 990 TO THE MEMBERS OF THE CAPE REGIONAL HEALTH SYSTEM, INC. EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE AND THEREAFTER MADE AVAILABLE TO EACH MEMBER OF THIS ORGANIZATION'S BOARD OF TRUSTEES.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 12 THE ORGANIZATION IS THE TAX-EXEMPT PARENT ENTITY OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC. 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 THE SYSTEM'S PRESIDENT/CEO FOR REVIEW. THEREAFTER THE PRESIDENT/CEO PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS, IF APPLICABLE, FOR REVIEW BY THE ORGANIZATION'S BOARD OF TRUSTEES.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION b; QUESTION 15 THE ORGANIZATION IS THE TAX-EXEMPT PARENT ENTITY OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC. THIS FILING ORGANIZATION ITSELF HAS NO PAID SENIOR MANAGEMENT PERSONNEL RECEIVING COMPENSATION DIRECTLY FROM THIS ORGANIZATION. RATHER, KEY SENIOR MANAGEMENT PERSONNEL, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE EMPLOYED BY THE TAX-EXEMPT HOSPITAL WITHIN THE HEALTHCARE SYSTEM. HOWEVER, THE COMPENSATION AND BENEFITS OF THESE INDIVIDUALS ARE SHOWN ON THIS TAX RETURN BECAUSE THEY ARE ALSO EITHER OFFICERS OR BOARD MEMBERS OF THIS ORGANIZATION. ACCORDINGLY, THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE EVALUATION AND 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 THE HOSPITAL'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. 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 IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE HOSPITAL TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. 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 APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTH CARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING BUT NOT LIMITED TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. 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 DEPARTMENT OF THE TREASURY.
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 A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES.
RELATED HOURS DISCLOSURE CORE FORM, PART VII, SECTION A, COLUMN B THE ORGANIZATION IS THE TAX-EXEMPT PARENT ENTITY OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC. THE SYSTEM INCLUDES BOTH FOR-PROFIT AND NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF TRUSTEE MEMBERS, OFFICERS AND/OR DIRECTORS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENT THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF TRUSTEES OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY ONE HOUR. THE HOURS REFLECTED ON PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES; NOT SOLELY THIS ORGANIZATION.
OTHER CHANGES IN NET ASSETS CORE FORM, PART XI; QUESTION 9 OTHER CHANGES IN FUND BALANCE INCLUDE: - NET TRANSFER OF CASH FROM CAPE REGIONAL MEDICAL CENTER, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEPMT ORGANZIATION - $2,000,000.
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 THE ORGANIZATION IS THE TAX-EXEMPT PARENT ENTITY OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPE REGIONAL MEDICAL CENTER, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE TAXPAYER AND ALL AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; 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 FINANCE AND PLANNING COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL HEALTH SYSTEM INC
 
Employer identification number

22-2629594
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) CAPE REGIONAL HOLDINGS LLC
2 STONE HARBOR BOULEVARD
CAPE MAY COURT HOUSE,NJ08210
45-2206617
REAL ESTATE NJ 843,128 8,113,772 CRHS
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1) CAPE REGIONAL MEDICAL CENTER

2 STONE HARBOR BLVD

CAPE MAY COURT HOUSE,NJ08210
21-0662542
HEALTH SVCS. NJ 501(C)(3) HOSPITAL CRHS
 
Yes
 












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) BURDETTE TOMLIN MRI PA

STONE HARBOR BOULEVARD PO BOX 593
CAPE MAY COURT HOUSE,NJ08210
22-3120589
HEALTHCARE SVCS. NJ N/A
C CORP.       Yes  
(2) CAPE REGIONAL HEALTH ENTERPRISES

TWO STONE HARBOR BLVD
CAPE MAY COURT HOUSE,NJ08210
22-2615938
HEALTHCARE MGT. NJ CRHS
 
C CORP. 1,774,204 4,371,237 100.000 % Yes  
(3) CAPE CARDIOLOGY ASSOCIATES INC

STONE HARBOR BLVD PO BOX 593
CAPE MAY COURT HOUSE,NJ08210
22-2859159
HEALTHCARE SVCS. NJ N/A
C CORP.       Yes  
(4) CAPE IMAGING SERVICES

STONE HARBOR BLVD PO BOX 59
CAPE MAY COURT HOUSE,NJ08210
22-3154952
HOLDING CO. NJ N/A
C CORP.       Yes  
(5) CAPE PHYSICIAN ASSOCIATES PA

TWO STONE HARBOR BOULEVARD
CAPE MAY COURT HOUSE,NJ08210
22-3172481
HEALTHCARE SVCS. NJ N/A
C CORP.       Yes  




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
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-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) CAPE REGIONAL MEDICAL CENTER INC

S 2,000,000 COST
(2) CAPE REGIONAL MEDICAL CENTER INC

E 54,423 COST
(3) CAPE REGIONAL MEDICAL CENTER INC

E 509,611 COST



Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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


Software ID:  
Software Version: