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 MEDICAL CENTER 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

21-0662542
E Telephone number

G Gross receipts $ 134,508,773
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: 1941
M State of legal domicile: NJ
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE THE HIGHEST QUALITY HEALTHCARE TO OUR COMMUNITY.
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 1,294
6 Total number of volunteers (estimate if necessary) ............. 6 425
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 908,558 1,268,446
9 Program service revenue (Part VIII, line 2g) ......... 116,118,227 113,212,133
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,826,159 3,971,820
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,067,153 997,060
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 120,920,097 119,449,459
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 23,162 22,891
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) 66,281,277 68,631,044
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).... 51,821,953 44,382,147
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 118,126,392 113,036,082
19 Revenue less expenses. Subtract line 18 from line 12....... 2,793,705 6,413,377
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 142,368,057 149,243,345
21 Total liabilities (Part X, line 26)............. 74,579,227 74,377,821
22 Net assets or fund balances. Subtract line 21 from line 20..... 67,788,830 74,865,524
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 MEDICAL CENTER, INC. ("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. 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 $ 55,204,565 including grants of $ 22,891 ) (Revenue $ 62,232,344 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY INPATIENT 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 $ 35,211,034 including grants of $ 0 ) (Revenue $ 35,913,037 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY OUTPATIENT 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.
4c (Code:   ) (Expenses $ 11,319,671 including grants of $ 0 ) (Revenue $ 15,066,752 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4d Other program services (Describe in Schedule O.)
(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet101,735,270
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)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
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
Yes
 
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
Yes
 
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).... Click to see attachment
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............ Click to see attachment
18
Yes
 
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................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
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... Click to see attachment
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........ Click to see attachment
22
Yes
 
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
 
No
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
 
No
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...
35b
 
 
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
121
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,294
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. 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
Yes
 
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
Yes
 
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
Yes
 
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
NJ
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you 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           4,000 0 0
(7) JOANNE CARROCINO FACHE........................................................................
TRUSTEE - PRESIDENT/CEO
 50.0
.......................   		X   X       500,836 0 66,025
(8) ARTHUR L CHILDS DO........................................................................
TRUSTEE - VP MEDICAL STAFF
 1.0
.......................   		X           10,000 0 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       2,500 0 0
(16) THOMAS J PIRATZKY........................................................................
EXECUTIVE DIRECTOR
 50.0
.......................   		    X       223,698 0 60,395
(17) MARK R GILL........................................................................
CFO
 50.0
.......................   		    X       299,598 0 100,065
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;
(18) RICHARD W WHEATLEY........................................................................
CIO
 50.0
.......................   		    X       191,466 0 24,799
(19) RICHARD P FALIVENA DO........................................................................
VP MEDICAL AFFAIRS
 50.0
.......................   		    X       333,959 0 34,829
(20) DEBORAH BAEHSER........................................................................
VP NURSING
 50.0
.......................   		    X       209,778 0 20,529
(21) DIANA STOVER RN MSN........................................................................
VP CLINICAL SERVICES
 50.0
.......................   		    X       190,457 0 83,315
(22) BYRON K HUNTER........................................................................
VP HUMAN RESOURCES
 50.0
.......................   		    X       188,225 0 57,006
(23) SUSAN JOHNSON........................................................................
PHARMACIST
 50.0
.......................   		        X   181,117 0 62,158
(24) RICHARD ARTYMOWICZ........................................................................
DIRECTOR OF PHARMACY
 50.0
.......................   		        X   158,534 0 53,328
(25) JOANNE VAUL........................................................................
DIRECTOR PHYSICAN INTEGRATION
 50.0
.......................   		        X   154,227 0 6,250
(26) FRANK VAUL........................................................................
DIRECTOR OF FINANCE
 50.0
.......................   		        X   146,491 0 37,554
(27) MATT SHABER........................................................................
PHARMACIST
 50.0
.......................   		        X   145,591 0 5,406






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,940,477 0 611,659
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet57
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
LF DRISCOLL CO LLC, 9 PRESIDENTIAL BLVDBALA CYNWYDPA19004 CONSTRUCTION 2,707,029
CROTHALL HEALTHCARE INC, 955 CHESTERBROOK BLVD SUITE 300WAYNEPA19087 ENVIRONMENTAL 1,980,727
SIEMENS MEDICAL SOLUTIONS USA INC, 51 VALLEY STREAM PARKWAYMALVERNPA19355 IT 1,361,011
ZANETT COMMERCIAL SOLUTIONS INC, 3899 SOLUTIONS CENTERCHICAGOIL606773080 IT CONSULTING 557,423
NIGHTINGALE NURSES LLC, 6401 SOUTH CONGRESS AVENUE SUITE 2BOCA RATONFL33487 STAFFING 543,367
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet17
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 100,305
d Related organizations...1d  
e Government grants (contributions)1e 8,154
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,159,987
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 1,268,446
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 541900 108,972,014 108,972,014    
b OTHER HEALTHCARE RELATED REVENUE 541900 4,240,119 4,240,119    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 113,212,133
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,111,699     2,111,699
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 152,544  
b Less: rental expenses 121,253  
c Rental income or (loss) 31,291 0
d Net rental income or (loss).......MediumBullet 31,291     31,291
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 16,739,143 17,050
b Less: cost or other basis and sales expenses 14,805,566 90,506
c Gain or (loss) 1,933,577 -73,456
d Net gain or (loss)..........MediumBullet 1,860,121     1,860,121
8a Gross income from fundraising events (not including
$ 100,305
of contributions reported on line 1c). See Part IV, line 18 ..
a 41,989
b Less: direct expenses ...b 41,989
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CHILD CARE 624410 654,170     654,170
b CAFETERIA REVENUE 900099 282,649     282,649
c TELEPHONE 517000 28,950     28,950
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 965,769
12 Total revenue. See Instructions......MediumBullet 119,449,459 113,212,133 0 4,968,880
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 22,891 22,891
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 .... 2,601,478 2,341,331 260,147  
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 47,165,784 42,449,206 4,716,578 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,895,166 4,405,649 489,517  
9 Other employee benefits ....... 9,986,450 8,987,804 998,646  
10 Payroll taxes ........... 3,982,166 3,583,949 398,217  
11 Fees for services (non-employees):        
a Management ...... 133,106 119,795 13,311  
b Legal ......... 221,908 199,717 22,191  
c Accounting ........... 307,377 276,639 30,738  
d Lobbying ........... 29,513 26,562 2,951  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 262,500 236,250 26,250  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 2,270,238 2,043,214 227,024  
12 Advertising and promotion .... 200,751 180,676 20,075  
13 Office expenses ....... 2,435,546 2,191,991 243,555  
14 Information technology ...... 1,006,430 905,787 100,643  
15 Royalties .. 0      
16 Occupancy ........... 36,000 32,400 3,600  
17 Travel ............ 138,988 125,089 13,899  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 918,360 826,524 91,836  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 7,572,056 6,814,850 757,206  
23 Insurance .............. 1,075,902 968,312 107,590  
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 MEDICAL SUPPLIES 15,003,594 13,503,235 1,500,359  
b PHYSICIAN FEES 3,316,568 2,984,911 331,657  
c MAINTENANCE 2,234,701 2,011,231 223,470  
d UTILITIES 2,013,938 1,812,544 201,394  
e All other expenses 5,204,671 4,684,713 519,958  
25 Total functional expenses. Add lines 1 through 24e 113,036,082 101,735,270 11,300,812 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 ............. 1,580 1 1,580
2 Savings and temporary cash investments ......... 8,658,546 2 2,916,477
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 11,464,337 4 10,691,443
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 ............. 250,541 7 181,838
8 Inventories for sale or use .............. 1,651,106 8 1,730,073
9 Prepaid expenses and deferred charges .......... 2,905,105 9 2,743,684
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 161,355,391
b Less: accumulated depreciation ..... 10b 109,631,185 46,958,231 10c 51,724,206
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 ..... 62,987,374 13 68,088,340
14 Intangible assets ............... 210,023 14 0
15 Other assets. See Part IV, line 11 ........... 7,281,214 15 11,165,704
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 142,368,057 16 149,243,345
Liabilities 17 Accounts payable and accrued expenses ......... 11,884,004 17 10,326,967
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 22,265,567 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 .. 843,594 23 22,872,808
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.................... 39,586,062 25 41,178,046
26 Total liabilities. Add lines 17 through 25......... 74,579,227 26 74,377,821
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 .............. 66,559,704 27 74,154,616
28 Temporarily restricted net assets ........... 1,171,126 28 652,908
29 Permanently restricted net assets ........... 58,000 29 58,000
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 ........... 67,788,830 33 74,865,524
34 Total liabilities and net assets/fund balances ........ 142,368,057 34 149,243,345
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
119,449,459
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
113,036,082
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
6,413,377
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
67,788,830
5
Net unrealized gains (losses) on investments ...............
5
4,605,456
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
-3,942,139
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
74,865,524
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 MEDICAL CENTER INC
 
Employer identification number

21-0662542
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)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
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
Total                  

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
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number

21-0662542
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
CAPE REGIONAL MEDICAL CENTER INC
  		Employer identification number

21-0662542
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
CAPE REGIONAL MEDICAL CENTER INC
  		Employer identification number

21-0662542
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
CAPE REGIONAL MEDICAL CENTER INC
  		Employer identification number

21-0662542
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number

21-0662542
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
12,507
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
17,006
j
Total. Add lines 1c through 1i ...............................
29,513
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE C; POLITICAL CAMPAIGN AND LOBBYING ACTIVITIES SCHEDULE C, PART II-B; LINES 1G & 1I THIS AMOUNT, $17,006, REPRESENTS A PERCENTAGE OF THE CHIEF EXECUTIVE OFFICER'S TOTAL COMPENSATION ALLOCATED TO LOBBYING EFFORTS PERFORMED BY THIS INDIVIDUAL ON BEHALF OF THE ORGANIZATION DURING 2012. SCHEDULE C, PART II-B; LINE 1g CAPE REGIONAL MEDICAL CENTER IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION ("AHA"), THE NEW JERSEY HOSPITAL ASSOCIATION ("NJHA") AND THE COALITION TO PROTECT AMERICA'S HEALTH CARE WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. THIS AMOUNT, $12,507, REPRESENTS THE PORTION OF THE ORGANIZATION'S ANNUAL DUES PAID TO AHA, NJHA AND THE COALITION TO PROTECT AMERICA'S HEALTH CARE IN 2012 WHICH ARE ALLOCATED TOWARDS THESE LOBBYING EFFORTS. THE ORGANIZATION IS A MEMBER OF FAIR SHARE HOSPITALS COLLABORATIVE, INC. TO WHICH IT PAID DUES IN THE AMOUNT OF $10,000 IN 2012. ONE OF THE FUNCTIONS OF FAIR SHARE HOSPITALS COLLABORATIVE, INC. IS TO ENGAGE IN LOBBYING ACTIVITIES PERFORMED ON BEHALF OF ITS MEMBER HOSPITALS.
Schedule C (Form 990 or 990EZ) 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 MEDICAL CENTER INC
 
Employer identification number

21-0662542
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 .... 1,229,126 1,005,881 1,190,288 866,571 858,989
b Contributions ........ 1,014,547 660,064 1,255,239 896,055 1,595,081
c Net investment earnings, gains, and losses -3,326 2,132 -707 1,358 11,543
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		1,529,439 438,951 1,438,939 573,696 1,599,042
f Administrative expenses ....          
g End of year balance ...... 710,908 1,229,126 1,005,881 1,190,288 866,571
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 Bullet8.160 %
c
Temporarily restricted endowment SchDMd Bullet91.840 %
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)
 
No
(ii) related organizations ........................
3a(ii)
 
No
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 .................   475,499 475,499
b Buildings ................   61,053,385 32,652,518 28,400,867
c Leasehold improvements ............   573,831 573,831 0
d Equipment ................   96,188,882 74,510,580 21,678,302
e Other .................   3,063,794 1,894,256 1,169,538
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 51,724,206
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) EQUITY SECURITIES; LIMITED USE 28,153,237 F
(2) LIMITED USE 11,619,881 F
(3) USE 10,521,136 F
(4) LIMITED USE 173,332 F
(5) LIMITED USE 1,732,636 F
(6) MUTUAL FUNDS; LIMITED USE 15,888,118 F



Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 68,088,340
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 6,483,712
(2) OTHER ASSETS 1,182,084
(3) OTHER RECEIVABLES 3,499,908






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 11,165,704
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED RETIREMENT BENEFITS 32,147,381
IBNR MALPRACTICE COSTS 1,231,318
IBNR WORKERS COMPENSATION LIABILITY 238,000
THIRD-PARTY PAYORS, NET 7,174,254
OTHER LIABILITIES 387,093




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 41,178,046
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 ....... 1 122,839,069
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 4,605,456
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 57,875
e Add lines 2a through 2d ..................... 2e 4,663,331
3 Subtract line 2e from line 1..................... 3 118,175,738
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 262,500
b Other (Describe in Part XIII.) ........... 4b 1,011,221
c Add lines 4a and 4b....................... 4c 1,273,721
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 119,449,459
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 112,831,457
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 58,125
e Add lines 2a through 2d...................... 2e 58,125
3 Subtract line 2e from line 1..................... 3 112,773,332
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 262,500
b Other (Describe in Part XIII.) ............ 4b 250
c Add lines 4a and 4b....................... 4c 262,750
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 113,036,082
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
ENDOWMENT FUNDS SCHEDULE D, PART V; QUESTION 4 ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH INTENT AND IN FURTHERANCE OF THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES.
TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X AN INDEPENDENT CPA FIRM AUDITED THE FINANCIAL STATEMENTS OF CAPE REGIONAL MEDICAL CENTER, INC. FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY. IN ADDITION THE ORGANIZATION WAS ALSO INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES. THE FOOTNOTE BELOW IS FROM THE MEDICAL CENTER'S 2012 AUDITED FINANCIAL STATEMENTS AND REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48: THE MEDICAL CENTER 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 MEDICAL CENTER DOES NOT BELIEVE ITS FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS.
REC. OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH REVENUE PER RETURN SCHEDULE D, PART XI; LINE 2D OTHER AMOUNTS INCLUDED IN LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: - OTHER NON-OPERATING INCOME TAX EXPENSE - ($250) - ADDITIONAL RENTAL EXPENSES NOT ALREADY INCLUDED IN REVENUE - $58,125.
REC. OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH REVENUE PER RETURN SCHEDULE D, PART XI; LINE 4B OTHER AMOUNTS INCLUDED ON FORM 990, PART VII, LINE 12 BUT NOT ON LINE 1: - CONTRIBUTIONS (TEMPORARILY RESTRICTED) - $1,014,547 AND - INVESTMENT RETURN (TEMPORARILY RESTRICTED) - ($3,326).
REC. OF EXPENSE PER AUDITED FINANCIAL STATEMENT WITH EXPENSES PER RETURN SCHEDULE D, PART XII; LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1: - OTHER NON-OPERATING INCOME TAX EXPENSE - $250 AND - ADDITIONAL RENTAL EXPENSES NOT ALREADY INCLUDED IN REVENUE - $58,125.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number

21-0662542
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF CLASSIC
(event type) 		(b) Event #2

H&H SHOW
(event type) 		(c) Other events

1
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 69,105 43,972 29,217 142,294
2 Less: Contributions . . 47,849 32,198 20,258 100,305
3 Gross income (line 1
minus line 2) . . . 		21,256 11,774 8,959 41,989
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . . 6,000 169   6,169
6 Rent/facility costs . . 14,406 2,219   16,625
7 Food and beverages .     8,959 8,959
8 Entertainment . . .        
9 Other direct expenses . 850 9,386   10,236
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 41,989
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow  
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number

21-0662542
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
 
No
b
If "Yes," did the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    6,179,186 1,345,957 4,833,229 4.280 %
b Medicaid (from Worksheet 3,
column a) .... 		    13,995,927 10,499,494 3,496,433 3.090 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    20,175,113 11,845,451 8,329,662 7.370 %
Other Benefits
     769,144 14,610 754,534 0.670 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    10,010 4,877 5,133  
j Total. Other Benefits ..     779,154 19,487 759,667 0.670 %
k Total. Add lines 7d and 7j .     20,954,267 11,864,938 9,089,329 8.040 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
11,822,404
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,861,022
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
43,165,860
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
52,012,951
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-8,847,091
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 CAPE REGIONAL MEDICAL CENTER INC
2 STONE HARBOR BOULEVARD
CAPE MAY COURT HOUSE,NJ08210
WWW.CAPEREGIONAL.COM 		X X         X     1
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
CAPE REGIONAL MEDICAL CENTER INC
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
FINANCIAL ASSISTANCE ELIGIBILITY SCHEDULE H, PART I, LINE 3C THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2012 POVERTY GUIDELINES (DEPARTMENT OF HEALTH AND SENIOR SERVICES). FEDERAL POVERTY GUIDELINES ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE.
COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A NOT APPLICABLE.
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 NO COSTS RELATING TO SUBSIDIZED HEALTHCARE SERVICES ARE ATTRIBUTABLE TO ANY PHYSICIAN CLINICS.
COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY THIS ORGANIZATION IMPROVE THE MEDICAL AND SOCIOECONOMIC WELL-BEING OF THE COMMUNITIES IN OUR CARE. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS, AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. THIS ORGANIZATION PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS AND FOR COMMUNITY PROVIDERS. PRESENTATIONS ARE PROVIDED BY PHYSICIANS, NURSES AND OTHER HEALTHCARE PROFESSIONALS.
BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM FINANCIAL STATEMENT, NET OF ACCOUNTS WRITTEN OFF AT CHARGES. THE ORGANIZATION PREPARES AND ISSUES AUDITED FINANCIAL STATEMENTS. THE ATTACHED TEXT WAS OBTAINED FROM THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION. UNCOMPENSATED CARE THE MEDICAL CENTER PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA ESTABLISHED BY THE STATE OF NEW JERSEY. THE DIRECT AND INDIRECT COST OF SERVICES AND SUPPLIES FURNISHED TO PATIENTS ELIGIBLE FOR SUCH CHARITY CARE, USING A RATIO OF COST TO GROSS CHARGES, APPROXIMATED $6,179,000 AND $5,626,000 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. GROSS CHARGES FORGONE RELATED TO CHARITY CARE SERVICES AMOUNTED TO APPROXIMATELY $25,534,000 AND $22,056,000 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THE MEDICAL CENTER'S PATIENT ACCEPTANCE POLICY IS BASED ON ITS MISSION STATEMENT AND ITS CHARITABLE PURPOSES. ACCORDINGLY, THE MEDICAL CENTER ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THIS POLICY RESULTS IN THE ASSUMPTION OF HIGHER-THAN-NORMAL PATIENT ACCOUNTS RECEIVABLE CREDIT RISKS. TO THE EXTENT THE MEDICAL CENTER REALIZES ADDITIONAL LOSSES RESULTING FROM SUCH HIGHER CREDIT RISK FOR PATIENTS THAT ARE NOT IDENTIFIED OR DO NOT MEET THE PREVIOUSLY DESCRIBED CHARITY DEFINITION, SUCH ADDITIONAL LOSSES ARE INCLUDED IN THE PROVISION FOR BAD DEBTS. ADDITIONALLY, THE MEDICAL CENTER SPONSORS CERTAIN OTHER CHARITABLE PROGRAMS, WHICH PROVIDE SUBSTANTIAL BENEFIT TO THE BROADER COMMUNITY. SUCH PROGRAMS INCLUDE SERVICES TO NEEDY AND ELDERLY POPULATIONS THAT REQUIRE SPECIAL SUPPORT, AS WELL AS HEALTH PROMOTION AND EDUCATION FOR THE GENERAL COMMUNITY WELFARE. THE HEALTH CARE REFORM ACT OF 1992, CHAPTER 160, ESTABLISHED THE HEALTH CARE SUBSIDY FUND TO PROVIDE A MECHANISM AND FUNDING SOURCE TO COMPENSATE HOSPITALS FOR CHARITY CARE. THE MEDICAL CENTER RECEIVED APPROXIMATELY $1,346,000 AND $1,057,000 FOR CHARITY CARE, WHICH IS INCLUDED IN NET PATIENT SERVICE REVENUE FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THE HEALTH CARE SUBSIDY FUND AMOUNTS ARE SUBJECT TO CHANGE FROM YEAR TO YEAR BASED ON AVAILABLE STATE BUDGET AMOUNTS AND ALLOCATION METHODOLOGIES.
MEDICARE SHORTFALL SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE DERIVED FROM THE 2012 MEDICARE COST REPORT. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE INTERNAL REVENUE SERVICE ("IRS"). THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "THE TERM CHARITABLE IS USED IN 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE," AND PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY, AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVED" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY DEPARTMENT WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS; AND SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE HOSPITAL FACILITIES AND ADVANCE MEDICAL CARE, TRAINING, EDUCATION, RESEARCH, PROGRAMS AND ACTIVITIES. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED "DUAL ELIGIBLES." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO BELIEVE THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A ME
DEBT COLLECTION POLICY SCHEDULE H, PART III, LINE 9B ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE, BUT RATHER, ACCOUNTED FOR AS AN ALLOWANCE. IT IS THE POLICY OF THE CAPE REGIONAL HEALTH SYSTEM BUSINESS OFFICE, AND ALL ITS MEDICAL CENTER AFFILIATES, TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. FOR ACCOUNTS DETERMINED TO BE "SELF-PAY" AND/OR ACCOUNTS WITH BALANCE AFTER PRIMARY INSURANCE PAYMENTS, THE COLLECTION POLICY REQUIRES: SENDING THREE STATEMENTS, A MINIMUM OF ONE PRE-COLLECTION LETTER, TELEPHONE CONTACT FOR ANY ACCOUNT OVER $2,500.00 OR AT THE DISCRETION OF THE ACCOUNT REPRESENTATIVE AND/OR SUPERVISOR. THE FACILITY ALSO HAS A CHARITY CARE ACCESS POLICY TO ASSURE PATIENTS ARE PROVIDED WITH CHARITY CARE ASSISTANCE DETERMINED BY STATE AND FEDERAL REGULATIONS. IT IS THE POLICY TO INFORM ALL PATIENTS DEEMED SELF-PAY OF THE APPROPRIATE ASSISTANCE PROGRAMS AVAILABLE. PATIENTS APPLYING FOR CHARITY CARE ASSISTANCE WILL BE FINANCIALLY SCREENED BY A RESOURCE ADVISOR TO DETERMINE ELIGIBILITY ACCORDING TO STATE AND FEDERAL GUIDELINES AND WILL BE INFORMED OF DOCUMENTATION NEEDED TO COMPLETE A CHARITY CARE APPLICATION. PATIENTS NOT ELIGIBLE FOR CHARITY CARE WILL BE FINANCIALLY COUNSELED FOR ALL OTHER OPTIONS. QUALIFIED PATIENTS WILL BE REFERRED TO ALL APPROPRIATE AGENCIES OR PROGRAMS TO MEET OTHER FINANCIAL NEEDS. AT THE TIME OF THE PATIENT VISIT AND AS PART OF THE REGISTRATION PROCESS AT THE FACILITY, THE FOLLOWING OPTIONS ARE MADE AVAILABLE TO PATIENTS: - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR MEDICAL ASSISTANCE INCLUDING MEDICAID AND SUPPLEMENTAL SECURITY INCOME; - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR THE CHARITY HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM; AND, - FINANCIAL ARRANGEMENTS INCLUDING: 1. CASH/CREDIT CARD (AMERICAN EXPRESS, DISCOVER, VISA, MASTERCARD), OR 2. FLEXIBLE PAYMENT PLANS. IN ADDITION TO THE ABOVE OPTIONS, THE FACILITY HAS ESTABLISHED A SELF-PAY ASSISTANCE PROGRAM FOR OUR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR MEDICAID OR THE NEW JERSEY HOSPITAL CHARITY CARE PAYMENT ASSISTANCE PROGRAM. THE SELF-PAY ASSISTANCE PROGRAM RATES ARE REFLECTIVE OF MEDICARE REIMBURSEMENT, AS REFERRED BY THE STATE OF NEW JERSEY.
FACILITY INFORMATION SCHEDULE H, PART V; SECTION B, QUESTIONS 1J, 3, 4, 5C, 6I & 7 NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTIONS 9, 10, 11 & 12 NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTIONS 14G IN ADDITION TO THOSE METHODS INDICATED IN SCHEDULE H, PART V, SECTION B, LINE 14, THE ORGANIZATION ALSO SENDS A FOLLOW-UP LETTER TO PATIENTS WITH A COPY OF THE FINANCIAL ASSISTANCE POLICY ATTACHED.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTIONS 16E,17E,18E,19C,19D,20D,21&22 NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 20C THE FACILITY USES 115% OF THE MEDICARE RATE AS THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.
NEEDS ASSESSMENT SCHEDULE H, PART VI; QUESTION 2 THIS ORGANIZATION CONDUCTS A REVIEW OF KEY FACTOR INFORMATION ANNUALLY WHICH INCLUDES: A REVIEW OF HEALTHCARE UTILIZATION OF ITS SERVICE AREA POPULATION BY SERVICES (UROLOGY, CARDIOLOGY, OBSTETRICS, ETC.) FOR DETERMINING INCREASED OR DECREASED HEALTH NEEDS; HEALTHCARE SERVICE ESTIMATES AND FORECASTS (BOTH INPATIENT AND OUTPATIENT); ASSESSMENTS OF LOCAL DEMOGRAPHIC AND SOCIOECONOMIC INFORMATION; AND, A REVIEW OF HEALTH STATUS/NEEDS ASSESSMENTS AND STUDIES CONDUCTED BY EXTERNAL PARTIES (HEALTH RESEARCH AND EDUCATION TRUST OF NEW JERSEY, KID'S COUNT, NEW JERSEY HEALTH & SENIOR SERVICES DEPARTMENT, ETC.). THIS ORGANIZATION CONDUCTS AN EXTENSIVE SERVICE AREA POPULATION PHYSICIAN NEED STUDY (BY PRIMARY AND SPECIALTY) EVERY THREE TO FIVE YEARS. SPECIFIC SPECIALTY NEEDS ARE CONDUCTED FOR IDENTIFIED GAPS IN SERVICE. THESE REVIEWS INFORM MEDICAL STAFF DEVELOPMENT AT THE MEDICAL CENTER TO ASSURE RESPONSIVENESS TO IDENTIFIED COMMUNITY NEEDS. IN ADDITION, THIS ORGANIZATION WORKS WITH LOCAL PROVIDERS TO PLAN AND DISCUSS HEALTH NEEDS OF THE POPULATION.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI; QUESTION 3 CHARITY CARE SIGNS ARE POSTED THROUGHOUT THE FACILITY, MAINLY IN PATIENT REGISTRATION AREAS. SIGNS ARE POSTED IN BOTH ENGLISH AND SPANISH. ALL PATIENTS DEEMED SELF PAY ARE SCREENED FOR FINANCIAL ASSISTANCE BY A RESOURCE ADVISOR ACCORDING TO THE FEDERAL POVERTY GUIDELINES AND REFERRED TO APPROPRIATE AGENCIES OR PROGRAMS.
COMMUNITY INFORMATION SCHEDULE H, PART VI; QUESTION 4 THIS ORGANIZATION IS IN A DIVERSE SUBURBAN LOCATION SERVING DIVERSE COMMUNITIES RANGING FROM LOW INCOME COMMUNITIES TO MORE AFFLUENT SUBURBAN AREAS, WHICH INCLUDE RESORT COMMUNITIES AT THE NEW JERSEY SHORE. THIS ORGANIZATION IS LOCATED IN CAPE MAY COURT HOUSE, IN CAPE MAY COUNTY. THIS ORGANIZATION IS COMMITTED TO SERVICE FOR ITS COMMUNITIES AND SERVES THE LOCAL POPULATION AS WELL AS THE NEEDS OF SUMMER VACATIONERS AND AN INFLUX OF LOW INCOME SUMMER WORKERS SERVING THOSE VACATIONERS. APPROXIMATELY 20% OF ITS PATIENTS CONSIST OF THE UNDERINSURED AND UNINSURED PAYER CATEGORIES.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI; QUESTION 5 THIS ORGANIZATION HOLDS A PUBLIC MEETING ATTENDED BY VARIOUS SENIOR MANAGEMENT AND BOARD MEMBERS OF CAPE REGIONAL MEDICAL CENTER. THE MAJORITY OF THE BOARD OF TRUSTEES ARE INDIVIDUALS WITH LOCAL BUSINESSES OR WHOM RESIDE IN THE COMMUNITY. MEDICAL CENTER STAFF MEMBERS SERVE ON THE BOARDS OF MANY LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND PROVIDE OTHER FORMS OF SUPPORT (FUNDRAISING, ACTIVITY PARTICIPATION). ALL QUALIFIED PHYSICIANS ARE EXTENDED PRIVILEGES BY THEIR RESPECTIVE DEPARTMENTS. UNDER THE DIRECTIVE OF THE ORGANIZATION'S CORPORATE FINANCE OFFICE, SURPLUS FUNDS ARE UTILIZED FOR CAPITAL PROJECTS TO IMPROVE SERVICES OR PURCHASE EQUIPMENT WHICH IN TURN, BENEFIT THE COMMUNITY. PLEASE ALSO REFER TO FORM 990, SCHEDULE O, WHICH CONTAINS THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
AFFILIATED HEALTHCARE SYSTEM SCHEDULE H, PART VI; QUESTION 6 OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE CAPE REGIONAL HEALTH SYSTEM. NOT FOR-PROFIT CAPE REGIONAL HEALTH SYSTEM ENTITIES: CAPE REGIONAL HEALTH SYSTEM, INC. CAPE REGIONAL HEALTH SYSTEM, INC. ("CRHS") IS THE TAX-EXEMPT PARENT OF CAPE REGIONAL MEDICAL CENTER, INC. ("CRMC"). THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER CRMC OR CRHS. CAPE REGIONAL HEALTH SYSTEM, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). CAPE REGIONAL HEALTH SYSTEM, INC. STRIVES TO CONTINUALLY DEVELOP AND OPERATE A HEALTHCARE SYSTEM WHICH PROVIDES SUBSTANTIAL COMMUNITY BENEFIT THROUGH THE PROVISION OF A COMPREHENSIVE SPECTRUM OF HEALTHCARE SERVICES TO THE RESIDENTS OF NEW JERSEY AND SURROUNDING COMMUNITIES. 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. NO INDIVIDUALS ARE DENIED NECESSARY MEDICAL CARE, TREATMENT OR SERVICES. CAPE REGIONAL HEALTH SYSTEM INCLUDES: CAPE REGIONAL MEDICAL CENTER, INC. THIS HOSPITAL 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 AND THE BOARD OF TRUSTEES OF CAPE REGIONAL HEALTH SYSTEM. BOTH BOARDS ARE COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. CAPE REGIONAL MEDICAL CENTER, INC. CRMC IS A 242-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN CAPE MAY COURT HOUSE, NEW JERSEY. CRMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE 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. FOR-PROFIT CAPE REGIONAL HEALTH SYSTEM ENTITIES: CAPE REGIONAL HEALTH ENTERPRISES, INC. AND SUBSIDIARIES A CONSOLIDATED GROUP OF FOR-PROFIT ENTITIES, INCLUDING CAPE CARDIOLOGY ASSOCIATES, INC., CAPE IMAGING SERVICES, INC. AND CRPT MANAGEMENT SERVICES, LLC, WHOSE PARENT IS CAPE REGIONAL HEALTH ENTERPRISES, INC. ("CRHE"). THE SOLE SHAREHOLDER OF CRHE IS CRHS. THESE ENTITIES ARE LOCATED IN CAPE MAY COURT HOUSE, NEW JERSEY. CAPE PHYSICIAN ASSOCIATES, P.A. A FOR-PROFIT PHYSICIAN PRACTICE PROFESSIONAL CORPORATION CONTROLLED BY CAPE REGIONAL MEDICAL CENTER, INC. THROUGH A NOMINEE OWNERSHIP BY A LICENSED PROFESSIONAL DUE TO STATE OF NEW JERSEY CORPORATE PRACTICE OF MEDICINE PROHIBITION RULES AND REGULATIONS. BURDETTE TOMLIN MRI, P.A. AN INACTIVE FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS CRHS.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI; QUESTION 7 NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. THE STATE OF NEW JERSEY DOES NOT REQUIRE HOSPITALS TO ANNUALLY FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW JERSEY.
FACILITY REPORTING GROUP(S) SCHEDULE H, PART VI; QUESTION 8 NOT APPLICABLE. THE HOSPITAL HAS ONLY ONE HOSPITAL FACILITY REFLECTED IN PART V, SECTION A.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number
21-0662542
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) Ancillary Healthcare Scholarship 2 22,891      












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
GRANT FUND MONITORING SCHEDULE I, PART I; QUESTION 2 AncillAry Healthcare ScholarshipS ARE AWARDED TO INDIVIDUALS BASED ON A REVIEW AND APPROVAL PROCESS FOR VARIOUS APPLICANTS IN ACCORDANCE WITH THE ORGANIZATION'S CHARITABLE PURPOSES, PROGRAMS AND SERVICES. GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.
Schedule I (Form 990) 2012


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number

21-0662542
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)		 413,267
0 		49,733
0 		37,836
0 		52,315
0 		13,710
0 		566,861
0 		0
0
(2)THOMAS J PIRATZKYEXECUTIVE DIRECTOR (i)
(ii)		 185,120
0 		18,399
0 		20,179
0 		28,713
0 		31,682
0 		284,093
0 		0
0
(3)MARK R GILLCFO (i)
(ii)		 261,149
0 		22,539
0 		15,910
0 		66,606
0 		33,459
0 		399,663
0 		0
0
(4)RICHARD W WHEATLEYCIO (i)
(ii)		 172,921
0 		18,206
0 		339
0 		6,021
0 		18,778
0 		216,265
0 		0
0
(5)RICHARD P FALIVENA DOVP MEDICAL AFFAIRS (i)
(ii)		 281,358
0 		33,963
0 		18,638
0 		10,802
0 		24,027
0 		368,788
0 		0
0
(6)DEBORAH BAEHSERVP NURSING (i)
(ii)		 189,518
0 		19,546
0 		714
0 		6,639
0 		13,890
0 		230,307
0 		0
0
(7)DIANA STOVER RN MSNVP CLINICAL SERVICES (i)
(ii)		 169,702
0 		16,464
0 		4,291
0 		59,284
0 		24,031
0 		273,772
0 		0
0
(8)BYRON K HUNTERVP HUMAN RESOURCES (i)
(ii)		 174,819
0 		13,060
0 		346
0 		22,712
0 		34,294
0 		245,231
0 		0
0
(9)SUSAN JOHNSONPHARMACIST (i)
(ii)		 159,724
0 		0
0 		21,393
0 		32,025
0 		30,133
0 		243,275
0 		0
0
(10)RICHARD ARTYMOWICZDIRECTOR OF PHARMACY (i)
(ii)		 143,874
0 		10,088
0 		4,572
0 		20,502
0 		32,826
0 		211,862
0 		0
0
(11)JOANNE VAULDIRECTOR PHYSICAN INTEGRATION (i)
(ii)		 149,227
0 		5,000
0 		0
0 		5,203
0 		1,047
0 		160,477
0 		0
0
(12)FRANK VAULDIRECTOR OF FINANCE (i)
(ii)		 134,024
0 		12,168
0 		299
0 		2,719
0 		34,835
0 		184,045
0 		0
0
(13)MATT SHABERPHARMACIST (i)
(ii)		 142,702
0 		0
0 		2,889
0 		2,820
0 		2,586
0 		150,997
0 		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; MARK R. GILL, $17,270 and BYRON K. HUNTER, $12,374.
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


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SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or 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 MEDICAL CENTER INC
 
Employer identification number

21-0662542
Identifier Return Reference Explanation
COMMUNITY BENEFIT STATEMENT CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS 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 A; QUESTIONS 6 & 7 CAPE REGIONAL HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. CAPE REGIONAL HEALTH SYSTEM, INC. HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11b THE ORGANIZATION IS AN AFFILIATE WITHIN CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. 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 AN AFFILIATE WITHIN CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THE ORGANIZATION AND THE SYSTEM REGULARLY MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO THE ORGANIZATION AND 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 AN AFFILIATE WITHIN CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. CAPE REGIONAL HEALTH SYSTEM INC.'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 THE COMPENSATION AND BENEFITS OF CAPE REGIONAL MEDICAL CENTER, INC.'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 OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE 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 HEALTHCARE 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 THIS ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OR INDEPENDENT CONTRACTORS OF THIS 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 AN AFFILIATE WITHIN CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CAPE REGIONAL HEALTH SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. 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: - Change in Pension Benefit Obligation - ($1,833,276); - TRANSFER TO CAPE REGIONAL HEALTH SYSTEM, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX EXEMPT ORGANIZATION - ($2,000,000); AND - NET ASSETS RELEASED FROM TEMPORARY RESTRICTION FOR OPERATIONS - ($108,863).
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 AN INDEPENDENT CPA FIRM AUDITED THE FINANCIAL STATEMENTS OF THE TAXPAYER FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY, AND ISSUED A CERTIFIED AUDITED FINANCIAL STATEMENT. AN UNQUALIFIED OPINION WAS ISSUED BY THE INDEPENDENT CPA FIRM EACH YEAR. THE TAXPAYER IS AN AFFILIATE WITHIN CAPE REGIONAL HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM'S FINANCE AND PLANNING COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE TAXPAYER'S FINANCIAL STATEMENTS AND THE SELECTION OF ITS 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


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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 MEDICAL CENTER INC
 
Employer identification number

21-0662542
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










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 HEALTH SYSTEM INC

2 STONE HARBOR BLVD

CAPE MAY COURT HOUSE,NJ08210
22-2629594 		HOLDING CO. NJ 501(C)(3) 509(A)(2)  
 
No












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

2 STONE HARBOR BOULEVARD PO BOX 59
CAPE MAY COURT HOUSE,NJ08210
22-3120589 		HEALTHCARE SVCS. NJ N/A
 C CORP.         No
(2) CAPE REGIONAL HEALTH ENTERPRISES

TWO STONE HARBOR BLVD
CAPE MAY COURT HOUSE,NJ08210
22-2615938 		HEALTHCARE MGT. NJ N/A
 C CORP.         No
(3) CAPE CARDIOLOGY ASSOCIATES INC

STONE HARBOR BOULEVARD PO BOX 59
CAPE MAY COURT HOUSE,NJ08210
22-2859159 		HEALTHCARE SVCS. NJ N/A
 C CORP.         No
(4) CAPE IMAGING SERVICES

STONE HARBOR BOULEVARD PO BOX 59
CAPE MAY COURT HOUSE,NJ08210
22-3154952 		HOLDING CO. NJ N/A
 C CORP.         No
(5) CAPE PHYSICIAN ASSOCIATES PA

TWO STONE HARBOR BOULEVARD
CAPE MAY COURT HOUSE,NJ08210
22-3172481 		HEALTHCARE SVCS. NJ CRMC
  		C CORP. 8,805,557 3,362,293 100.000 % 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
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
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 HEALTH SYSTEM INC

 R 2,000,000 COST
(2) CAPE REGIONAL HEALTH SYSTEM INC

 D 54,423 COST
(3) CAPE REGIONAL HEALTH SYSTEM INC

 D 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


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