TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) PHILIP MCLOUGHLIN...................................................................... TRUSTEE (UNTIL 5/18)	2.0 ................. 2.0	X		0	0	0
(2) MICHAEL K LAUF...................................................................... PRESIDENT/CEO/TRUSTEE	55.0 ................. 5.0	X	X	0	2,672,978	289,344
(3) NATE RUDMAN MD...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(4) JOEL CROWELL...................................................................... SEE SCH O FOR TITLE	2.0 ................. 2.0	X	X	0	0	0
(5) SUZANNE FAY GLYNN ESQ...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(6) DEWITT DAVENPORT...................................................................... CHAIRMAN	2.0 ................. 2.0	X	X	0	0	0
(7) DIANE COLETTI...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(8) WILLIAM ZAMMER...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(9) SUMNER B TILTON JR...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(10) E JAMES MULCAHY JR...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(11) ROBERT TALERMAN...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(12) GARY VACON...................................................................... VICE CHAIR/TRUSTEE	2.0 ................. 2.0	X	X	0	0	0
(13) ROBERT WILSTERMAN MD...................................................................... TRUSTEE	40.0 ................. 2.0	X		791,933	0	60,781
(14) WILLIAM AGEL MD...................................................................... TRUSTEE	40.0 ................. 2.0	X		523,405	0	44,677
(15) RAMANI AYER...................................................................... TRUSTEE (FROM 5/18)	2.0 ................. 2.0	X		0	0	0
(16) THEODORE CALIANOS MD...................................................................... TRUSTEE	40.0 ................. 2.0	X		378,974	0	43,167
(17) PAUL HOULE MD...................................................................... TRUSTEE	40.0 ................. 2.0	X		1,099,091	0	62,207

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) BRUCE JOHNSTON........................................................................ TRUSTEE/TREASURER (FROM 5/18)	2.0 .......................2.0	X	X			0	0	0
(19) MICHAEL L CONNORS........................................................................ SENIOR VP FINANCE/CFO	55.0 .......................5.0		X			0	539,912	92,817
(20) MICHAEL G JONES ESQ........................................................................ SEE SCH O FOR TITLE	55.0 .......................5.0		X			0	412,450	78,339
(21) MICHAEL BUNDY........................................................................ COO	45.0 .......................5.0			X		0	452,973	57,273
(22) DONALD A GUADAGNOLI MD........................................................................ CMO CAPE COD HOSPITAL	45.0 .......................5.0			X		0	529,045	85,338
(23) ALEXANDER HEARD MD........................................................................ CHIEF MEDICAL OFFICER - FH	45.0 .......................5.0			X		84,330	611,313	67,672
(24) PATRICK J KANE........................................................................ SVP OF MRKTG,COMMUN AND DEVLP	45.0 .......................5.0			X		0	395,113	31,505
(25) CHRISTIAN BROWN........................................................................ SR VP MANAGED CARE	45.0 .......................5.0			X		0	393,040	79,946
(26) EMILY SCHORER........................................................................ SVP HUMAN RESOURCES	45.0 .......................5.0			X		0	331,273	58,910
(27) KEVIN RALPH........................................................................ SVP DEVELOPMENT	45.0 .......................5.0			X		0	297,026	60,128
(28) THERESA M AHERN........................................................................ SVP, STRAT, COMMUNITY/GOV REL.	45.0 .......................5.0			X		0	334,682	63,062
(29) KEVIN J MULROY........................................................................ SVP CHIEF QUALITY & SAFETY OFF	45.0 .......................5.0			X		0	474,478	75,112
(30) JEANNE FALLON........................................................................ SR VP & CIO (UNTIL 4/11/17)	45.0 .......................5.0			X		0	316,781	22,488
(31) JEFFREY S DYKENS........................................................................ VP FINANCE & OPERATIONS	45.0 .......................5.0			X		0	310,981	64,327
(32) NOELENE CERVIN........................................................................ VP BUDGETING & OPER. SUPPORT	45.0 .......................5.0			X		0	262,379	58,866
(33) LORI JEWETT........................................................................ CEO - FH	45.0 .......................5.0			X		0	287,208	42,343
(34) DIANNE C KOLB........................................................................ PRESIDENT VNA (UNTIL 8/8/17)	45.0 .......................5.0			X		0	168,574	38,377
(35) CARTER HUNT........................................................................ ADMIN SPEC&HOSP BASED CARE	45.0 .......................5.0			X		0	216,135	64,415
(36) VICTOR OLIVEIRA........................................................................ VP PATIENT SVCS(UNTIL 3/17)	45.0 .......................5.0			X		0	241,943	36,133
(37) JUDITH C QUINN........................................................................ VP OF PATIENT CARE	45.0 .......................5.0			X		0	279,725	49,841
(38) RICHARD B ZELMAN MD........................................................................ PHYSICIAN	40.0 .......................0.0				X	1,549,782	0	48,011
(39) ACHILLES PAPAVASILIOU MD........................................................................ PHYSICIAN	40.0 .......................0.0				X	1,122,283	0	63,501
(40) NICHOLAS COPPA MD........................................................................ PHYSICIAN	40.0 .......................0.0				X	1,082,702	0	65,372
(41) GORDON NAKATA MD........................................................................ PHYSICIAN	40.0 .......................0.0				X	1,073,238	0	62,639
(42) PHILLIP J DOMBROWSKI MD........................................................................ PHYSICIAN	40.0 .......................0.0				X	772,950	0	12,325

(A) Name and business address	(B) Description of services	(C) Compensation
CAPE COD HEALTHCARE INC, 297 NORTH STREET BLDG 3 HYANNIS,MA02601	PURCHASED SERVICES	52,832,634
QUALITY IN REAL TIME, 15 VERBENA AVENUE SUITE 210 FLORAL PARK,NY11001	CODING REVIEW	490,660
CORE MEDICAL GROUP, 3000 GOFFS FALLS RD SUITE 101 MANCHESTER,NH03103	CONTRACT RN, PT, OT	396,003
DELTA HEALTH, 400 LAKEMONT PARK BLVD ALTOONA,PA16602	MIS-SUPPORT	275,159
MEDTRONIC CARE MANAGEMENT, 7980 CENTURY BLVD CHANHASSEN,MN55317	PATIENT SUPPORT SVCS	140,178
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 10

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	9,458,675	15,572,146	13,584,232	15,341,766	15,447,109	69,403,928
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....						0
3	The value of services or facilities furnished by a governmental unit to the organization without charge..						0
4	Total. Add lines 1 through 3	9,458,675	15,572,146	13,584,232	15,341,766	15,447,109	69,403,928
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)..						2,821,753
6	Public support. Subtract line 5 from line 4.						66,582,175

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..	9,458,675	15,572,146	13,584,232	15,341,766	15,447,109	69,403,928
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	3,486,933	4,951,534	5,368,273	5,985,405	7,272,965	27,065,110
9	Net income from unrelated business activities, whether or not the business is regularly carried on..	1,059,076	1,000,152	798,057	408	-544,982	2,312,711
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	2,189,718	2,271,023	2,353,977	2,422,397	2,647,341	11,884,456
11	Total support. Add lines 7 through 10						110,666,205

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

4,036,039,797

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

Section C. Computation of Public Support Percentage

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

60.165 %

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

65.282 %

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

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

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

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1	0
2	Recoveries of prior-year distributions	2	0
3	Other gross income (see instructions)	3	0
4	Add lines 1 through 3	4	0
5	Depreciation and depletion	5	0
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6	0
7	Other expenses (see instructions)	7	0
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8	0

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a	0
b	Average monthly cash balances	1b	0
c	Fair market value of other non-exempt-use assets	1c	0
d	Total (add lines 1a, 1b, and 1c)	1d	0
e	Discount claimed for blockage or other factors (explain in detail in Part VI): 0
2	Acquisition indebtedness applicable to non-exempt use assets	2	0
3	Subtract line 2 from line 1d	3	0
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4	0
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5	0
6	Multiply line 5 by .035	6	0
7	Recoveries of prior-year distributions	7	0
8	Minimum Asset Amount (add line 7 to line 6)	8	0

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1	0
2	Enter 85% of line 1	2	0
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3	0
4	Enter greater of line 2 or line 3	4	0
5	Income tax imposed in prior year	5	0
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6	0

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

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes		0
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity		0
3 Administrative expenses paid to accomplish exempt purposes of supported organizations		0
4 Amounts paid to acquire exempt-use assets		0
5 Qualified set-aside amounts (prior IRS approval required)		0
6 Other distributions (describe in Part VI). See instructions		0
7Total annual distributions. Add lines 1 through 6.		0
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions		0
9 Distributable amount for 2019 from Section C, line 6		0
10 Line 8 amount divided by Line 9 amount		0 %

Section E - Distribution Allocations (see instructions)	(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6			0
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.		0
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......0
c From 2016.......0
d From 2017.......0
e From 2018.......0
fTotal of lines 3a through e	0
g Applied to underdistributions of prior years		0
h Applied to 2019 distributable amount			0
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.	0
4Distributions for 2019 from Section D, line 7:
$ 0
a Applied to underdistributions of prior years		0
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.	0
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.		0
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.			0
7 Excess distributions carryover to 2020. Add lines 3j and 4c.	0
8 Breakdown of line 7:
a Excess from 2015.....0
b Excess from 2016.....0
c Excess from 2017.....0
d Excess from 2018.....0
e Excess from 2019.....0

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

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2019

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

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

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

Name of organization CAPE COD HEALTHCARE INC & AFFILIATES

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

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

Page 3

Name of organization CAPE COD HEALTHCARE INC & AFFILIATES		Employer identification number 90-0054984

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

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

Page 4


Name of organization CAPE COD HEALTHCARE INC & AFFILIATES			Employer identification number 90-0054984
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2019

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

963,629

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

963,629

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1I	Cape Cod Hospital and Falmouth Hospital Association, Inc. pay membership dues to the Massachusetts Hospital Association which engages in lobbying purposes as defined by Medicare. Per the MHA advisory, 90.14% of dues paid should be allocated to lobbying activity. MHA determined that of the 90.14%, 9.51% was related to federal lobbying and 80.63% was related to state-based lobbying. Please note that the increase in the percentage, as compared to previous years, was due primarily to MHA's activities surrounding the 2018 Massachusetts ballot question. The increase only impacted the FY 2018 dues that were paid to MHA in the fall of 2017. For FY18 for Cape Cod Hospital and Falmouth Hospital Association, Inc. combined, the lobbying portion equals $963,629.

Return Reference

Explanation

PART II-B, LINE 1I

Cape Cod Hospital and Falmouth Hospital Association, Inc. pay membership dues to the Massachusetts Hospital Association which engages in lobbying purposes as defined by Medicare. Per the MHA advisory, 90.14% of dues paid should be allocated to lobbying activity. MHA determined that of the 90.14%, 9.51% was related to federal lobbying and 80.63% was related to state-based lobbying. Please note that the increase in the percentage, as compared to previous years, was due primarily to MHA's activities surrounding the 2018 Massachusetts ballot question. The increase only impacted the FY 2018 dues that were paid to MHA in the fall of 2017. For FY18 for Cape Cod Hospital and Falmouth Hospital Association, Inc. combined, the lobbying portion equals $963,629.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	41,606,730	38,809,089	37,495,620	38,872,003	36,060,986
b	Contributions ...	504,886	30,699	57,261	1,523,222	1,925,651
c	Net investment earnings, gains, and losses	1,353,728	3,061,173	2,000,285	-2,217,064	1,613,999
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,014,678	759,148	744,077	682,541	728,633
f	Administrative expenses ....		-464,917
g	End of year balance ......	42,450,666	41,606,730	38,809,089	37,495,620	38,872,003

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

80.760 %

Term endowment SchDMd Bullet

19.240 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	23,627,542		23,627,542
b	Buildings ....	404,720,923	183,625,388	221,095,535
c	Leasehold improvements	4,024,463	1,748,550	2,275,913
d	Equipment ....	226,940,276	177,709,553	49,230,723
e	Other .....	3,134,256	922,115	2,212,141
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				298,441,854

Schedule D (Form 990) 2019

Page 3

Part VII

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

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) LONG-TERM INVESTMENTS	417,657,717	F
(B) FUNDS HELD UNDER BOND	3,410,362	F
(C) TEMP RESTRICTED INVESTMENTS	24,888,547	F
(D) PERM RESTRICTED INVESTMENTS	33,785,042	F
(E) SHORT TERM INVESTMENTS - FDN	25,835,636	F
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	505,577,304

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1)DUE FROM AFFILIATES				54,989,486
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				54,989,486

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	48,074,533
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference	Explanation
SCHEDULE D, PART V, LINE 4	THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO FURTHER THE HEALTHCARE MISSION OF CAPE COD HEALTHCARE AND ITS AFFILIATES.
SCHEDULE D, PART X, LINE 2	THE ORGANIZATION DOES NOT HAVE A FIN 48 FOOTNOTE AS ANY UNCERTAIN TAX POSITIONS WERE DEEMED IMMATERIAL.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	1	Program Services	CAPTIVE INSURANCE	2,957,963
















3a	Sub-total ....	1			2,957,963
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	1			2,957,963

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2019

Schedule F (Form 990) 2019

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2019

Schedule F (Form 990) 2019Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2019

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2019

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
SCHEDULE F, PART I, COLUMN F	EXPENSES ARE CODED IN THE GENERAL LEDGER TO THE CAPTIVE INSURANCE COMPANY.

Schedule F (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

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?

YesNo

If "Yes," list the 10 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
	Borns GroupVDM 503 BROWN COUNTY 19N ABERDEEN, SD57401	DIRECT MAIL		No	220,016	68,237	151,779









Total . . . . . . . . . . . . . . . . . . . .					220,016	68,237	151,779

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

CA, CT, FL, IL, KS, MA, MI, MO, NH, NJ, NY, NC, PA, RI, SC, WI

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on 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 GALA EVENT (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	598,037	598,037
2	Less: Contributions . . . .	9,350	9,350
3	Gross income (line 1 minus line 2) . . . . . .	588,687	588,687

4	Cash prizes . . . . .	0	0
5	Noncash prizes . . . .	43,000	43,000
6	Rent/facility costs . . . .	6,800	6,800
7	Food and beverages . . .	74,539	74,539
8	Entertainment . . . .	16,351	16,351
9	Other direct expenses . . .	92,063	92,063
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		232,753
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		355,934

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

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

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

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

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

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. 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 provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	6,681,622	2,121,069	4,560,553	0.530 %
b	Medicaid (from Worksheet 3, column a) . . . . .	105,176,811	87,175,941	18,000,870	2.110 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	10,286,642	8,366,669	1,919,973	0.220 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	122,145,075	97,663,679	24,481,396	2.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2,642,379	0	2,642,379	0.310 %
f	Health professions education (from Worksheet 5) . . .	1,786,163	211,678	1,574,485	0.180 %
g	Subsidized health services (from Worksheet 6) . . . .	333,989,928	300,109,808	33,880,120	3.960 %
h	Research (from Worksheet 7) .	0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,078,867	0	1,078,867	0.130 %
j	Total. Other Benefits . .	339,497,337	300,321,486	39,175,851	4.580 %
k	Total. Add lines 7d and 7j .	461,642,412	397,985,165	63,657,247	7.440 %

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

Schedule H (Form 990) 2019

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense
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	36,166	36,166
7	Community health improvement advocacy
8	Workforce development	705,572	705,572
9	Other
10	Total	741,738	741,738

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

14,392,093

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. ......

9,003,313

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

Section B. Medicare

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

278,629,043

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

260,616,527

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

18,012,516

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Facility reporting group
1	CAPE COD HOSPITAL 27 PARK STREET HYANNIS,MA02601 SEE PART V, SECTION C 2135	X	X	X	A
2	FALMOUTH HOSPITAL ASSOCIATION INC 100 TER HEUN DRIVE FALMOUTH,MA02540 SEE PART V, SECTION C 2289	X	X	X	A

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	A
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

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

Yes

6 a

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

Yes

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

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

Yes

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

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

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

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

Yes

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

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

SEE PART V, SECTION C

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

SEE PART V, SECTION C

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	A
Name of hospital facility or letter of facility reporting group

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION A	WEBSITES PART V, SECTION A, LINE 1 - CAPE COD HOSPITAL WWW.CAPECODHEALTH.ORG/LOCATIONS/CAPE-COD-HOSPITAL
PART V, SECTION A, LINE 2 - FALMOUTH HOSPITAL	WWW.CAPECODHEALTH.ORG/LOCATIONS/FALMOUTH-HOSPITAL
PART V, SECTION B, LINE 5	OVER 20 DATA SOURCES WERE UTILIZED TO COLLECT BARNSTABLE COUNTY AND TOWN-LEVEL HEALTH STATISTICS ON DISEASE INCIDENCE AND PREVALENCE, HOSPITAL UTILIZATION, MORBIDITY AND MORTALITY, BARRIERS TO ACCESSING CARE, AND BEHAVIORAL RISK FACTORS. REGIONAL STATISTICS WERE ANALYZED AND COMPARED TO STATE AND NATIONAL STATISTICS TO IDENTIFY WHERE DEMOGRAPHIC AND HEALTH DISPARITIES EXIST. ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL SELECTED JOHN SNOW, INC. (JSI) A PUBLIC HEALTH RESEARCH FIRM, TO CONDUCT PRIMARY RESEARCH INCLUDING HEALTH DATA RESEARCH, KEY INFORMANT INTERVIEWS AND FACILITATION OF COMMUNITY AND PROVIDER FORUMS. JSI INTERVIEWED OVER 25 REGIONAL LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY AND WHO OFFER INFORMATION OR EXPERTISE RELATIVE TO THE SIGNIFICANT HEALTH NEEDS OF VULNERABLE POPULATIONS. THEY INCLUDED SUCH ENTITIES AS MUNICIPAL PUBLIC HEALTH DEPARTMENTS,HUMAN SERVICE AGENCIES, SCHOOLS AND LAW ENFORCEMENT AGENCIES, FEDERALLY QUALIFIED HEALTH CENTERS,COMMUNITY ORGANIZATIONS SERVING LOW-INCOME, VULNERABLE AND MEDICALLY UNDERSERVED POPULATIONS, ELECTED OFFICIALS, AND HOSPITAL CLINICIANS AND ADMINISTRATORS. FIVE COMMUNITY INPUT FORUMS WERE HELD ACROSS BARNSTABLE COUNTY. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS ATTENDED. THESE FORUMS PROVIDED AN OPPORTUNITY TO PRESENT STATISTICAL HEALTH FINDINGS TO PARTICIPANTS AND IDENTIFY GAPS IN SERVICES. ADDITIONALLY, THE FORUMS FACILITATED DIALOGUE ON ISSUES NOT IDENTIFIED AND TARGET POPULATIONS MOST IMPACTED BY HEALTH ISSUES. A POST-FORUM SURVEY WAS PROVIDED TO PARTICIPANTS TO IDENTIFY AND RANK HEALTH PRIORITIES IN THE REGION. FEEDBACK AND INPUT FROM THE KEY INFORMANT INTERVIEWS AND FROM ATTENDEES OF THE COMMUNITY AND PROVIDER FORUMS WAS USED TO INFORM THE SELECTION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS. THE FOLLOWING ORGANIZATIONS PARTICIPATED IN THE COMMUNITY INPUT ACTIVITIES THROUGHOUT THE PHASES OF THE PROJECT: PUBLIC HEALTH EXPERTS, HEALTH CARE PROVIDERS AND HEALTH SERVICE ORGANIZATIONS AIDS SUPPORT GROUP OF CAPE COD ALZHEIMER'S FAMILY SUPPORT CENTER OF CAPE COD ARBOR COUNSELING SERVICES BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT BARNSTABLE COUNTY DEPARTMENT OF HUMAN SERVICES BARNSTABLE COUNTY PUBLIC NURSING DIVISION CCHC EMERGENCY SERVICES CCHC CENTERS FOR BEHAVIORAL HEALTH CAPE & ISLANDS EMERGENCY MEDICAL SERVICES SYSTEM CARON TREATMENT CENTER COMMUNITY HEALTH CENTER OF CAPE COD DUFFY HEALTH CENTER EMERALD PHYSICIANS FALMOUTH HUMAN SERVICES GOSNOLD ON CAPE COD HARBOR COMMUNITY HEALTH CENTER-HYANNIS HOPE HEALTH HOPE DEMENTIA & ALZHEIMER'S SERVICES OF CAPE COD MASHPEE WAMPANOAG HEALTH SERVICE UNIT OUTER CAPE HEALTH SERVICES SPAULDING REHABILITATION HOSPITAL CAPE COD SPECIALTY NETWORK FOR THE UNINSURED TOWN OF BREWSTER HEALTH DEPARTMENT TOWN OF FALMOUTH HEALTH DEPARTMENT TOWN OF MASHPEE HUMAN SERVICES VINFEN VISITING NURSE ASSOCIATION OF CAPE COD ORGANIZATIONS SERVING LOW-INCOME, MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS: BARNSTABLE PUBLIC SCHOOL SYSTEM BOYS & GIRLS CLUB OF CAPE COD CAPE COD CENTER FOR WOMEN CAPE COD CHILD DEVELOPMENT CAPE COD COUNCIL OF CHURCHES CAPE COD WIC CAPE COD NEIGHBORHOOD SUPPORT COALITION CHILD AND FAMILY SERVICES COALITION FOR CHILDREN COMMUNITY ACTION COMMITTEE OF CAPE COD & THE ISLANDS CHILDREN'S COVE COMMUNITY DEVELOPMENT PARTNERSHIP ELDER SERVICES OF CAPE COD & THE ISLANDS FALMOUTH PUBLIC SCHOOL SYSTEM FALMOUTH SERVICE CENTER FALMOUTH TOGETHER WE CAN FALMOUTH VOLUNTEERS IN PUBLIC SCHOOLS THE FAMILY PANTRY OF CAPE COD GLENNA KOHL FUND FOR HOPE HEALTH IMPERATIVES HEALTHY LIVING CAPE COD HELPING OUR WOMEN HOMELESS PREVENTION COUNCIL HOUSING ASSISTANCE CORPORATION INDEPENDENCE HOUSE JUSTICE RESOURCE INSTITUTE LYME AWARENESS OF CAPE COD OUTER CAPE WOMEN INFANTS AND CHILDREN (WIC) MOTHER AND INFANT RECOVERY NETWORK NATIONAL ALLIANCE ON MENTAL ILLNESS CAPE COD SAMARITANS ON CAPE COD AND THE ISLANDS SANDPIPER NURSERY SCHOOL SANDWICH PUBLIC SCHOOL SYSTEM SHINE (SERVING HEALTH INFORMATION NEEDS OF EVERYONE) SIGHT LOSS SERVICES TOWN OF FALMOUTH COUNCIL ON AGING TOWN OF MASHPEE COUNCIL ON AGING TOWN OF PROVINCETOWN COUNCIL ON AGING TOWN OF SANDWICH COUNCIL ON AGING TOWN OF TRURO COUNCIL ON AGING WE CAN YMCA OF CAPE COD COUNTY, TOWN, OR MUNICIPAL ENTITIES AND REGIONAL TASK FORCES: CAPE & ISLANDS UNITED WA CAPE COD COMMUNITY COLLEGE CAPE COD DISTRICT ATTORNEY'S OFFICE CAPE COD FOUNDATION CAPE & ISLANDS SUICIDE PREVENTION COALITION YARMOUTH POLICE DEPARTMENT MA DEPARTMENT OF MENTAL HEALTH MA DEPARTMENT OF PUBLIC HEALTH MASHPEE WAMPANOAG TRIBE HEALTH SERVICES COMMUNITY HEALTH NETWORK AREA 27 BEHAVIORAL HEALTH PROVIDER COALITION OF CAPE COD & THE ISLANDS BARNSTABLE COUNTY REGIONAL SUBSTANCE ABUSE COUNCIL BARNSTABLE TOWN COUNCIL SUBSTANCE USE IN PREGNANCY TASK FORCE
PART V, SECTION B, LINE 6 (A)	CAPE COD HOSPITAL AND FALMOUTH HOSPITAL JOINTLY CONDUCTED THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT.
PART V, SECTION B, LINE 7(A)	https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/
PART V, SECTION B, LINE 10(A)	https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/
PART V, SECTION B, LINE 11	THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA INCLUDE CHRONIC AND INFECTIOUS DISEASE, BEHAVIORAL HEALTH, ACCESS TO CARE AND DISEASE PREVENTION AND WELLNESS. CAPE COD HOSPITAL (CCH) AND FALMOUTH HOSPITAL (FH) WILL ADDRESS THESE SPECIFIC ISSUES THROUGH A COMPREHENSIVE SET OF IMPLEMENTATION STRATEGIES THAT INCLUDE HOSPITAL-BASED PROGRAMS, COLLABORATIVE EFFORTS WITH NUMEROUS REGIONAL HEALTH PARTNERS AND PROVIDING GRANTS TO COMMUNITY BASED ORGANIZATIONS WITH INITIATIVES THAT ALIGN WITH COMMUNITY HEALTH IMPROVEMENT STRATEGIES. THREE SPECIFIC ISSUES IDENTIFIED THROUGH THE ASSESSMENT FALL OUTSIDE OF THE CORE COMPETENCIES OF THE HOSPITALS AND WERE NOT INCLUDED IN THE CCH AND FH IMPLEMENTATION STRATEGIES. THE ISSUES ARE TRANSPORTATION, HOUSING AND HOMELESSNESS, AND EMPLOYMENT. THESE ISSUES ARE LONG-STANDING REGIONAL CHALLENGES AND WERE IDENTIFIED IN THE PREVIOUS CHNA AS ISSUES OUTSIDE THE SCOPE OF SIGNIFICANT HEALTH NEEDS THAT THE HOSPITALS CAN REASONABLY ADDRESS. RESIDENTS IMPACTED BY THESE ISSUES WILL BE SERVED BY THE HOSPITALS SINCE IT IS THEIR MISSION TO SERVE ALL WITHOUT REGARD TO SEX, RACE, CREED, RESIDENCE, NATIONAL ORIGIN, SEXUAL ORIENTATION, OR ABILITY TO PAY. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL RECOGNIZE THAT THERE ARE REGIONAL ENTITIES WITH THE CORE COMPETENCIES, KNOWLEDGE, STAFF AND FUNDING SOURCES TO SPECIFICALLY ADDRESS THE ISSUES OF TRANSPORTATION, HOUSING AND HOMELESSNESS, AND EMPLOYMENT. THE HOSPITALS WILL COLLABORATE ON ACTIVITIES THAT ARE LED BY THE APPROPRIATE AGENCIES.
PART V, SECTION B, LINE 13(B)	IN SOME CASES, THE MASSACHUSETTS HEALTHCONNECTOR CALCULATOR OR MODIFIED ADJUSTED GROSS INCOME IS USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY.
PART V, SECTION B, LINE 13(H)	STATE REGULATIONS
PART V, SECTION B, LINE 16(A), 16(B), 16(C)	HTTPS://WWW.CAPECODHEALTH.ORG/PATIENTS-VISITORS/PAYING-FOR-CARE/FINANCIAL- ASSISTANCE/

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?83
Name and address		Type of Facility (describe)
1	Visiting Nurse Association of Cape Cod 255 Independence Drive Hyannis,MA02601	home health
2	CAPE COD HEALTHCARE INC 297 NORTH STREET BLDG 3 HYANNIS,MA02601	ADMINISTRATIVE
3	Fontaine Medical Center 525 Long Pond Drive HARWICH,MA02645	medical group practice
4	CAPE COD HEALTHCARE NEUROSURGER 46 NORTH ST STE 4 HYANNIS,MA02601	medical group practice
5	Bramblebush Medical Group 21 Bramblebush Park FALMOUTH,MA02540	medical group practice
6	Seaside Pediatrics 150 Ansel Hallet Road West Yarmouth,MA02673	medical group practice
7	Manning Jr William J MD 700 Attucks Lane Suite 1A HYANNIS,MA02601	medical group practice
8	Fontaine OUTPATIENT CENTER 525 Long Pond Drive Harwich,MA02645	medical group practice
9	Guo X Y David MD PhD-GASTROENTEROLOGY 90 TER HEUN DRIVE STE 302 Falmouth,MA02540	medical group practice
10	BAYSIDE INTERNAL MEDICINE 2 Jan Sebastian Way Suite 100 Sandwich,MA02563	medical group practice
11	SHAPIRO GARY& YAMIN JUSTIN MD-GASTRO 700 ATTUCKS LANE STE 1C Hyannis,MA02601	medical group practice
12	Theodore A Calianos II MD-PL&RECON 160 Falmouth Road Suite B MASHPEE,MA02649	medical group practice
13	CAPE COD OBSTETRICS & GYNECOLOGY 90 Ter Heun Drive SUITE 100 Falmouth,MA02540	medical group practice
14	Chatham Medical Group 1629 Main Street Chatham,MA02633	medical group practice
15	Endocrine Center of Cape Cod 1030 FALMOUTH RD STE 201 Hyannis,MA02601	medical group practice
16	Fal Specialty Care Practice 90 Ter Heun Drive Suite 302 Falmouth,MA02540	medical group practice
17	NEUROLOGISTS OF CAPE COD 46 North Street SUITE 7 Hyannis,MA02601	medical group practice
18	Nauset Family Practice 81 Old Colony Way STE D ORLEANS,MA02653	medical group practice
19	Devin McManus Medical Practice 10 BrambleBush Drive FALMOUTH,MA02540	medical group practice
20	Cape Health Insurance Company - FOREIGN 297 NORTH ST 3 HYANNIS,MA02601	administrative
21	Healthcare Foundation 32 MAIN STREET Hyannis,MA02601	administrative
22	Healthcare Foundation 348 GIFFORD ST STE 4 FALMOUTH,MA02540	ADMINISTRATIVE
23	JML Care Center 184 Ter Heun Drive falmouth,MA02540	skilled nur & rehab
24	Cape & Islands Health Services II 14 Yellow Brick Road HYANNIS,MA02601	COLLECTION CENTER
25	Cape & Islands Health Services II 5 Industrial Drive Suite 102 MASHPEE,MA02649	COLLECTION CENTER
26	Cape & Islands Health Services II 200 Jones Road FALMOUTH,MA02540	COLLECTION CENTER
27	Cape & Islands Health Services II 525 Long Pond Drive HARWICH,MA02645	COLLECTION CENTER
28	Cape & Islands Health Services II 81 Old Colony Way ORLEANS,MA02653	COLLECTION CENTER
29	Cape & Islands Health Services II 2 Jan Sebastian Way Route 130 SANDWICH,MA02563	COLLECTION CENTER
30	Cape & Islands Health Services II 860 Route 134 Unit 2 South Dennis,MA02660	COLLECTION CENTER
31	Cape & Islands Health Services II 1 Trowbridge Road Bourne,MA02532	COLLECTION CENTER
32	Cape & Islands Health Services II 68B Route 6A SANDWICH,MA02563	COLLECTION CENTER
33	Cape & Islands Health Services II 1629 MAIN STREET CHATHAM,MA02633	COLLECTION CENTER
34	Cape & Islands Health Services II 27 PARK STREET HYANNIS,MA02601	COLLECTION CENTER
35	Heritage at Falmouth 140 Ter Heun Drive FALMOUTH,MA02540	ASSISTED LIVING
36	Cape Cod Human Services 460 West Main Street HYANNIS,MA02601	outpatient clinic
37	Cape Cod Human Services 525 Long Pond Drive HARWICH,MA02645	outpatient clinic
38	Cape Cod Medical Office Building Inc 20 Gleason Street HYANNIS,MA02601	administrative
39	Orleans Medical CENTER 204 Main Street Orleans,MA02653	Medical Group Practice
40	CAPE COD Dermatology 150 Ansel Hallett Road W Yarmouth,MA02673	Medical Group Practice
41	Cape Cod Rheumatology Center 1030 FALMOUTH RD STE 201 HYANNIS,MA02601	MEDICAL GROUP PRACTICE
42	CCHC Cardiovascular Center 25 Main Street HYANNIS,MA02601	MEDICAL GROUP PRACTICE
43	Ziad Farah MD-Fontaine Medical Center 525 Long Pond Drive HARWICH,MA02645	MEDICAL GROUP PRACTICE
44	Fontaine Urgent Care Center 525 Long Pond Drive HARWICH,MA02645	MEDICAL GROUP PRACTICE
45	Park Street Primary Care 62 Park Street HYANNIS,MA02601	MEDICAL GROUP PRACTICE
46	Sandwich Medical Group STONEMAN OUTPATIENT2 Jan Sebastian SANDWICH,MA02563	MEDICAL GROUP PRACTICE
47	Sandwich Primary Care 2 JAN SEBASTIAN WAY SUITE 202 SANDWICH,MA02563	MEDICAL GROUP PRACTICE
48	Upper Cape Orthopedics 26 Edgerton Drive Suite C NORTH FALMOUTH,MA02556	MEDICAL GROUP PRACTICE
49	Michael Barnett MD Practice 348 Gifford Street FALMOUTH,MA02540	MEDICAL GROUP PRACTICE
50	Vascular And Vein Center Of Cape Cod 90 Ter Heun Drive 3RD Fl MOB STE Falmouth,MA02540	Medical Group Practice
51	CCHC General & Specialty Surgery 105 Park Street Hyannis,MA02601	Medical Group Practice
52	Cape Cod Sports Medicine 360 Gifford Street Unit 2B Falmouth,MA02540	Medical Group Practice
53	CARDIOVASCULAR CENTER - FALMOUTH 90 TER HEUN DRIVE SUITE 300 FALMOUTH,MA02540	Medical Group Practice
54	GASTROENTEROLOGY HYANNIS - PARK STREET 105 PARK STREET HYANNIS,MA02601	Medical Group Practice
55	STONEMAN OUTPATIENT CENTER - URGENT CARE 2 JAN SEBASTIAN DRIVE SUITE 101 SANDWICH,MA02563	Medical Group Practice
56	MASHPEE SURGICAL CENTER 160 FALMOUTH ROAD MASHPEE,MA02649	MEDICAL GROUP PRACTICE
57	SOUTHEASTERN SURGICAL ASSOCIATES 100 CAMP STREET HYANNIS,MA02601	MEIDCAL GROUP PRACTICE
58	FALMOUTH URGENT CARE 273 TEATICKET HIGHWAY FALMOUTH,MA02536	MEDICAL GROUP PRACTICE
59	HYANNIS URGENT CARE 1220 IYANNOUGH ROAD HYANNIS,MA02601	MEDICAL GROUP PRACTICE
60	UPPER CAPE EAR NOSE THROAT 200 A JONES ROAD FALMOUTH,MA02540	MEDICAL GROUP PRACTICE
61	ORTHOPEDIC SPECIALISTS 5 BRAMBLEBUSH DRIVE FALMOUTH,MA02540	MEDICAL GROUP PRACTICE
62	CCHC DEMENTIA&ALZHEIMER'S CAREGIVER SUPP 4 BAYVIEW ST WEST YARMOUTH,MA02673	ADMINISTRATIVE
63	CCHC PODIATRIC MEDICINE & FOOT SURGERY 1030 FALMOUTH RD 202 HYANNIS,MA02601	MEDICAL GROUP PRACTICE
64	IDCS-INFECTIOUS DISEASE CLINICAL SERV 34 PARK ST HYANNIS,MA02601	MEDICAL GROUP PRACTICE
65	CCH OBGYN SATELLITE 60A PARK ST HYANNIS,MA02601	MEDICAL GROUP PRACTICE
66	MACCMSSP REFERRAL DEPT 25 COMMUNICATION WAY HYANNIS,MA02601	ADMINISTRATIVE
67	DIABETIC EDUCATION 22 LEWIS BAY RD STE 102 HYANNIS,MA02601	EDUCATIONAL
68	DIABETIC EDUCATION 1629 MAIN ST CHATHAM,MA02633	EDUCATIONAL
69	TRADEWINDS ADULT DAY HEALTH OF VNA OF CC 290 ROUTE 130 SANDWICH,MA02563	ADULT DAY HEALTH
70	COMPASS ADULT DAY HEALTH 1 AUSTON RD F HARWICH,MA02645	ADULT DAY HEALTH
71	VNA OF CAPE COD - EASTHAM 3960 STATE HWY RD 6 2 EASTHAM,MA02642	HOME HEALTH
72	VNA OF CAPE COD - FALMOUTH 67 TER HEUN DR FALMOUTH,MA02540	HOME HEALTH
73	VNA OF CAPE COD - MARTHA'S VINEYARD 49 STATE RD VINEYARD HAVEN,MA02568	HOME HEALTH
74	VNA OF CAPE COD - NANTUCKET 2 SANFORD RD 2 NANTUCKET,MA02554	HOME HEALTH
75	VNA OF CAPE COD -PLYMOUTH 57 OBERY ST U3 PLYMOUTH,MA02360	HOME HEALTH
76	VNA OF CAPE COD - PROVINCETOWN 26 ALDEN ST PROVINCETOWN,MA02657	HOME HEALTH
77	VNA OF CAPE COD - SOUTH DENNIS 434 ROUTE 134 BLDG D 3 SOUTH DENNIS,MA02660	HOME HEALTH
78	VNA OF CAPE COD - WAREHAM 185 MAIN ST WAREHAM,MA02571	HOME HEALTH
79	VNA THRIFTIQUE 1074 RTE 28 SOUTH YARMOUTH,MA02664	THRIFT STORE
80	CCH THRIFT STORE 690 MAIN ST HYANNIS,MA02601	THRIFT STORE
81	CAPE & ISLANDS HEALTH SERVICES II 35 WILKENS LANE HYANNIS,MA02601	COLLECTION CENTER
82	ORLEANS MEDICAL CENTER 204 MAIN ST ORLEANS,MA02653	OUTPATIENT CLINIC
83	CAPE COD RESEARCH INSTITUTE 27 PARK ST HYANNIS,MA02601	RESEARCH

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
PART I, LINE 3C	N/A
PART I, LINE 6A	N/A
PART I, LINE 7, COLUMN F	THE AMOUNT OF BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN LINE 7, COLUMN F WAS $ 14,392,093. THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AND BY FOLLOWING THE FORM 990, SCHEDULE H INSTRUCTIONS. THE TOTAL PERCENTAGE OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST IN THE TABLE WAS CALCULATED ON A GROUP RETURN BASIS AS REQUIRED BY THE FORM 990 INSTRUCTIONS, AND NOT ON A HOSPITAL-ONLY BASIS.
PART II LINE 6 AND LINE 8	COALITION BUILDING Cape Cod Healthcare clinical, Community Benefits and support staff participated in a variety of coalition building activities within the service area to address and improve care related to women's health, behavioral health, chronic and infectious disease prevention and management and substance use and misuse in the region. Regional coalitions serve as alliances for combined and coordinated action to improve key health issues. Coalition activities ranged from implementation of new programs to offering community trainings and educational on important health topics to the development of multi-sector partnerships. WORKFORCE DEVELOPMENT CAPE COD HEALTHCARE'S PHYSICIAN RECRUITMENT PROGRAM STRIVES TO IDENTIFY AREAS OF UNMET NEED AND IMPROVE ACCESS TO PRIMARY AND SPECIALTY CARE FOR VULNERABLE POPULATIONS, ESPECIALLY THOSE OVER 65 WITH PUBLIC HEALTH INSURANCE COVERAGE. THROUGH RIGOROUS EFFORTS HIGHLY QUALIFIED PHYSICIANS AND PHYSICIAN EXTENDERS ARE RECRUITED AND RETAINED TO MEET THE HEALTH CARE NEEDS OF RESIDENTS OF CAPE COD.
PART III, LINES 2-3	THE ORGANIZATION IS REPORTING $9,003,313 OF BAD DEBT EXPENSE THAT MEETS ITS FINANCIAL ASSISTANCE POLICY. THIS AMOUNT IS RELATED TO BAD DEBT FROM BOTH HOSPITALS DURING FY18 OF UNINSURED PATIENTS WHO WERE SEEN IN THE ER AND RECEIVED MEDICALLY NECESSARY SERVICES. CAPE COD HEALTHCARE RECEIVES PAYMENTS FOR SERVICES RENDERED FROM FEDERAL AND STATE AGENCIES (UNDER THE MEDICARE AND MEDICAID PROGRAMS), MANAGED CARE PAYORS, COMMERCIAL INSURANCE COMPANIES, AND PATIENTS. PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF CONTRACTUAL ALLOWANCES AND RESERVES FOR DENIALS, UNCOMPENSATED CARE, AND DOUBTFUL ACCOUNTS. THE LEVEL OF RESERVES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL AND PRIVATE EMPLOYER HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. IF A PATIENT IS INELIGIBLE FOR CHARITY CARE BECAUSE HIS OR HER INCOME EXCEEDS THE ELIGIBILITY GUIDELINES, ANY UNCOLLECTIBLE ACCOUNTS RECEIVABLE BALANCE IS WRITTEN OFF TO BAD DEBT AS REPORTED IN PART III, LINE 2.
PART III, LINE 4	REFER TO PAGES 14-15 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR FOOTNOTES RELATED TO ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT.
PART III LINE 9(B)	HOSPITAL FINANCIAL ASSISTANCE PROGRAMS PATIENTS WHO ARE ELIGIBLE FOR ENROLLMENT IN A STATE PUBLIC ASSISTANCE PROGRAM, LIKE THE MASSACHUSETTS MASSHEALTH OR HEALTH SAFETY NET PROGRAMS, ARE DEEMED ENROLLED IN A FINANCIAL ASSISTANCE PROGRAM. FOR ALL PATIENTS THAT ARE ENROLLED IN THESE STATE PUBLIC ASSISTANCE PROGRAMS, THE HOSPITAL MAY ONLY BILL THOSE PATIENTS FOR THE SPECIFIC CO-PAYMENT, CO-INSURANCE, OR DEDUCTIBLE THAT IS OUTLINED IN THE APPLICABLE STATE REGULATIONS AND WHICH MAY FURTHER BE INDICATED ON THE STATE MEDICAID MANAGEMENT INFORMATION SYSTEM. THE HOSPITAL WILL SEEK A SPECIFIED PAYMENT FOR THOSE PATIENTS THAT DO NOT QUALIFY FOR ENROLLMENT IN A MASSACHUSETTS STATE PUBLIC ASSISTANCE SUCH AS OUT-OF-STATE RESIDENTS, BUT WHO MAY OTHERWISE MEET THE GENERAL FINANCIAL ELIGIBILITY CATEGORIES OF A STATE PUBLIC ASSISTANCE PROGRAM. FOR THESE PATIENTS, THE PAYMENT AMOUNT WILL BE SET AT THE HOSPITAL, WHEN REQUESTED BY THE PATIENT AND BASED ON AN INTERNAL REVIEW OF EACH PATIENT'S FINANCIAL STATUS, MAY OFFER A PATIENT AN ADDITIONAL DISCOUNT ON AN UNPAID BILL. ANY SUCH REVIEW SHALL BE PART OF A SEPARATE HOSPITAL FINANCIAL ASSISTANCE PROGRAM THAT IS APPLIED ON A UNIFORM BASIS TO PATIENTS, AND WHICH TAKES INTO CONSIDERATION THE PATIENT'S DOCUMENTED FINANCIAL SITUATION AND THE PATIENT'S INABILITY TO MAKE A PAYMENT AFTER REASONABLE COLLECTION ACTIONS. ANY DISCOUNT THAT IS PROVIDED BY THE HOSPITAL IS CONSISTENT WITH FEDERAL AND STATE REQUIREMENTS, AND DOES NOT INFLUENCE A PATIENT TO RECEIVE SERVICES FROM THE HOSPITAL. POPULATIONS EXEMPT FROM COLLECTION ACTIVITIES: THERE ARE SEVERAL SITUATIONS WHERE A PATIENT CAN BE EXEMPTED FROM FURTHER BILLING AND COLLECTION PROCEDURES ONCE THE DETERMINATION IS MADE THAT THE PATIENT IS EXEMPT PURSUANT TO STATE REGULATIONS: A) PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN, OR DESIGNATED A "LOW INCOME PATIENT" BY THE OFFICE OF MEDICAID, SUBJECT TO THE FOLLOWING EXCEPTIONS: (I) THE HOSPITAL MAY SEEK TO BILL AND COLLECT THE CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM. (II) THE HOSPITAL MAY ALSO INITIATE BILLING AND COLLECTION EFFORTS FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM, (INCLUDING RECEIPT OR VERIFICATION OF THE SIGNED APPLICATION) THE HOSPITAL SHALL CEASE ITS BILLING AND COLLECTION ACTIVITIES. (III) THE HOSPITAL WILL NOT CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED BY THE HOSPITAL DURING THE PERIOD FOR WHICH HE OR SHE HAS BEEN DETERMINED TO BE A LOW INCOME PATIENT BY THE OFFICE OF MEDICAID. HOWEVER, THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON A LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED, EXPIRED, OR NOT OTHERWISE IDENTIFIED ON THE STATE'S VIRTUAL GATEWAY OR RECIPIENT ELIGIBILITY VERIFICATION SYSTEM. ONCE A LOW INCOME PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN COMMONWEALTH CARE PROGRAMS, THE HOSPITAL WILL CEASE ITS BILLING AND COLLECTION EFFORTS FOR SERVICES PROVIDED PRIOR TO THE BEGINNING OF THEIR ELIGIBILITY. (IV) THE HOSPITALS MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE.
PART VI, LINE 2	NEEDS ASSESSMENT: THE 2017-2019 CAPE COD HOSPITAL AND FALMOUTH HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT REPORT (CHNA REPORT) AND IMPLEMENTATION PLAN WAS RELEASED AND MADE WIDELY AVAILABLE TO THE PUBLIC ON SEPTEMBER 30, 2016. THE GOALS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROJECT ARE TO MONITOR REGIONAL HEALTH DATA, ENGAGE HOSPITAL STAKEHOLDERS, PROMOTE PARTNERSHIPS BETWEEN THE HOSPITALS AND COMMUNITY ORGANIZATIONS AND DEVELOP MULTI-YEAR IMPLEMENTATION STRATEGIES TO GUIDE HOSPITAL INITIATIVES TO IMPROVE THE HEALTH OF BARNSTABLE COUNTY RESIDENTS. THE METHODOLOGY FOR CONDUCTING THE ASSESSMENT INCLUDED THE COLLECTION AND ANALYSIS OF PRIMARY AND SECONDARY HEALTH DATA, GATHERING SIGNIFICANT INPUT FROM THE COMMUNITY, AND THE IDENTIFICATION AND PRIORITIZATION OF KEY HEALTH NEEDS FOR THE REGION. OVER 20 DATA SOURCES WERE UTILIZED TO COLLECT BARNSTABLE COUNTY AND TOWN-LEVEL HEALTH STATISTICS ON DISEASE INCIDENCE AND PREVALENCE, HOSPITAL UTILIZATION, MORBIDITY AND MORTALITY, BARRIERS TO ACCESSING CARE, AND BEHAVIORAL RISK FACTORS. REGIONAL STATISTICS WERE ANALYZED AND COMPARED TO STATE AND NATIONAL STATISTICS TO IDENTIFY WHERE DEMOGRAPHIC AND HEALTH DISPARITIES EXIST. ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS REPRESENTING LOW-INCOME, MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS PROVIDED CRITICAL INSIGHT AND FEEDBACK ON THE REGIONAL HEALTH NEEDS THROUGH KEY INFORMATION INTERVIEWS AND COMMUNITY INPUT FORUMS. THROUGH THIS COLLECTION OF DATA AND COMMUNITY INPUT THE SIGNIFICANT HEALTH NEEDS OF BARNSTABLE COUNTY RESIDENTS WERE DISTINGUISHED AND PRIORITIZED BASED ON THE FREQUENCY, URGENCY, SCOPE, SEVERITY AND MAGNITUDE OF THE IDENTIFIED ISSUES. THE SIGNIFICANT HEALTH NEEDS AND ASSOCIATED TARGET POPULATIONS IDENTIFIED THROUGH THE CHNA REPORT WILL SERVE AS THE FOUNDATION FOR COMMUNITY BENEFITS AND HOSPITAL PLANNING SPANNING FISCAL YEARS 2017-2019. THE FOLLOWING SOURCES WERE UTILIZED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTS: - CAPE COD HOSPITAL AND FALMOUTH HOSPITAL UTILIZATION DATA - BARNSTABLE COUNTY DEPARTMENT OF HUMAN SERVICES: ANALYSIS OF SUBSTANCE ABUSE ON CAPE COD, A BASELINE ASSESSMENT, BARNSTABLE COUNTY BEHAVIORAL HEALTH WEB PORTAL, BARNSTABLE COUNTY PUBLIC HEALTH AND WELLNESS WEB PORTAL - CAPE COD FOUNDATION CONNECT CAPE COD - UNIVERSITY OF MASSACHUSETTS (UMASS) DONAHUE INSTITUTE LONG-TERM PROJECTIONS FOR MASSACHUSETTS REGIONAL AND MUNICIPALITIES - MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH: MASSACHUSETTS COMMUNITY HEALTH INFORMATION PROFILE (MASS CHIP), MASSACHUSETTS BEHAVIORAL HEALTH RISK FACTOR SURVEILLANCE SYSTEM - US CENSUS BUREAU: US CENSUS 2010, AMERICAN COMMUNITY SURVEY ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL SELECTED JOHN SNOW, INC. (JSI) A PUBLIC HEALTH RESEARCH FIRM, TO CONDUCT PRIMARY RESEARCH INCLUDING HEALTH DATA RESEARCH, KEY INFORMANT INTERVIEWS AND FACILITATION OF COMMUNITY AND PROVIDER FORUMS. JSI INTERVIEWED OVER 25 REGIONAL LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY AND WHO OFFER INFORMATION OR EXPERTISE RELATIVE TO THE SIGNIFICANT HEALTH NEEDS OF VULNERABLE POPULATIONS. THEY INCLUDED SUCH ENTITIES AS MUNICIPAL PUBLIC HEALTH DEPARTMENTS, HUMAN SERVICE AGENCIES,SCHOOLS AND LAW ENFORCEMENT AGENCIES, FEDERALLY QUALIFIED HEALTH CENTERS, COMMUNITY ORGANIZATIONS SERVING LOW-INCOME, VULNERABLE AND MEDICALLY UNDERSERVED POPULATIONS, ELECTED OFFICIALS, AND HOSPITAL CLINICIANS AND ADMINISTRATORS. FIVE COMMUNITY INPUT FORUMS WERE HELD ACROSS BARNSTABLE COUNTY. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS ATTENDED. THESE FORUMS PROVIDED AN OPPORTUNITY TO PRESENT STATISTICAL HEALTH FINDINGS TO PARTICIPANTS AND IDENTIFY GAPS IN SERVICES. ADDITIONALLY, THE FORUMS FACILITATED DIALOGUE ON ISSUES NOT IDENTIFIED AND TARGET POPULATIONS MOST IMPACTED BY HEALTH ISSUES. A POST-FORUM SURVEY WAS PROVIDED TO PARTICIPANTS TO IDENTIFY AND RANK HEALTH PRIORITIES IN THE REGION. FEEDBACK AND INPUT FROM THE KEY INFORMANT INTERVIEWS AND FROM ATTENDEES OF THE COMMUNITY AND PROVIDER FORUMS WAS USED TO INFORM THE SELECTION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS.
PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: FOR THOSE PATIENTS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER THEIR UNPAID HOSPITAL BILLS. IN ORDER TO ASSIST UNINSURED AND UNDERINSURED PATIENTS IN FINDING AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL WILL PROVIDE ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS AS WELL AS IN GENERAL NOTICES POSTED THROUGHOUT THE HOSPITAL. THE GOAL OF THESE NOTICES IS TO INFORM PATIENTS THAT THEY MAY BE ELIGIBLE TO APPLY FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM, SUCH AS, BUT NOT LIMITED TO, MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, HEALTH SAFETY NET, OR MEDICAL HARDSHIP THROUGH THE HEALTH SAFETY NET. THE HOSPITAL WILL PROVIDE, UPON REQUEST, SPECIFIC INFORMATION ABOUT THE ELIGIBILITY PROCESS TO BE DESIGNATED A LOW INCOME PATIENT UNDER EITHER THE STATE HEALTH SAFETY NET PROGRAM OR THROUGH THE HOSPITAL'S OWN INTERNAL CHARITY CARE PROGRAM. THE HOSPITAL WILL ALSO NOTIFY THE PATIENT ABOUT PAYMENT PLANS THAT MAY BE AVAILABLE TO HIM OR HER BASED ON THE SIZE OF HIS OR HER FAMILY AND FAMILY INCOME.
PART VI, LINE 4	DEMOGRAPHICS OF THE SERVICE AREA CAPE COD HEALTHCARE IS THE COMMUNITY SAFETY-NET PROVIDER OF HEALTH CARE SERVICES FOR THE YEAR-ROUND RESIDENTS AND MILLIONS OF ANNUAL VISITORS TO BARNSTABLE COUNTY, ALSO KNOWN AS "CAPE COD." CAPE COD HOSPITAL AND FALMOUTH HOSPITAL, THE ONLY TWO ACUTE-CARE, NON-PROFIT HOSPITALS IN THE REGION, TOGETHER SHARE THE 15 TOWNS OF BARNSTABLE COUNTY AS THEIR PRIMARY SERVICE AREA. THE UPPER CAPE REGION INCLUDES THE MASHPEE WAMPANOAG TRIBAL REGION. CAPE COD HOSPITAL, LOCATED IN HYANNIS, MA, IS A 259-BED ACUTE-CARE, NON-PROFIT HOSPITAL. FALMOUTH HOSPITAL, LOCATED IN FALMOUTH, MA, IS A 95-BED ACUTE-CARE, NON-PROFIT HOSPITAL. BARNSTABLE COUNTY IS A GEOGRAPHICALLY ISOLATED REGION LOCATED ON THE EASTERN SEABOARD OF MASSACHUSETTS. THE NARROW PENINSULA SPANS OVER 70 MILES IN LENGTH AND HOSTS A YEAR-ROUND POPULATION OF 215,449 RESIDENTS. BARNSTABLE COUNTY CONSISTS OF 15 TOWNS THAT VARY IN YEAR-ROUND POPULATION SIZE FROM ABOUT 45,000 RESIDENTS (BARNSTABLE) TO SLIGHTLY MORE THAN 1,700 RESIDENTS (TRURO). IN ADDITION TO SERVING YEAR-ROUND RESIDENTS,THE REGIONAL COMMUNITY INFRASTRUCTURE, INCLUDING CAPE COD HOSPITAL AND FALMOUTH HOSPITAL, MUST MEET THE DEMANDS OF A SIGNIFICANT INFLUX OF SEASONAL RESIDENTS AND VISITORS EACH YEAR. THE CAPE COD COMMISSION PRODUCED ESTIMATES, USING SURVEY DATA FROM SECOND HOMEOWNERS TO INDICATE THAT THE POPULATION OF SUMMER RESIDENTS ON CAPE COD, WHEN AVERAGED OVER A FULL YEAR, IS EQUIVALENT TO AN ADDITIONAL 68,856 FULL-TIME RESIDENTS. THIS COUPLED WITH DAY VISITORS AND SHORT TERM TRAVELER VOLUME RESULTS IN AN ESTIMATED 7 MILLION VISITORS AND RESIDENTS ON CAPE COD IN A GIVEN SUMMER SEASON. THIS SEASONAL POPULATION EXPANSION AND CONTRACTION CREATES UNIQUE CHALLENGES FOR THE CAPE'S HEALTH CARE SYSTEM, TRANSPORTATION NETWORK, WORKFORCE, BUSINESS COMMUNITY, AND HOUSING MARKET. POPULATION TRENDS AND AGE DEMOGRAPHIC ANALYSIS REVEALS TWO STRIKING TRENDS THAT WILL IMPACT BARNSTABLE COUNTY IN THE NEAR FUTURE. CURRENT DATA AND FUTURE DEMOGRAPHIC PREDICTIONS FOR THE REGION DEMONSTRATE THAT BARNSTABLE COUNTY'S OVERALL POPULATION IS DECLINING AND INCREASING IN AGE. ACCORDING TO THE LONG-TERM POPULATION PROJECTIONS FOR MASSACHUSETTS REGIONS AND MUNICIPALITIES, A PUBLICATION BY THE UMASS DONAHUE INSTITUTE, ALL REGIONS IN MA WILL EXPERIENCE POSITIVE POPULATION GROWTH FROM 2010-2035 EXCEPT FOR BARNSTABLE COUNTY AND THE ISLANDS OF NANTUCKET AND MARTHA'S VINEYARD. A PROJECTED NET LOSS OF 13% OF THE OVERALL POPULATION OF BARNSTABLE COUNTY IS PREDICTED BETWEEN 2010 AND 2035. BY 2035, THE TOTAL YEAR-ROUND POPULATION IS EXPECTED TO DECREASE TO APPROXIMATELY 188,000 RESIDENTS, A POPULATION SIMILAR TO HISTORIC 1990 NUMBERS. THIS DECLINE IS ATTRIBUTED TO TWO FACTORS, AN OUTFLOW OF YOUNG PEOPLE FROM THE REGION, AND DEATHS CONTINUING TO OUTNUMBER BIRTHS. IN ADDITION TO THE DECLINING POPULATION, THE YEAR-ROUND POPULATION OF BARNSTABLE COUNTY WILL CONTINUE TO HAVE A SIGNIFICANTLY LARGER PROPORTION OF SENIORS OVER THE AGE OF 65 THAN THE STATE OF MASSACHUSETTS (MA) AND THE UNITED STATES (U.S.). ACCORDING TO 2009-2013 AMERICAN COMMUNITY SURVEY ESTIMATES, NEARLY 26% OF THE YEAR-ROUND POPULATION OF BARNSTABLE COUNTY IS OVER THE AGE OF 65 COMPARED TO 14% IN MA AND 13% IN THE U.S. IT IS PREDICTED THAT BY THE YEAR 2035, NEARLY 35% OF THE POPULATION OF BARNSTABLE COUNTY WILL BE OVER THE AGE OF 65.4. IN MA, 58% OF THE OVERALL POPULATION IS COMPRISED OF RESIDENTS BETWEEN THE AGES OF 0-44 YEARS COMPARED TO ONLY 42% IN BARNSTABLE COUNTY. 'BABY BOOMERS', WHO ARE CURRENTLY INCLUDED IN THE AGE BRACKET OF 45 TO 64 YEAR-OLD RESIDENTS, REPRESENT AN ADDITIONAL 32% OF THE CAPE'S POPULATION. THESE COMBINED POPULATION STATISTICS SKEW BARNSTABLE COUNTY'S MEDIAN AGE TO OVER 50 YEARS OLD, THE HIGHEST FOR ALL COUNTIES IN MASSACHUSETTS. THIS IS MORE THAN A DECADE OLDER THAN THE MA MEDIAN AGE OF 39 YEARS AND THE U.S. MEDIAN AGE OF 37 YEARS. A COMMON THEME DISCUSSED IN STAKEHOLDER INTERVIEWS AND COMMUNITY/PROVIDER FORUMS WAS THAT PERSONS OVER THE AGE OF 65 AND YOUTH (15-24 YEARS OLD)REPRESENTED TWO OF THE MOST VULNERABLE POPULATIONS IN THE SERVICE AREA.YOUTH WERE IDENTIFIED AS A TARGET POPULATION DUE TO CONCERNS RELATED TO EARLY ONSET OF MENTAL HEALTH CONDITIONS, SUBSTANCE USE AND RISKY HEALTH BEHAVIORS. BARNSTABLE COUNTY'S GENDER DEMOGRAPHICS MIRROR THOSE OF MA; 52% OF RESIDENTS ARE FEMALE AND 48% ARE MALE. NEARLY 12% OF BARNSTABLE COUNTY RESIDENTS OVER THE AGE OF 18 ARE VETERANS WHICH IS HIGHER THAN THE PERCENTAGE IN BOTH MA (7%) AND THE U.S. (9%). IN BARNSTABLE COUNTY, 13% OF RESIDENTS REPORT THAT THEY ARE LIVING WITH A DISABILITY COMPARED TO 11% IN MA. BARNSTABLE COUNTY MUST MEET THE UNIQUE HEALTH NEEDS OF VETERANS AND PERSONS LIVING WITH DISABILITIES WHO MAY BE AT A GREATER RISK OF DEVELOPING COMORBID CONDITIONS AND OFTEN ENCOUNTER LIMITED ACCESS OR BARRIERS TO CARE. INCOME AND POVERTY ALTHOUGH BARNSTABLE COUNTY HAS A LOWER PROPORTION OF LOW-INCOME RESIDENTS THAN DOES MA (9% VS. 11%), REPRESENTATIVES OF ORGANIZATIONS THAT SERVE VULNERABLE, LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS REPORT A GROWING NUMBER OF RESIDENTS WHO STRUGGLE TO SECURE AND MAINTAIN STABLE EMPLOYMENT. THEY ALSO RELY ON PUBLIC ASSISTANCE PROGRAMS TO AFFORD HEALTH INSURANCE, FOOD AND HOUSING. ACCORDING TO FIVE-YEAR CENSUS ESTIMATES (2009-2013), THE MEDIAN HOUSEHOLD INCOME OF BARNSTABLE COUNTY RESIDENTS WAS $60,526 COMPARED TO $66,866 FOR ALL MASSACHUSETTS RESIDENTS. IN 2014, A HIGHER PERCENT OF PER CAPITA INCOME WAS DERIVED FROM TRANSFER PAYMENTS (SOCIAL SECURITY, DISABILITY PENSIONS, HOUSING AND FOOD SUBSIDY PROGRAMS, AND UNEMPLOYMENT BENEFITS) IN BARNSTABLE COUNTY (19%) COMPARED TO MA (15%) AND THE U.S. (17%). VULNERABLE POPULATIONS ARE FURTHER CHALLENGED BY EMPLOYMENT OPPORTUNITIES ON CAPE COD WHICH DECREASE DURING WINTER MONTHS DUE TO CHARACTERISTICS INHERENT IN A SEASONAL ECONOMY DEPENDENT ON TOURISM AND OTHER FACTORS. IN 2015, THE UNEMPLOYMENT RATE IN BARNSTABLE COUNTY RANGED FROM 9% IN JANUARY TO 5% IN JULY COMPARED TO A STEADY ANNUAL RATE OF 6% UNEMPLOYMENT FOR MA OVERALL. ACCORDING TO FIVE-YEAR ESTIMATES (2009-2013) OF THE AMERICAN COMMUNITY SURVEY: - MORE THAN 48% OF BARNSTABLE COUNTY RESIDENTS WHO RENT AND 38% WHO OWN A HOUSING UNIT ARE COST-BURDENED, SPENDING 35% OR MORE OF THEIR TOTAL INCOME ON HOUSING. ACCORDING TO THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, FAMILIES WHO PAY MORE THAN 30% OF THEIR INCOME FOR HOUSING ARE CONSIDERED COST-BURDENED AND MAY HAVE DIFFICULTY AFFORDING NECESSITIES SUCH AS FOOD, CLOTHING, TRANSPORTATION AND MEDICAL CARE. - 42% OF BARNSTABLE COUNTY RESIDENTS RECEIVE PUBLICLY-FUNDED HEALTH INSURANCE COVERAGE COMPARED TO 32% OF RESIDENTS IN MA OVERALL, AND 42% OF RESIDENTS RECEIVE SOCIAL SECURITY PAYMENTS COMPARED TO 28% IN MA OVERALL. COMBINED TOGETHER, THESE INDICATORS PAINT A PICTURE OF MANY RESIDENTS IN NEED. THE COMMUNITY INPUT COLLECTION PHASE OF THE PROJECT IDENTIFIED NUMEROUS TARGET POPULATIONS IN NEED OF HEALTH INTERVENTIONS. THESE INCLUDED FINANCIALLY DISADVANTAGED POPULATIONS, INCLUDING INDIVIDUALS WITH TRANSITIONAL EMPLOYMENT, CHILDREN UNDER THE AGE OF 18, INDIVIDUALS/FAMILIES WITH HOUSING INSECURITIES, AND THOSE LIVING ON FIXED INCOMES. RACE, ETHNICITY AND LANGUAGE IN ADDITION TO AGE AND INCOME, RACE, ETHNICITY, AND LANGUAGE PLAY A ROLE IN DETERMINING HEALTH OUTCOMES FOR RESIDENTS. COMPARED TO MA, BARNSTABLE COUNTY HAS A RELATIVELY HOMOGENEOUS POPULATION WITH 92% IDENTIFYING AS CAUCASIAN IN 2009-2013 CENSUS ESTIMATES. MASSACHUSETTS IS MORE RACIALLY DIVERSE WITH ONLY 76% OF RESIDENTS IDENTIFYING AS CAUCASIAN. ACCORDING TO FIVE-YEAR ESTIMATES OF THE AMERICAN COMMUNITY SURVEY (2009-2013) THE LARGEST RACIAL/ETHNIC MINORITY GROUPS ON CAPE COD ARE HISPANICS/LATINOS AND AFRICAN-AMERICAN RESIDENTS WITH EACH GROUP REPRESENTING ABOUT 2% OF THE POPULATION. IN THAT SAME TIME PERIOD, 7% OF THE POPULATION LIVING IN BARNSTABLE COUNTY WAS FOREIGN-BORN, COMPARED TO 15% FOR THE COMMONWEALTH OF MASSACHUSETTS. SLIGHTLY MORE THAN 8% OF THE POPULATION FIVE YEARS OR OLDER IN BARNSTABLE COUNTY SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME COMPARED TO 22% IN THE COMMONWEALTH. WHILE DIVERSITY MAY BE LOW COMPARATIVELY, PUBLIC HEALTH EXPERTS AND INDIVIDUALS REPRESENTING LOW-INCOME, VULNERABLE, AND MEDICALLY UNDERSERVED POPULATIONS ON CAPE COD CITE THAT FOREIGN-BORN RESIDENTS AND RACIAL/ETHNIC MINORITIES ON CAPE COD (E.G., HISPANICS, AFRICAN AMERICANS, AND PORTUGUESE-SPEAKING BRAZILIANS) WERE MOST LIKELY TO EXPERIENCE BARRIERS TO ACCESSING CARE AND ARE DISPROPORTIONALLY IDENTIFIED WITHIN HIGH NEEDS POPULATIONS AS COMPARED TO OTHERS.
INSURANCE STATUS	MASSACHUSETTS LEADS THE NATION AS THE STATE WITH THE LOWEST RATE OF UNINSURED RESIDENTS. IN 2014, ONLY 4% OF RESIDENTS IN THE COMMONWEALTH LACKED MEDICAL HEALTH INSURANCE, COMPARED TO 10% NATIONALLY, DUE TO THE STATE'S EARLY HEALTH REFORM EFFORTS WHICH BEGAN IN 2006. HOWEVER, THERE IS VARIATION IN INSURED POPULATIONS ACROSS THE STATE OF MA ACCORDING TO THE GEOGRAPHY OF UNINSURANCE IN MASSACHUSETTS 2009-2013, A PUBLICATION BY THE BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION AND THE URBAN INSTITUTE. ACCORDING TO THE STUDY, BARNSTABLE COUNTY, AT 3.4%, HAS THE HIGHEST PERCENTAGE OF UNINSURED CHILDREN (0-17 YEARS) IN THE STATE COMPARED TO ALL OTHER COUNTIES. BARNSTABLE COUNTY, WITH AN OVERALL 5% UNINSURED RATE (ADULTS AND CHILDREN), IS ALSO THE 4TH HIGHEST RANKING COUNTY IN MA FOR THE NUMBER OF UNINSURED PERSONS OF ALL AGES. INPUT FROM PUBLIC HEALTH EXPERTS AND INDIVIDUALS REPRESENTING LOW-INCOME, VULNERABLE, AND MEDICALLY-UNDERSERVED POPULATIONS ON CAPE COD NOTE THAT BEYOND INDIVIDUALS AND CHILDREN WHO ARE UNINSURED, THERE ARE MANY RESIDENTS WHO ARE 'UNDER-INSURED'. THIS POPULATION STRUGGLES WITH THE COST OF PUBLICLY AVAILABLE HEALTH PLANS, COVERAGE OF DEDUCTIBLES AND PRESCRIPTIONS, AND WITH MAINTAINING INSURANCE COVERAGE UNDER CONTINUOUS ENROLLMENT CHANGES. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL DERIVE APPROXIMATELY 67% OF PATIENT SERVICE REVENUES FROM PUBLIC PAYERS. FROM FY2013 TO FY2015 THE HOSPITALS' PERCENTAGE OF MEDICAID AND MEDICARE STEADILY INCREASED WHILE THE PERCENTAGE FROM NON-GOVERNMENT SOURCES STEADILY DECREASED. AS BOTH STATE AND FEDERAL PAYERS FACE BUDGETING CONCERNS, PUBLIC PAYER REIMBURSEMENT IS FORECASTED TO REMAIN FLAT OR DECLINE. MANY OF THE KEY SERVICES USED BY VULNERABLE POPULATIONS SUCH AS BEHAVIORAL HEALTH ARE POORLY REIMBURSED. THESE TRENDS DEMONSTRATE CONTINUED RELIANCE ON SOURCES OF PUBLIC HEALTH COVERAGE AS THE AREA DEMOGRAPHICS BECOME MORE CHALLENGING. CONCLUSION UNDERSTANDING THE COMMUNITY NEED AND HEALTH STATUS OF BARNSTABLE COUNTY RESIDENTS BEGINS WITH IDENTIFYING THE DEMOGRAPHIC PROFILE AND UNDERLYING SOCIO-ECONOMIC DRIVERS THAT IMPACT HEALTH AND HEALTH EQUITY. ASSESSING SOCIAL DETERMINANTS OF HEALTH SUCH AS AGE, INCOME, RACE/ETHNICITY,LANGUAGE, INCOME, POVERTY, UNEMPLOYMENT, INSURANCE COVERAGE, AND HOUSING STATUS PROVIDES CRITICAL INFORMATION FOR IDENTIFYING TARGET POPULATIONS AND COMMUNITY SETTINGS FOR HEALTH IMPROVEMENT INTERVENTIONS AND ACTIVITIES.
PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: Cape Cod Healthcare, Inc., (CCHC) through its Community Benefits initiatives, is committed to enhancing the quality of and access to comprehensive health care services for all residents of Cape Cod. Through continuous assessment of community needs, coordinated planning and the allocation of resources, this commitment includes a special focus on the unmet needs of the financially disadvantaged and underserved populations. We will take a leadership role in collaborative efforts joining our resources, talent, and commitment with that of other providers, organizations and community members. The Community Benefits Mission Statement was affirmed by the CCHC Community Health Committee and the Board of Trustees in 2000 and remains in effect. THE FOLLOWING IS A LIST OF FY 18 TARGET POPULATIONS: - Individuals managing or at risk of developing chronic and infectious diseases such as cancer, cardiovascular disease, Alzheimer's disease and dementia, Hepatitis C, and tick-borne diseases. - Residents facing barriers to care due to language, cost, or age, including those who are uninsured or under-insured. - Individuals with mental health disorders, substance use disorders, and co-occurring disorders. - Senior population, ages 65 and older. - Youth and young adults, ages 15 to 24 years old. Key Accomplishments of Reporting Year The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan served as the foundation for CCHC's FY18 Community Benefits program. CCHC's Community Benefits activities focused on the four health priorities identified in the report: chronic and infectious disease, behavioral health, access to care, and disease prevention and wellness. New and expanded hospital programs were developed in alignment with implementation goals, objectives and strategies for each priority. CCHC supported partnerships with over 50 local non-profit health and human service organizations, and a network of federally qualified health centers, through project support and grant investments to improve the health of Barnstable County residents. Hospital staff dedicated time and expertise to strategic partnerships, coalitions, and task force efforts locally, regionally, and across Massachusetts. Chronic and Infectious Disease Prevention, screening, detection, and management of chronic and infectious diseases were supported through a variety of CCHC Community Benefits activities. Hospital cancer support services including counseling, support groups, and survivorship activities for patients and caregivers were complemented with a new Oncology Nutrition program, which started in February 2018. The successful Living Fit for You! Cancer Wellness Program at Falmouth Hospital was expanded in August 2018 to include Cape Cod Hospital's campus. The program provides free of charge rehabilitation, wellness consultations, exercise, and education services to help adults undergoing cancer treatment manage fatigue, de-conditioning and loss of physical function. CCHC Community Benefits also provided grants to the Cape Wellness Collaborative and YMCA Cape Cod LIVESTRONG program to ensure that patients undergoing and recovering from cancer treatment had access to community-based wellness programs and complementary services such as massage, acupuncture, yoga and nutritional counseling. The CCHC Integrated Cancer Committee, comprised of physicians, nurses and support staff, conducted educational campaigns and community outreach events. These events informed youth about the risks of tobacco use and the general public about skin cancer prevention, including high-risk screening opportunities. CCHC clinical teams provided disease education, rehabilitation and pathways to chronic disease self- management for individuals living with congestive heart failure, chronic pulmonary diseases, and diabetes. A Community Benefits grant to the Cape Cod Times Needy Fund provided assistance for basic needs such as housing and utility payments, transportation, adaptive medical equipment, and child care specifically for individuals managing a chronic disease. A CCHC Community Benefits grant supported the Alzheimer's Family Caregiver Support Centers expanding free counseling for families and caregivers in outposts across the Outer, Lower, Mid, and Upper regions of Cape Cod. In addition, the organization now hosts concurrent weekly support group meetings for individuals with Alzheimer's disease and their caregivers at Cape Cod Hospital. CCHC provided funding for two innovative community-based programs to support tick-borne disease education in FY18. Through a partnership with the UMASS Laboratory of Medical Zoology, CCHC was the only hospital system in MA to subsidize tick testing for residents within a hospital service area. CCHC also partnered with the Cape Cod Cooperative Extension to produce a 10-part online video series titled "Tickology" to provide easily accessible community education on tick disease prevention. CCHC Infectious Disease Clinical Services is the recipient of federal and state Ryan White grant funding to support comprehensive primary medical care and medical case management for individuals with HIV/AIDS living in Barnstable County. CCHC, through partnerships with other local organizations, aligned local efforts to meet National HIV/AIDS Strategy and the Massachusetts Integrated HIV Prevention and Care Plan to reduce the number of new HIV infections, increase access to care, improve health outcomes for individuals living with HIV/AIDS, and reduce HIV-related health inequities and disparities. Behavioral Health CCHC Community Benefits expanded hospital-based services and collaborations with local federally qualified health centers and behavioral health providers to strengthen regional services and community resources for individuals with mental health and substance use disorders. CCHC's Centers for Behavioral Health joined the MA Department of Public Health and MA Department of Mental Health on the Zero Suicide Initiative to increase suicide prevention and reduce suicide deaths on Cape Cod. CCHC also provides a Community Crisis Line, staffed by clinicians, offering free and confidential emotional support and referral assistance for individuals in crisis and their families. CCHC Community Benefits funded a community wide Mental Health First Aid Training project in partnership with the National Alliance on Mental Illness (NAMI) Cape Cod, which resulted in 13 certified instructors to train exponentially more people in the evidence-based program in our community. CCHC Community Benefits provided grants to three federally qualified health centers on Cape Cod. Duffy Health Center, Harbor Community Health Center- Hyannis, and Outer Cape Health Services received grants supporting integrated behavioral health services, establishing an Office Based Addiction Treatment program and continuation of a community navigator program that assists individuals most at risk in our region. Through a partnership with, and grant to Gosnold, Inc., CCHC Community Benefits expanded the Recovery Specialist program in the emergency departments at Cape Cod Hospital and Falmouth Hospital. The program provides peer-led recovery engagement services for patients with Substance Use Disorders. Recovery Specialists work as part of the emergency departments' care teams to motivate patients to accept treatment upon discharge from the emergency departments. Additional funding to Gosnold, Inc. provided Recovery Coaching scholarships for 30 individuals who completed treatment for their Substance Use Disorder. Recovery Coaches assist individuals with building recovery support systems and improving outcomes related to employment, housing, legal and life skills. Cape Cod Hospital received grant funding from Massachusetts Department of Public Health to provide assistance to pregnant women with Opioid Use Disorders through the Moms Do Care program. The program provides peer-led services to obtain prenatal care, substance use treatment, and address social determinant of health issues. At the conclusion of the grant, CCHC supported transitioning the program to the Duffy Health Center with a Community Benefits grant, and CCHC remains a strategic collaborator on the project. CCHC staff from the maternity and pediatric departments at Cape Cod Hospital and Falmouth Hospital actively participated in statewide initiatives by the Neonatal Quality Improvement Collaborative of MA. Initiatives included staff development and piloting new models of care for newborns and families impacted by perinatal opioid use and neonatal abstinence syndrome.
Access to Care	In FY18, CCHC continued to invest significantly in expanding access to care for vulnerable and medically underserved populations in Barnstable County. CCHC Community Benefits continued its grant support of the Specialty Network for the Uninsured (SNU) program in Barnstable County. The SNU program coordinates appointments and follow-up care with local medical specialists for uninsured and under-insured patients in our region, reducing barriers to local access and addressing gaps in specialty services not offered by local community health centers. Through the Community Based Interpreters program, CCHC Community Benefits funding provided free medical interpreter services for limited-English speaking patients in community-based primary and specialty care offices across the region. In partnership with the Cape and Islands Emergency Medical Services System, CCHC expanded the impact of medical interpreter services in pre-hospital settings. CCHC provides training and funding for phone-based interpreter services that connect paramedics and first responders to interpreters via cell phones in ambulances to improve communication with limited-English speaking patients during transport to a hospital. Hospital social workers and case managers assisted low-income and vulnerable patients in need through direct referrals to community services, prescription assistance, and transportation vouchers upon discharge. Financial counselors at Cape Cod Hospital and Falmouth Hospital were available to all Barnstable County residents to assist with health insurance questions and needs including Mass Health and Medicare coverage applications and renewal assistance. CCHC has been at the forefront of establishing strategic relationships ensuring a strong and skilled future allied health workforce in our region. Cape Cod Community College and Cape Cod Healthcare Nursing Education Collaborative is a program that expands opportunities for education, clinical training, and employment, as well as RN student debt relief and career exploration pathways for high school students. In several clinical departments including behavioral health, radiology, and laboratory services across both hospitals, clinicians provide supervision, training, and job shadowing for students from UMASS Medical School, regional community colleges, and local vocational and technical schools. Disease Prevention and Wellness In FY18, Cape Cod Healthcare efforts focused on building partnerships and support for community based prevention and wellness initiatives impacting residents across the lifespan from infants to seniors. CCHC Community Benefits expanded efforts supporting new families. Expanded efforts included prenatal and parenting classes in English and Portuguese, support groups for new mothers, fatherhood initiatives, and a breastfeeding warmline that provided families with phone support for questions related to breastfeeding. CCHC also partnered with a local Early Intervention program to provide pre-discharge meetings with Early Intervention staff. Early Intervention staff educated parents about services and supports available to infants, young children and their families through the program. Through a partnership with the Cape & Islands United Way, CCHC Community Benefits supported the Strong from the Start Initiative aimed at improving the social, emotional and developmental outcomes for children ages 0-3 years in Barnstable County. The objectives of Strong from the Start is to strengthen families, reduce achievement and word gaps and provide children with the social, emotional and language skills to thrive in school and in life. CCHC Community Benefits built a coalition of more than 50 community organizations to support the Quality of Life Initiative. The initiative provided guest speakers, materials and helpful tools to educate the community about the importance of advance care planning. In addition, CCHC Community Benefits joined a coalition of more than 30 organizations called Healthy Aging Cape Cod. Led by Barnstable County Department of Human Services, the purpose of the coalition is to undertake regional planning that supports our aging demographic and aligns local efforts with statewide efforts to build an Age and Dementia-friendly Massachusetts. Healthy Parks, Healthy People, a program supported through a collaboration between Cape Cod Healthcare, the US National Park Service, and the Cape Cod National Seashore, continued with its focus on promoting open space for physical activity and wellness. Activities included educational events by CCHC physicians and physical therapists, a walking program, and a 5K walk/run for residents and visitors of Cape Cod. CCHC Community Benefits grants supported elder suicide prevention trainings through the Samaritans of Cape Cod, HPV vaccination and cervical cancer education for providers, parents and youth by Team Maureen and chronic disease and mindfulness programs at local family homeless shelters by Housing Assistance Corporation on Cape Cod. In addition to these FY18 hospital initiatives, community collaborations, and grant investments, CCHC Community Benefits continued to play leadership roles in health and human service organizations and coalitions across our region. These included, but were not limited to, the Barnstable County Economic Development Council, Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Cape Cod Chamber of Commerce, and the Cape & Islands Community Health Area Network (CHNA 27) Steering Committee. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEMS ROLES: THE HOSPITALS ARE PART OF AN AFFILIATED HEALTHCARE SYSTEM AND THEIR RESPECTIVE ROLES ARE: CAPE COD HOSPITAL - A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN HYANNIS,MASSACHUSETTS FALMOUTH HOSPITAL ASSOCIATION, INC. - A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN FALMOUTH, MASSACHUSETTS CAPE COD HEALTHCARE, INC. - A NOT-FOR-PROFIT CORPORATION THAT SERVES AS THE PARENT COMPANY OF VARIOUS ENTITIES PROVIDING HEALTH CARE SERVICES TO THE POPULATION OF CAPE COD, MASSACHUSETTS CAPE COD HEALTHCARE FOUNDATION,INC. - A NOT-FOR-PROFIT CORPORATION ORGANIZED TO PROVIDE DEVELOPMENT AND FUNDRAISING SUPPORT TO CAPE COD HEALTHCARE CAPE AND ISLANDS HEALTH SERVICES II, INC. - A NOT-FOR-PROFIT CORPORATION ORGANIZED TO PROVIDE VARIOUS NON-HOSPITAL HEALTH CARE SERVICES MEDICAL AFFILIATES OF CAPE COD, INC. - A NOT-FOR-PROFIT MEDICAL GROUP PRACTICE VISITING NURSE ASSOCIATION OF CAPE COD - A NOT-FOR-PROFIT PROVIDER OF HOME HEALTH SERVICES CAPE COD HUMAN SERVICES, INC. - A NOT-FOR-PROFIT PROVIDER OF OUTPATIENT MENTAL HEALTH SERVICES FALMOUTH ASSISTED LIVING, INC., D/B/A HERITAGE AT FALMOUTH - A NOT-FOR-PROFIT CORPORATION THAT OWNS AN ASSISTED LIVING FACILITY JML CARE CENTER, INC. - A NOT-FOR-PROFIT SKILLED NURSING AND REHABILITATION FACILITY CAPE COD RESEARCH INSTITUTE - A NOT-FOR-PROFIT THAT CONDUCTS CLINICAL RESEARCH AND RELATED EDUCATIONAL ACTIVITIES CAPE HEALTH INSURANCE COMPANY - A CAPTIVE INSURANCE COMPANY THAT PROVIDES MEDICAL PROFESSIONAL AND GENERAL LIABILITY INSURANCE TO CAPE COD HEALTHCARE CAPE COD HOSPITAL MEDICAL OFFICE BUILDING - A PROVIDER OF LEASED AND SUBLEASED SPACE TO CAPE COD HOSPITAL AND RELATED AFFILIATIONS PART VI, LINE 7 ALL STATES WHERE ORGANIZATION FILES A COMMUNITY BENEFITS REPORT: MA

Schedule H (Form 990) 2019

Additional Data

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number
90-0054984

Part I

General Information on Grants and Assistance

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

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section (if applicable)	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Cape Cod Council of Churches 81 Willow Ave Hyannis,MA02601	04-2382479	501(c)(3)	5,400	FMV	N/A	Behavioral Health
(2) AIDS Support Group of Cape Cod PO BOX 1522 Provincetown,MA02657	04-2908722	501(c)(3)	28,013	FMV	N/A	Chronic and Infectious Disease
(3) Alzheimer's Family Caregiver Support Center Inc 309 Waverly Oaks Rd Waltham,MA02452	13-3039601	501(c)(3)	30,000	FMV	N/A	Chronic and Infectious Disease
(4) TOWN OF BARNSTABLE 367 MAIN ST Hyannis,MA02601	04-6001079	GOV'T	22,000	FMV	N/A	Access to Healthcare
(5) BC Sheriff Dept Community Mental Health Initiative 6000 SHERIFFS PL Bourne,MA02532	46-6002284	GOV'T	60,000	FMV	N/A	Behavioral Health
(6) Cape Cod Coop ExtBCHS RSAC PO BOX 427 Barnstable,MA02630	04-6001419	GOV'T	42,000	FMV	N/A	Behavioral Health & Chronic Disease
(7) C&I United Way Strong from Start Initiative PO BOX 367 CENTERVILLE,MA02632	04-2271714	501(c)(3)	17,500	FMV	N/A	Prevention and Wellness
(8) Cape Cod Healthcare Inc 297 North St Hyannis,MA02601	22-2600704	501(c)(3)	24,945	FMV	N/A	General Support
(9) Cape Cod Times Needy Fund PO BOX 804 Hyannis,MA02601	22-2480332	501(c)(3)	15,000	FMV	N/A	Chronic and Infectious Disease
(10) Cape Wellness Collaborative 11 Potter Ave Hyannis,MA02601	47-2360979	501(c)(3)	30,000	FMV	N/A	Chronic and Infectious Disease
(11) CC Child Development - Hospital to Home Program 83 Pearl St Hyannis,MA02601	23-7324732	501(c)(3)	12,300	FMV	N/A	Behavioral Health
(12) CYRACOM LLC 5780 N SWAN RD Tucson,AZ85718	27-1261982		28,537	FMV	N/A	Access to Healthcare
(13) Duffy Health Center 94 MAIN ST Hyannis,MA02601	04-3373741	501(c)(3)	91,000	FMV	N/A	Behavioral Health Prevention and Wellness
(14) Gosnold on Cape Cod 200 TER HEUN DRIVE Falmouth,MA02540	04-2502970	501(c)(3)	125,000	FMV	N/A	Behavioral Health
(15) Harbor Health Services Inc 1135 MORTON ST MATTAPAN,MA02126	23-7100550	501(c)(3)	134,000	FMV	N/A	Behavioral Health
(16) Helping our Women 34 CONWELL ST Provincetown,MA02657	04-3179955	501(c)(3)	6,000	FMV	N/A	Chronic Disease
(17) Housing Assistance Corp 460 W MAIN ST Hyannis,MA02601	23-7431255	501(c)(3)	17,743	FMV	N/A	Prevention and Wellness
(18) NAMI Cape Cod 5 MARK LANE Hyannis,MA02601	04-2785229	501(c)(3)	30,000	FMV	N/A	Prevention and Wellness
(19) Outer Cape Health Services PO BOX 1413 WELLFLEET,MA02667	04-2509828	501(c)(3)	61,500	FMV	N/A	Access to Healthcare
(20) Samaritans on Cape Cod & the Islands PO BOX 65 Falmouth,MA02541	04-2738811	501(c)(3)	12,168	FMV	N/A	Prevention and Wellness
(21) Team Maureen PO Box 422 N Falmouth,MA02556	45-2473500	501(c)(3)	27,650	FMV	N/A	Chronic and Infectious Disease
(22) Town of Yarmouth Health Dept 1146 ROUTE 28 S Yarmouth,MA02664	04-6001377	GOV'T	5,660	FMV	N/A	Prevention and Wellness
(23) Umass Lab of Medical Zoology 333 South St Ste 450 Shrewsbury,MA01545	04-3167352	501(c)(1)	29,580	FMV	N/A	Chronic Disease
(24) Wellstrong 385 Welliott Rd Centerville,MA02632	81-1935657	501(c)(3)	10,000	FMV	N/A	Behavioral Health
(25) YMCA Cape Cod - Livestrong 12245 IYANNOUGH RD W Barnstable,MA02668	04-2394925	501(c)(3)	29,500	FMV	N/A	Chronic and Infectious Disease

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

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) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	THE ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN THE U.S. CONSISTS OF FOLLOWING THE HUD GUIDELINES SET BY THEM.

Schedule I (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MICHAEL K LAUF PRESIDENT/CEO/TRUSTEE	(i) (ii)	0 ------------- 991,489	0 ------------- 1,488,900	0 ------------- 192,589	0 ------------- 249,053	0 ------------- 40,291	0 ------------- 2,962,322	0 ------------- 102,000
2ROBERT WILSTERMAN MD TRUSTEE	(i) (ii)	770,101 ------------- 0	19,060 ------------- 0	2,772 ------------- 0	25,080 ------------- 0	35,701 ------------- 0	852,714 ------------- 0	0 ------------- 0
3WILLIAM AGEL MD TRUSTEE	(i) (ii)	448,809 ------------- 0	58,422 ------------- 0	16,174 ------------- 0	10,800 ------------- 0	33,877 ------------- 0	568,082 ------------- 0	0 ------------- 0
4THEODORE CALIANOS MD TRUSTEE	(i) (ii)	370,781 ------------- 0	6,387 ------------- 0	1,806 ------------- 0	10,800 ------------- 0	32,367 ------------- 0	422,141 ------------- 0	0 ------------- 0
5PAUL HOULE MD TRUSTEE	(i) (ii)	932,685 ------------- 0	165,440 ------------- 0	966 ------------- 0	27,506 ------------- 0	34,701 ------------- 0	1,161,298 ------------- 0	0 ------------- 0
6MICHAEL L CONNORS SENIOR VP FINANCE/CFO	(i) (ii)	0 ------------- 431,607	0 ------------- 77,850	0 ------------- 30,455	0 ------------- 55,606	0 ------------- 37,211	0 ------------- 632,729	0 ------------- 19,481
7MICHAEL G JONES ESQ SEE SCH O FOR TITLE	(i) (ii)	0 ------------- 316,680	0 ------------- 76,632	0 ------------- 19,138	0 ------------- 43,278	0 ------------- 35,061	0 ------------- 490,789	0 ------------- 15,965
8MICHAEL BUNDY COO	(i) (ii)	0 ------------- 368,843	0 ------------- 83,500	0 ------------- 630	0 ------------- 24,508	0 ------------- 32,765	0 ------------- 510,246	0 ------------- 0
9DONALD A GUADAGNOLI MD CMO CAPE COD HOSPITAL	(i) (ii)	0 ------------- 412,488	0 ------------- 83,475	0 ------------- 33,082	0 ------------- 54,775	0 ------------- 30,563	0 ------------- 614,383	0 ------------- 21,001
10ALEXANDER HEARD MD CHIEF MEDICAL OFFICER - FH	(i) (ii)	84,330 ------------- 442,806	0 ------------- 167,877	0 ------------- 630	3,066 ------------- 28,695	0 ------------- 35,911	87,396 ------------- 675,919	0 ------------- 0
11PATRICK J KANE SVP OF MRKTG,COMMUN AND DEVLP	(i) (ii)	0 ------------- 304,840	0 ------------- 70,684	0 ------------- 19,589	0 ------------- 28,480	0 ------------- 3,025	0 ------------- 426,618	0 ------------- 15,450
12CHRISTIAN BROWN SR VP MANAGED CARE	(i) (ii)	0 ------------- 300,781	0 ------------- 69,769	0 ------------- 22,490	0 ------------- 46,069	0 ------------- 33,877	0 ------------- 472,986	0 ------------- 13,000
13EMILY SCHORER SVP HUMAN RESOURCES	(i) (ii)	0 ------------- 257,318	0 ------------- 62,220	0 ------------- 11,735	0 ------------- 24,581	0 ------------- 34,329	0 ------------- 390,183	0 ------------- 10,345
14KEVIN RALPH SVP DEVELOPMENT	(i) (ii)	0 ------------- 242,777	0 ------------- 49,688	0 ------------- 4,561	0 ------------- 24,086	0 ------------- 36,042	0 ------------- 357,154	0 ------------- 3,646
15THERESA M AHERN SVP, STRAT, COMMUNITY/GOV REL.	(i) (ii)	0 ------------- 250,297	0 ------------- 68,625	0 ------------- 15,760	0 ------------- 40,619	0 ------------- 22,443	0 ------------- 397,744	0 ------------- 11,500
16KEVIN J MULROY SVP CHIEF QUALITY & SAFETY OFF	(i) (ii)	0 ------------- 368,757	0 ------------- 80,782	0 ------------- 24,939	0 ------------- 40,051	0 ------------- 35,061	0 ------------- 549,590	0 ------------- 15,875
17JEANNE FALLON SR VP & CIO (UNTIL 4/11/17)	(i) (ii)	0 ------------- 77,946	0 ------------- 0	0 ------------- 238,835	0 ------------- 13,364	0 ------------- 9,124	0 ------------- 339,269	0 ------------- 12,650
18JEFFREY S DYKENS VP FINANCE & OPERATIONS	(i) (ii)	0 ------------- 246,358	0 ------------- 41,876	0 ------------- 22,747	0 ------------- 28,158	0 ------------- 36,169	0 ------------- 375,308	0 ------------- 12,000
19NOELENE CERVIN VP BUDGETING & OPER. SUPPORT	(i) (ii)	0 ------------- 216,358	0 ------------- 39,050	0 ------------- 6,971	0 ------------- 25,269	0 ------------- 33,597	0 ------------- 321,245	0 ------------- 0
20LORI JEWETT CEO - FH	(i) (ii)	0 ------------- 239,990	0 ------------- 37,800	0 ------------- 9,418	0 ------------- 40,818	0 ------------- 1,525	0 ------------- 329,551	0 ------------- 4,000
21DIANNE C KOLB PRESIDENT VNA (UNTIL 8/8/17)	(i) (ii)	0 ------------- 131,411	0 ------------- 0	0 ------------- 37,163	0 ------------- 22,480	0 ------------- 15,897	0 ------------- 206,951	0 ------------- 10,403
22CARTER HUNT ADMIN SPEC&HOSP BASED CARE	(i) (ii)	0 ------------- 194,445	0 ------------- 18,713	0 ------------- 2,977	0 ------------- 27,409	0 ------------- 37,006	0 ------------- 280,550	0 ------------- 0
23VICTOR OLIVEIRA VP PATIENT SVCS(UNTIL 3/17)	(i) (ii)	0 ------------- 61,085	0 ------------- 0	0 ------------- 180,858	0 ------------- 22,988	0 ------------- 13,145	0 ------------- 278,076	0 ------------- 11,575
24RICHARD B ZELMAN MD PHYSICIAN	(i) (ii)	1,393,164 ------------- 0	100,000 ------------- 0	56,618 ------------- 0	10,800 ------------- 0	37,211 ------------- 0	1,597,793 ------------- 0	0 ------------- 0
25ACHILLES PAPAVASILIOU MD PHYSICIAN	(i) (ii)	932,608 ------------- 0	189,045 ------------- 0	630 ------------- 0	28,800 ------------- 0	34,701 ------------- 0	1,185,784 ------------- 0	0 ------------- 0
26NICHOLAS COPPA MD PHYSICIAN	(i) (ii)	930,737 ------------- 0	151,545 ------------- 0	420 ------------- 0	28,800 ------------- 0	36,572 ------------- 0	1,148,074 ------------- 0	0 ------------- 0
27GORDON NAKATA MD PHYSICIAN	(i) (ii)	932,608 ------------- 0	140,000 ------------- 0	630 ------------- 0	27,938 ------------- 0	34,701 ------------- 0	1,135,877 ------------- 0	0 ------------- 0
28PHILLIP J DOMBROWSKI MD PHYSICIAN	(i) (ii)	697,101 ------------- 0	50,000 ------------- 0	25,849 ------------- 0	10,800 ------------- 0	1,525 ------------- 0	785,275 ------------- 0	0 ------------- 0
29JUDITH C QUINN VP OF PATIENT CARE	(i) (ii)	0 ------------- 217,129	0 ------------- 39,228	0 ------------- 23,368	0 ------------- 24,308	0 ------------- 25,533	0 ------------- 329,566	0 ------------- 10,700

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference

Explanation

SCHEDULE J, PART I, LINE 4A

Jeanne Fallon, Sr. VP and CIO until 4/11/17, received severance payments of $173,208 during calendar year 2017. The arrangement provides for continued payment of the individual's salary and benefits for a period of 15 months, including medical and dental insurance coverage. Victor Oliveira, VP of Patient Services until 3/17, received severance payments of $124,000 during calendar year 2017. The arrangement provides for continued payment of the individual's salary and benefits for a period of 12 months, including medical and dental insurance coverage. SCHEDULE J, PART I, LINE 4B - 457(F) CAPE COD HEALTHCARE, INC. AND AFFILIATES SPONSORS A 457(F) VOLUNTARY PERSONAL DEFERRAL PLAN ("THE PLAN") FOR KEY EXECUTIVES. VESTING IS DEFERRED FOR AT LEAST TWO YEARS FROM THE DATE OF THE AWARD. THE PLAN OFFERS PARTICIPATING EMPLOYEES AN ANNUAL DEFERRAL OF CASH COMPENSATION. AMOUNTS DEFERRED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND AMOUNTS PAID UNDER THE PLAN DURING CALENDAR YEAR 2017 WERE AS FOLLOWS: - MICHAEL K. LAUF - $72,613 - MICHAEL G. JONES - $17,333 - MICHAEL L. CONNORS - $19,258 - DIANNE C. KOLB - $31,969 - JEANNE FALLON - $36,138 - JEFFREY S. DYKENS - $12,704 - PATRICK KANE - $16,817 - THERESA AHERN - $12,988 - VICTOR OLIVEIRA - $36,745 - DONALD GUADAGNOLI MD - $22,232 - EMILY SCHORER - $11,105 - KEVIN MULROY - $16,762 - CHRISTIAN BROWN - $13,853 - LORI JEWETT - $4,173 - JUDITH C. QUINN - $11,327 - KEVIN RALPH - $3,931 CAPE COD HEALTHCARE, INC. AND AFFILIATES ALSO SPONSOR A NONQUALIFIED PENSION RESTORATION ACCOUNT PLAN FOR KEY EXECUTIVES. THE ORGANIZATION MAKES CONTRIBUTIONS OF TWO PERCENT OF THE INDIVIDUAL'S ANNUAL SALARY (INCLUDING BONUS) THROUGHOUT THE PLAN YEAR. AMOUNTS DEFERRED ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND UNDER THE PLAN, PARTICIPANTS ARE ENTITLED TO CERTAIN BENEFITS UPON RETIREMENT, TERMINATION, OR DEATH. During calendar year 2017, Michael Lauf also participated in a Section 457(f) plan. Twelve percent of his base salary was contributed and each contribution is subject to a three year vesting schedule. The amount deferred in calendar year 2017 was $120,000 and is included in Schedule J, Part II, Column (C). IN ADDITION, $100,146 WAS PAID OUT FROM HIS CEO SUPPLEMENTAL PLAN, AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III).

SCHEDULE J, PART I, LINE 7

Discretionary bonuses are awarded annually based upon both the performance of the organization and the individual. Bonuses are reflected in Schedule J, Part II, Column B(ii). THE INDIVIDUALS REPORTED IN SCHEDULE J, PART II REPORTED AS BEING PAID FROM A RELATED ORGANIZATION WERE EMPLOYEES OF, AND COMPENSATED BY CAPE COD HEALTHCARE, INC., THE PARENT CORPORATION.

Schedule J (Form 990) 2019

Additional Data

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- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number
90-0054984

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MHEFA REVENUE BONDS SERIES E	04-2456011	000000000	01-12-2012	29,440,000	REISSUE SER E (6/18/08 & 2/12/09)		X		X		X
B	MHEFA REVENUE BONDS SERIES 2012A	04-3431814	000000000	02-24-2012	25,800,000	REFUND SER B(8/15/98)& C(11/15/01)		X		X		X
C	MDFA REVENUE BONDS SERIES 2013	04-3431814	57584VAH8	07-11-2013	50,831,729	REFUND SER C(10/9/01) & CAP.IMPR.		X		X		X
D	MDFA REVENUE BONDS SERIES 2014	04-3431814	000000000	09-29-2014	24,000,000	RENOVATION & REAL ESTATE PURCHASE		X		X		X
	MDFA REVENUE BONDS SERIES 2017	04-3431814	000000000	02-01-2017	52,315,359	REFUND SERIES D(2/16/2010)		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	19,626,666		15,480,000		0		1,400,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	29,440,000		25,800,000		50,843,109		24,001,267
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		1,295,804		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	0		336,100		803,269		0
8 Credit enhancement from proceeds .............	0		0		0		241,456
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	0		0		27,999,812		0
11 Other spent proceeds .............	29,440,000		25,463,900		20,735,223		23,759,811
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2012		2012		2014		2015
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X				X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X				X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X				X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X				X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X				X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X			X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference

Explanation

PART IV, LINE 2(C)

THE DATE THE REBATE COMPUTATIONS WERE LAST PERFORMED FOR EACH BOND ARE BELOW: MDFA, REVENUE BONDS, SERIES E - 07/12/2012 MDFA, REVENUE BONDS, SERIES 2012A - 06/30/2016 MDFA, REVENUE BONDS, SERIES 2013 - 06/30/2018 MDFA, REVENUE BONDS, SERIES 2014 - 08/31/2015 SINCE THE BOND PROCEEDS HAVE BEEN SPENT FOR EACH BOND AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number
90-0054984

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MHEFA REVENUE BONDS SERIES E	04-2456011	000000000	01-12-2012	29,440,000	REISSUE SER E (6/18/08 & 2/12/09)		X		X		X
B	MHEFA REVENUE BONDS SERIES 2012A	04-3431814	000000000	02-24-2012	25,800,000	REFUND SER B(8/15/98)& C(11/15/01)		X		X		X
C	MDFA REVENUE BONDS SERIES 2013	04-3431814	57584VAH8	07-11-2013	50,831,729	REFUND SER C(10/9/01) & CAP.IMPR.		X		X		X
D	MDFA REVENUE BONDS SERIES 2014	04-3431814	000000000	09-29-2014	24,000,000	RENOVATION & REAL ESTATE PURCHASE		X		X		X
	MDFA REVENUE BONDS SERIES 2017	04-3431814	000000000	02-01-2017	52,315,359	REFUND SERIES D(2/16/2010)		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	19,626,666		15,480,000		0		1,400,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	29,440,000		25,800,000		50,843,109		24,001,267
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		1,295,804		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	0		336,100		803,269		0
8 Credit enhancement from proceeds .............	0		0		0		241,456
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	0		0		27,999,812		0
11 Other spent proceeds .............	29,440,000		25,463,900		20,735,223		23,759,811
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2012		2012		2014		2015
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X				X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X				X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X				X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X				X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X				X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X			X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference

Explanation

PART IV, LINE 2(C)

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) DR KATIE RUDMAN	SPOUSE OF TRUSTEE	116,158	MACC EMPLOYEE		No
(2) Sarah K Guadagnoli RN	DAUGHTER OF KEY EMPLOYEE	65,484	CCH EMPLOYEE		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	79	1,163,954	VALUE OF STOCK REC'D
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN (B)	THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS RECEIVED. SCHEDULE M, PART I, LINE 32(A) ON OCCASION THE ORGANIZATION UTILIZES A BROKER TO DISPOSE OF NONCASH CONTRIBUTIONS (OTHER THAN PUBLICLY TRADED SECURITIES).

Schedule M (Form 990) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Return Reference	Explanation
FORM 990, PART I, LINE 1 AND PART III, LINE 1	WE WILL BE THE HEALTH SERVICE PROVIDER OF CHOICE FOR CAPE COD RESIDENTS BY ACHIEVING AND MAINTAINING THE HIGHEST STANDARDS IN HEALTH CARE DELIVERY AND SERVICE QUALITY. TO DO SO, WE WILL PARTNER WITH OTHER HEALTH AND HUMAN SERVICE PROVIDERS AS WELL AS INVEST IN NEEDED MEDICAL TECHNOLOGIES, HUMAN RESOURCES AND CLINICAL SERVICES. ABOVE ALL, WE WILL HELP IDENTIFY AND RESPOND TO THE NEEDS OF OUR COMMUNITY. Community Benefits Mission Statement Cape Cod Healthcare, Inc., (CCHC) through its Community Benefits initiatives, is committed to enhancing the quality of and access to comprehensive health care services for all residents of Cape Cod. Through continuous assessment of community needs, coordinated planning and the allocation of resources, this commitment includes a special focus on the unmet needs of the financially disadvantaged and underserved populations. We will take a leadership role in collaborative efforts joining our resources, talent, and commitment with that of other providers, organizations and community members. The Community Benefits Mission Statement was affirmed by the CCHC Community Health Committee and the Board of Trustees in 2000 and remains in effect.
Target Populations	Name of target population: Individuals managing or at risk of developing chronic and infectious diseases such as cancer, cardiovascular disease, Alzheimer's disease and dementia, Hepatitis C, diabetes and tick-borne diseases. Basis for Selection: Aligned with state and national health priorities, Barnstable County residents managing chronic diseases are at the greatest risk of declined health and death. Cancer, cardiovascular disease, Alzheimer's disease/dementia, Hepatitis C, diabetes and tick-borne diseases were identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report as diseases of particular concern for the region. Name of target population: Residents facing barriers to care due to language, cost, or age, including those who are uninsured or under-insured. Basis for Selection: The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report identified specific target populations that encounter barriers to care or gaps in coverage despite high rates of insured residents in Barnstable County. The report specifically identified children ages 0-17 years, individuals lacking year-round employment, seniors living on a fixed income, seasonal workers, and foreign-born residents who do not meet eligibility criteria for Mass Health enrollment. Name of target population: Individuals with mental health disorders, substance use disorders and co-occurring disorders. Basis for Selection: Access to, and availability of, community-based behavioral health care in Barnstable County is an area of concern. This is evidenced by high rates of patients presenting with mental health and substance use disorders in hospital emergency departments. Specific challenges reported by the community and included in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report include a shortage of psychiatric providers, wait times for outpatient appointments, limited inpatient treatment options for substance use, and insurance barriers to care. Name of target population: Senior population, ages 65 and older. Basis for Selection: According to the U.S. Census Bureau, American Community Survey five year population estimates (2012-2016), nearly 28% of the year round population in Barnstable County is over the age of 65. Increasing consumption of and need for health care services, concerns of social isolation, availability of appropriate housing and transportation, and access to healthy and adequate food were specific challenges identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report for residents over the age of 65. Name of target population: Youth and young adults, ages 15 to 24 years old. Basis for Selection: Youth and young adults, ages 15-24 years old, were identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report as a specific at-risk population due to increasing rates of substance use treatment admissions and concerning health risk behaviors. Publication of Target Populations Annual Report Hospital/HMO Web Page Publicizing Target Pop. https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/ Key Accomplishments of Reporting Year The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan served as the foundation for CCHC's FY18 Community Benefits program. CCHC's Community Benefits activities focused on the four health priorities identified in the report: chronic and infectious disease, behavioral health, access to care, and disease prevention and wellness. New and expanded hospital programs were developed in alignment with implementation goals, objectives and strategies for each priority. CCHC supported partnerships with over 50 local non-profit health and human service organizations, and a network of federally qualified health centers, through project support and grant investments to improve the health of Barnstable County residents. Hospital staff dedicated time and expertise to strategic partnerships, coalitions, and task force efforts locally, regionally, and across Massachusetts. Chronic and Infectious Disease Prevention, screening, detection, and management of chronic and infectious diseases were supported through a variety of CCHC Community Benefits activities. Hospital cancer support services including counseling, support groups, and survivorship activities for patients and caregivers were complemented with a new Oncology Nutrition program, which started in February 2018. The successful Living Fit for You! Cancer Wellness Program at Falmouth Hospital was expanded in August 2018 to include Cape Cod Hospital's campus. The program provides free of charge rehabilitation, wellness consultations, exercise, and education services to help adults undergoing cancer treatment manage fatigue, de-conditioning and loss of physical function. CCHC Community Benefits also provided grants to the Cape Wellness Collaborative and YMCA Cape Cod LIVESTRONG program to ensure that patients undergoing and recovering from cancer treatment had access to community-based wellness programs and complementary services such as massage, acupuncture, yoga and nutritional counseling. The CCHC Integrated Cancer Committee, comprised of physicians, nurses and support staff, conducted educational campaigns and community outreach events. These events informed youth about the risks of tobacco use and the general public about skin cancer prevention, including high-risk screening opportunities. CCHC clinical teams provided disease education, rehabilitation and pathways to chronic disease self- management for individuals living with congestive heart failure, chronic pulmonary diseases, and diabetes. A Community Benefits grant to the Cape Cod Times Needy Fund provided assistance for basic needs such as housing and utility payments, transportation, adaptive medical equipment, and child care specifically for individuals managing a chronic disease. A CCHC Community Benefits grant supported the Alzheimer's Family Caregiver Support Centers expanding free counseling for families and caregivers in outposts across the Outer, Lower, Mid, and Upper regions of Cape Cod. In addition, the organization now hosts concurrent weekly support group meetings for individuals with Alzheimer's disease and their caregivers at Cape Cod Hospital. CCHC provided funding for two innovative community-based programs to support tick-borne disease education in FY18. Through a partnership with the UMASS Laboratory of Medical Zoology, CCHC was the only hospital system in MA to subsidize tick testing for residents within a hospital service area. CCHC also partnered with the Cape Cod Cooperative Extension to produce a 10-part online video series titled "Tickology" to provide easily accessible community education on tick disease prevention. CCHC Infectious Disease Clinical Services is the recipient of federal and state Ryan White grant funding to support comprehensive primary medical care and medical case management for individuals with HIV/AIDS living in Barnstable County. CCHC, through partnerships with other local organizations, aligned local efforts to meet National HIV/AIDS Strategy and the Massachusetts Integrated HIV Prevention and Care Plan to reduce the number of new HIV infections, increase access to care, improve health outcomes for individuals living with HIV/AIDS, and reduce HIV-related health inequities and disparities. Behavioral Health CCHC Community Benefits expanded hospital-based services and collaborations with local federally qualified health centers and behavioral health providers to strengthen regional services and community resources for individuals with mental health and substance use disorders. CCHC's Centers for Behavioral Health joined the MA Department of Public Health and MA Department of Mental Health on the Zero Suicide Initiative to increase suicide prevention and reduce suicide deaths on Cape Cod. CCHC also provides a Community Crisis Line, staffed by clinicians, offering free and confidential emotional support and referral assistance for individuals in crisis and their families.
CCHC Community Benefits funded a community wide Mental Health	First Aid Training project in partnership with the National Alliance on Mental Illness (NAMI) Cape Cod, which resulted in 13 certified instructors to train exponentially more people in the evidence-based program in our community. CCHC Community Benefits provided grants to three federally qualified health centers on Cape Cod. Duffy Health Center, Harbor Community Health Center- Hyannis, and Outer Cape Health Services received grants supporting integrated behavioral health services, establishing an Office Based Addiction Treatment program and continuation of a community navigator program that assists individuals most at risk in our region. Through a partnership with, and grant to Gosnold, Inc., CCHC Community Benefits expanded the Recovery Specialist program in the emergency departments at Cape Cod Hospital and Falmouth Hospital. The program provides peer-led recovery engagement services for patients with Substance Use Disorders. Recovery Specialists work as part of the emergency departments' care teams to motivate patients to accept treatment upon discharge from the emergency departments. Additional funding to Gosnold, Inc. provided Recovery Coaching scholarships for 30 individuals who completed treatment for their Substance Use Disorder. Recovery Coaches assist individuals with building recovery support systems and improving outcomes related to employment, housing, legal and life skills. Cape Cod Hospital received grant funding from Massachusetts Department of Public Health to provide assistance to pregnant women with Opioid Use Disorders through the Moms Do Care program. The program provides peer-led services to obtain prenatal care, substance use treatment, and address social determinant of health issues. At the conclusion of the grant, CCHC supported transitioning the program to the Duffy Health Center with a Community Benefits grant, and CCHC remains a strategic collaborator on the project. CCHC staff from the maternity and pediatric departments at Cape Cod Hospital and Falmouth Hospital actively participated in statewide initiatives by the Neonatal Quality Improvement Collaborative of MA. Initiatives included staff development and piloting new models of care for newborns and families impacted by perinatal opioid use and neonatal abstinence syndrome. Access to Care In FY18, CCHC continued to invest significantly in expanding access to care for vulnerable and medically underserved populations in Barnstable County. CCHC Community Benefits continued its grant support of the Specialty Network for the Uninsured (SNU) program in Barnstable County. The SNU program coordinates appointments and follow-up care with local medical specialists for uninsured and under-insured patients in our region, reducing barriers to local access and addressing gaps in specialty services not offered by local community health centers. Through the Community Based Interpreters program, CCHC Community Benefits funding provided free medical interpreter services for limited-English speaking patients in community-based primary and specialty care offices across the region. In partnership with the Cape and Islands Emergency Medical Services System, CCHC expanded the impact of medical interpreter services in pre-hospital settings. CCHC provides training and funding for phone-based interpreter services that connect paramedics and first responders to interpreters via cell phones in ambulances to improve communication with limited-English speaking patients during transport to a hospital. Hospital social workers and case managers assisted low-income and vulnerable patients in need through direct referrals to community services, prescription assistance, and transportation vouchers upon discharge. Financial counselors at Cape Cod Hospital and Falmouth Hospital were available to all Barnstable County residents to assist with health insurance questions and needs including Mass Health and Medicare coverage applications and renewal assistance. CCHC has been at the forefront of establishing strategic relationships ensuring a strong and skilled future allied health workforce in our region. Cape Cod Community College and Cape Cod Healthcare Nursing Education Collaborative is a program that expands opportunities for education, clinical training, and employment, as well as RN student debt relief and career exploration pathways for high school students. In several clinical departments including behavioral health, radiology, and laboratory services across both hospitals, clinicians provide supervision, training, and job shadowing for students from UMASS Medical School, regional community colleges, and local vocational and technical schools. Disease Prevention and Wellness In FY18, Cape Cod Healthcare efforts focused on building partnerships and support for community based prevention and wellness initiatives impacting residents across the lifespan from infants to seniors. CCHC Community Benefits expanded efforts supporting new families. Expanded efforts included prenatal and parenting classes in English and Portuguese, support groups for new mothers, fatherhood initiatives, and a breastfeeding warm-line that provided families with phone support for questions related to breastfeeding. CCHC also partnered with a local Early Intervention program to provide pre-discharge meetings with Early Intervention staff. Early Intervention staff educated parents about services and supports available to infants, young children and their families through the program. Through a partnership with the Cape & Islands United Way, CCHC Community Benefits supported the Strong from the Start Initiative aimed at improving the social, emotional and developmental outcomes for children ages 0-3 years in Barnstable County. The objectives of Strong from the Start is to strengthen families, reduce achievement and word gaps and provide children with the social, emotional and language skills to thrive in school and in life. CCHC Community Benefits built a coalition of more than 50 community organizations to support the Quality of Life Initiative. The initiative provided guest speakers, materials and helpful tools to educate the community about the importance of advance care planning. In addition, CCHC Community Benefits joined a coalition of more than 30 organizations called Healthy Aging Cape Cod. Led by Barnstable County Department of Human Services, the purpose of the coalition is to undertake regional planning that supports our aging demographic and aligns local efforts with statewide efforts to build an Age and Dementia-friendly Massachusetts. Healthy Parks, Healthy People, a program supported through a collaboration between Cape Cod Healthcare, the US National Park Service, and the Cape Cod National Seashore, continued with its focus on promoting open space for physical activity and wellness. Activities included educational events by CCHC physicians and physical therapists, a walking program, and a 5K walk/run for residents and visitors of Cape Cod. CCHC Community Benefits grants supported elder suicide prevention trainings through the Samaritans of Cape Cod, HPV vaccination and cervical cancer education for providers, parents and youth by Team Maureen and chronic disease and mindfulness programs at local family homeless shelters by Housing Assistance Corporation on Cape Cod. In addition to these FY18 hospital initiatives, community collaborations, and grant investments, CCHC Community Benefits continued to play leadership roles in health and human service organizations and coalitions across our region. These included, but were not limited to, the Barnstable County Economic Development Council, Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Cape Cod Chamber of Commerce, and the Cape & Islands Community Health Area Network (CHNA 27) Steering Committee. Plans for Next Reporting Year Annual Community Benefits plans for Cape Cod Hospital, Falmouth Hospital and Cape Cod Healthcare reflect the priorities, goals and objectives embedded in the three-year implementation strategies included in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan. CCHC Community Benefits FY17-FY19 Goals: 1.Improve chronic and infectious disease prevention and management to meet the growing needs of an aging and at-risk population. 2.Strengthen regional health services and community resources for individuals with mental health conditions, substance use, co-occurring disorders, and comorbidities. 3.Reduce barriers to care and strengthen the regional health safety net for vulnerable populations. 4.Improve the health and disease prevention of all residents of Barnstable County and sustain the wellness of seniors and caregivers.
5.Support regional health efforts through direct grant funding and	a competitive RFP grants program with funding guidelines that are aligned WITH COMMUNITY BENEFITS PRIORITIES AND TARGET POPULATIONS. 6.Strengthen regional collaboration and maintain leadership roles with the following community-based coalitions: Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Community Health Area Network (CHNA 27) and Healthy Aging Cape Cod. Community Benefits Process Community Benefits Leadership/Team Cape Cod Healthcare, Cape Cod Hospital and Falmouth Hospital, along with our affiliates, strive to be the health service provider of choice for Barnstable County residents and visitors by achieving and maintaining the highest standards in healthcare delivery and service quality. To do so, we partner with other health and human service providers from across the region and invest in needed medical technologies, developing the current and future workforce and clinical services. The development of Cape Cod Healthcare's strategic initiatives and community collaborations, including the Community Benefits program, is led by Michael K. Lauf, Chief Executive Officer and Theresa M. Ahern, Senior Vice President, Strategy, Community and Governmental Affairs. Michael L. Connors, Cape Cod Healthcare's Chief Financial Officer, provides fiscal oversight of the Community Benefits reporting process. The Community Health Committee, a designated subcommittee of Cape Cod Healthcare's Board of Trustees, serves as the Community Benefits Advisory Council and provides strategic oversight to the program. The Committee is comprised of leaders of health and human services organizations, community health centers, county government, and community-based organizations representing residents across a spectrum of ages, socioeconomic status, and racial, cultural and ethnic diversity, as well as current members of the CCHC Board of Trustees. The Committee develops and recommends policies to the Cape Cod Healthcare Board of Trustees regarding Community Benefits programs, sets priorities, awards priority grant funding to community organizations, and advises on community health issues and initiatives including community health needs assessments and ongoing community engagement. FY18 Community Health Committee Members: Suzanne Fay Glynn, Esq. (Chair) CCHC Board Member Glynn Law Offices 49 Locust Street, Falmouth, MA 02540 508.548.8282 dar@glynnlawoffices.com Representing: CCHC Board of Trustees Elizabeth Albert Director Barnstable County Human Services P.O. Box 427, Barnstable, MA 02630 508.375.6626 balbert@barnstablecounty.org Representing: Regional health and human services community, regional network on homelessness, countywide substance use coalition and regional planning for aging demographics. Leo Blandford Director of Community-Based Coordinated Care Outer Cape Health Services 710 MA Route 28 Harwich Port, MA 02646 lblandford@outercape.org 508-905-2814 Representing: Federally Qualified Health Centers, Lower and Outer Cape region, behavioral health and substance use disorder services. Eleanor Claus Kinlin Grover Real Estate 927 Route 6A, Yarmouthport, MA 02675 508-362-3000 x203 eclaus@kinlingrover.com Representing: Community members at large. Alisa Galazzi Chief Executive Officer Housing Assistance Corporation on Cape Cod 460 West Main Street Hyannis, MA 02601 508-771-5400 agalazzi@haconcapecod.org Representing: Regional programs addressing homelessness, housing security, and development of attainable housing. Mary Devlin Public Health and Wellness Division Manager Visiting Nurse Association of Cape Cod 255 Independence Drive, Hyannis, MA 02601 508-957-7619 mdevlin@vnacapecod.org Representing: Regional public health programs with emphasis on chronic disease prevention and healthy aging of the senior population. Michael McGuire Director Cape Cod Cooperative Extension P.O. Box 367, Barnstable, MA 02630 508-375-6701 mmaguire@barnstablecounty.org Representing: Barnstable County initiatives related to nutrition, food safety, tick borne diseases, water quality protection and youth and family programs. Patricia Mitrokostas Director of Prevention Programs, Public Relations & Organizational Advancement Gosnold, Inc. 350 Gifford Street, Suite W-10, Falmouth, MA 02540 508-540-2317 pmitrokostas@gosnold.org Representing: Regional substance use prevention, intervention, and treatment programs for individuals and families. Stacie Peugh Chief Executive Officer YMCA Cape Cod 2245 Iyannough Rd, West Barnstable, MA 02668 508-362-6500 speugh@ymcacapecod.org Representing: Youth development, chronic disease management programs, wellness and prevention. Susan Travers Director Truro Council on Aging 7 Standish Way, North Truro 02652 508-487-2462 Stravers@truro-ma.gov Representing: Councils on Aging Serving Together (COAST), senior populations, and the Lower and Outer region of Barnstable County. Cape Cod Healthcare member: Theresa M. Ahern Senior Vice President, Strategy, Community and Governmental Affairs Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA 02601 774-470-5506 tahern@capecodhealth.org Community Benefits Team Meetings The FY18 Community Health Committee meetings were held on the following dates and times: November 7, 2017 9:00-11:00 am February 27, 2018 4:00-5:30 pm June 13, 2018 4:00-5:30 pm July 17, 2018 4:00-5:00 pm Community Partners AIDS Support Group of Cape Cod Alzheimer's Family Caregiver Support Center Arts Foundation of Cape Cod Barnstable County Cape Cod Cooperative Extension Services Barnstable County Department of Human Services Barnstable County Regional Substance Use Council Barnstable County Sheriff's Office Barnstable Public School District Behavioral Health Innovators Behavioral Health Provider Coalition of Cape Cod & the Islands Big Brothers Big Sisters of Cape Cod & the Islands Boys & Girls Club of Cape Cod Cape & Islands EMS Systems, Inc. Cape & Islands United Way Cape Cod Child Development Cape Cod Community College Cape Cod Foundation Cape Cod Hunger Network Cape Cod Medical Reserve Corps Cape Cod Times Needy Fund Cape Wellness Collaborative Caron Treatment Centers Children's Cove Community Health Network Area 27 Cape Cod & Islands (CHNA 27) Dance in the Rain Peer to Peer Mental Health Center Dream Day Cape Cod Duffy Health Center Falmouth Housing Corporation Family Pantry of Cape Cod Flower Angels USA Glenna Kohl Fund for Hope Good Grief Project Greater Hyannis Civic Association Hyannis Open Streets Project Gosnold, Inc. Harbor Community Health Centers Hyannis Healthy Aging Cape Cod Helping Our Women Housing Assistance Corporation Cape Cod Independence House Massachusetts Department of Public Health Massachusetts Department of Mental Health National Alliance on Mental Illness Cape Cod Outer Cape Health Services Parkinson Support Network of Cape Cod Pause A While Samaritans on Cape Cod and the Islands Shea's Youth Basketball Association Specialty Network for the Uninsured Sustainable CAPE Team Maureen Town of Barnstable Youth Commission Town of Yarmouth Park and Recreations Department United States National Park Service and Cape Cod National Seashore University of Massachusetts Laboratory of Medical Zoology University of Massachusetts Medical School WE CAN WellStrong YMCA Cape Cod Community Health Needs Assessment Date Last Assessment Completed and Current Status The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report (CHNA Report) and Implementation Plan was released and made widely available to the public on September 30, 2016. Consultants/Other Organizations The following organizations participated in the 2017-2019 Cape Cod Hospital and Falmouth Hospital community health needs assessment project: AIDS Support Group of Cape Cod, Alzheimer's Family Support Center of Cape Cod, Arbor Counseling Services, Barnstable County Department of Health and Environment, Barnstable County Department of Human Services,
Barnstable County Public Nursing Division, Barnstable County Regional	Substance Use Council, Barnstable Public School System, Barnstable Town Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Boys & Girls Club of Cape Cod, Cape & Islands Emergency Medical Services System, Cape & Islands Suicide Prevention Coalition, Cape & Islands United Way, Cape Cod Center for Women, Cape Cod Child Development, Cape Cod Community College, Cape Cod Council of Churches, Cape Cod District Attorney's Office, Cape Cod Foundation, Cape Cod Neighborhood Support Coalition, Cape Cod WIC, Caron Treatment Center, CCHC Centers for Behavioral Health, CCHC Emergency Services, Child and Family Services, Children's Cove, Coalition for Children, Community Action Committee of Cape Cod & the Islands, Community Development Partnership, Community Health Center of Cape Cod, Community Health Network Area 27, Duffy Health Center, Elder Services of Cape Cod & the Islands, Emerald Physicians, Falmouth Human Services, Falmouth Public School System, Falmouth Service Center, Falmouth Together We Can Falmouth Volunteers in Public Schools, Glenna Kohl Fund for Hope, Gosnold, Inc., Harbor Community Health Center-Hyannis, Health Imperatives Cape Cod, Healthy Living Cape Cod, Helping Our Women, Homeless Prevention Council, HOPE Dementia & Alzheimer's Services of Cape Cod, Hope Health, Housing Assistance Corporation, Independence House, John Snow, Inc., Justice Resource Institute, Lyme Awareness of Cape Cod, MA Department of Mental Health, MA Department of Public Health, Mashpee Wampanoag Tribe Health Service Unit, Mother and Infant Recovery Network, National Alliance on Mental Illness Cape Cod, Outer Cape Health Services, Outer Cape Women Infants and Children (WIC), Samaritans on Cape Cod and the Islands, Sandpiper Nursery School, Sandwich Public School System, SHINE (Serving Health Information Needs of Everyone), Sight Loss Services, Spaulding Rehabilitation Hospital Cape Cod, Specialty Network for the Uninsured, Substance Use in Pregnancy Task Force, The Family Pantry of Cape Cod, Town of Brewster Health Department, Town of Falmouth Council on Aging, Town of Falmouth Health Department, Town of Mashpee Council on Aging, Town of Mashpee Human Services, Town of Provincetown Council on Aging, Town of Sandwich Council on Aging, Town of Truro Council on Aging, Vinfen, Visiting Nurse Association of Cape Cod, WE CAN, Yarmouth Police Department, and the YMCA Cape Cod. Data Sources CHNA, Community Focus Groups, Consumer Group, Hospital, Interviews, MassCHIP, Other, Public Health Personnel, Surveys, US Census: American Community Survey, Center for Disease Control and Prevention, Behavioral Health Risk Factor Surveillance System, and local and regional reports and studies on demographics, health conditions and community needs. CHNA Document - PDF format CCHC CHNA REPORT_2017-2019.PDF Implementation Strategy (optional) File Upload (optional) Not Specified Community Benefits Programs Annual Strategic Grants Program: Chronic and Infectious Disease and Prevention Program Type: Community Education, Community Participation/Capacity Building Initiative, Grant/Donation/Foundation/Scholarship, health Screening, Outreach to Underserved, Prevention, Support Group. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantaged Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Housing Stability/Homelessness, Mental Illness and Mental Health. DoN Health Priorities (optional): Built Environment, Housing. Target Population: Regions Served: County-Barnstable - Health Indicator: Immunization, Mental Health, Other: Cancer, Other: Elder Care, Other: First Aid/ACLS/CPR, Other: Hepatitis, Other: Homelessness, Other: Lyme Disease, Other: Nutrition, Other: Sexually Transmitted Diseases, Other: Stress Management, Physical Activity, Responsible Sexual Behavior - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Award up to $250,000 to local non-profit organizations operating quality programs with anticipated outcomes aligned with Cape Cod Hospital and Falmouth Hospital implementation strategies related to chronic and infectious diseases and prevention and wellness. Goal Status Eleven organizations received $250,474 in grants ranging from $5,400 to $30,000. The recipients of grant awards included AIDS Support Group of Cape Cod, A Baby Center, Alzheimer's Family Caregiver Support Center, Cape Cod Cooperative Extension, Cape Cod Times Needy Fund, Cape Wellness Collaborative, Housing Assistance Corporation on Cape Cod, National Alliance on Mental Illness Cape Cod, Samaritans on Cape Cod & the Islands, Team Maureen, and the YMCA Cape Cod. Partners - Partner Name, Description and Web Address AIDS Support Group of Cape Cod - www.asgcc.org Alzheimers Family Caregiver Support Center - www.alzheimerscapecod.org A Baby Center - www.ababycenter.org Cape Cod Cooperative Extension - www.capecodextension.org Cape Cod Times Needy Fund - www.needyfund.org Housing Assistance Corporation on Cape Cod - www.haconcapecod.org Cape Wellness Collaborative - www.capewellness.org Team Maureen - www.teammaureen National Alliance on Mental Illness Cape Cod - www.namicapecod Samaritians on Cape Cod & The Islands - www.capesamaritans.org YMCA Cape Cod - www.ymcacapecod.org Contact Information Mary Pumphery 297 North Street Building 3, 3rd Floor Hyannis, MA 02601 Phone: 774-470-5506 Detailed Description The FY18 Annual Strategic Grants Program was a competitive grant initiative with the objective to support community-based chronic and infectious disease and prevention and wellness projects aligned with two of the four health priorities identified in the FY17 - FY19 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan. Grants were awarded to organizations with projects that reached vulnerable populations, maximized partnership collaboration and featured evidence-based programs or promising practices with the objective to improve the health of Barnstable County residents. Recovery Specialist Program in the Emergency Departments at Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services, Grant/Donation/Foundation/Scholarship, Outreach to Underserved. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, reducing Health Disparity. EOHHS Focus Issue(s) (optional): Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional): Social Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Mental Health, Other: Alcohol and Substance Abuse, Other: Hepatitis, Other: Uninsured/Underinsured, substance Abuse - Sex: All - Age Group: Adult, Adult-Elder, Adult-Young, All Adults - Ethnic Group: All - Language: All. Goal Description Engage and consult with at least 250 patients with Substance Use Disorders treated in the Emergency Departments at Cape Cod Hospital and Falmouth Hospital. Goal Status The Recovery Specialists provided consultations to 548 patients in Cape Cod Hospital and Falmouth Hospital Emergency Departments in FY18. Goal Description Motivate and assist 40% of patients who receive a consultation from the Recovery Specialist to accept a transfer to treatment or direct referral to treatment prior to discharge from the Emergency Department. Goal Status Seventy-six percent (76%) of the 548 patients who received Recovery Specialist consultation and engagement accepted direct transfer or direct referrals to inpatient/outpatient treatment upon discharge from the Emergency Departments. Treatment modalities included inpatient detoxification, hospital transfers, intensive outpatient programs, and Medication Assisted Treatment and Office-Based Addiction Programs. Goal Description Offer post-discharge follow-up and assistance to patients with Substance Use Disorders who refused services while in the Emergency Departments. Goal Status Post-discharge follow-up was offered to patients beginning in February of 2018. Two hundred and eighty-four (284) patients received post-discharge follow-up by phone including Specialists extending their assistance by coordinating referrals and treatment program placement. Twenty-six percent (26%) of those receiving post-discharge follow-up support accepted direct referrals to treatment. accepted direct referrals to treatment.
Partner Name, Description and Web Address	Gosnold, Inc. - www.gosnold.org Barnstable County Regional Substance Use Council - www.bchumanservices.net/initiatives/regional-substance-use-council/ Outer Cape Health Services - www.outercape.org Duffy Health Center - www.duffyhealthcenter.org Community Health Center of Cape Cod - www.chcofcapecod.org Harbor Community Health Center- Hyannis - www.hhsi.us/locations/harbor-community-health-center-hyannis/ Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description - Cape Cod Hospital and Falmouth Hospital partnered with Gosnold, Inc. to provide peer-led Recovery Specialist services in the Emergency Departments at both hospitals. Recovery Specialists have the lived experience of addiction and recovery and engage patients with Substance Use Disorders prior to discharge from the Emergency Departments. Recovery Specialists work as part of the hospital care team with the objective to motivate patients to accept treatment for Substance Use Disorders through a transfer to an inpatient treatment program or direct referrals to outpatient treatment programs. CCHC Cancer Support Services and Survivorship Activities Program Type: Community Education, Direct Services, Grant/Donation/Foundation/Scholarship, Support Group. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Built Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Other: Cancer, Other: Cancer - Breast, Other: Cancer - Cervical, Other: Cancer - Colo-rectal, Other: Cancer - Lung, Other: Cancer - Multiple Myeloma, Other: Cancer - Other, Other: Cancer - Ovarian, Other: Cancer - Prostate, Other: Cancer - Skin, Other: Cardiac Disease, Other: Cultural Competency, Other: Nutrition, Physical Activity - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Oncology Social Workers will provide psycho-social support to over 3,000 patients. Goal Status Oncology Social Workers provided services to more than 3,500 oncology patients. Services included direct counseling, family counseling, referrals to support services, referrals to support groups and financial counseling. Patients were provided direct referrals to the following community-based programs: transportation provided by the American Cancer Society's Road to Recovery Program and Lyft rides to appointments through Boston Cancer Support program, access to free complementary services such as massage, acupuncture and nutritional counseling through the Cape Wellness Collaborative, and physical reconditioning programs through CCHC's Living Fit for You! Cancer Wellness Program and the YMCA's LIVESTRONG program. Goal Description Support groups will be provided to patients and families. Goal Status More than 550 patients and family members attended CCHC support groups in FY18. Support groups included Leukemia and Lymphoma Society Family Support Groups, Support for People with Oral, Health, and Neck Cancers, Breast Cancer Support Groups and Ostomy Clinics. Support groups were facilitated by CCHC staff and hosted at CCHC facilities. Goal Description Host a Cancer Survivorship Day event to celebrate survivors, inspire those recently diagnosed and support families and caregivers. Goal Status The FY18 Survivorship Day event hosted more than 150 attendees and 25 volunteers from the CCHC Cancer Program. Support organizations, including The American Cancer Society, Team Maureen, and the Cape Wellness Collaborative provided information on prevention, support programs and self-care. CCHC employees donated 103 gift bags that were distributed to survivors. Goal Description Host a Cancer Survivorship Day event to celebrate survivors, inspire those recently diagnosed and support families and caregivers. Goal Status The FY18 Survivorship Day event hosted more than 150 attendees and 25 volunteers from the CCHC Cancer Program. Support organizations, including The American Cancer Society, Team Maureen, and the Cape Wellness Collaborative provided information on prevention, support programs and self-care. CCHC employees donated 103 gift bags that were distributed to survivors. Goal Description Through a grant from the American Cancer Society, CCHC will offer an Oncology Nutrition program to improve patients' quality of life and outcomes. Goal Status CCHC launched an Oncology Nutrition program and provided 1:1 counseling for 216 patients and their families with a Registered Dietitian through 300 visits. Services offered by the Oncology Nutrition program include meal planning for various diets and nutritional needs, assistance with initiating a tube feed for patients who are no longer able to consume foods orally, working closely with patient's care team to ensure adequate nutrition at patient's home, and providing local grocery store and local organic market gift cards for patients in need of additional monetary/dietary support. Partner Name, Description and Web Address American Cancer Society www.cancer.org/about-us/local/massachusetts.html YMCA Cape Cod LIVESTRONG www.ymcacapecod.org/programs/health-well-being/livestrong/ Cape Wellness Collaborative Visiting Nurse Association of Cape Cod Team Maureen www.capewellness.org/ www.vnacapecod.org www.teammaureen.org Boston Cancer Support www.bostoncancersupport.org Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description CCHC Cancer Support Services provides oncology patients and their families' psychological and social support during their treatment journey. A team of Oncology Social Workers provide ongoing counseling and support groups and direct referrals to services such as transportation, home care, and community-based wellness services such as reiki, acupuncture and massage. A new Oncology Nutrition program was started in FY18 and cancer survivorship is celebrated, supported and recognized within hospital departments and in the community. Living Fit for you! Cancer Wellness Program at Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Not Specified. Target Population: Regions Served: County-Barnstable - Health Indicator: Mental Health, Other: Cancer, Other: Cancer - Breast, Other: Cancer - Cervical, Other: Cancer - Colo-rectal, Other: Cancer - Lung, Other: Cancer - Multiple Myeloma, Other: Cancer - Other, Other: Cancer - Ovarian, Other: Cancer - Prostate, Other: Cancer - Skin, Other: Chronic Pain, Other: Nutrition, Physical Activity, - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Provide free group exercise program, 1:1 wellness counseling, oncology rehabilitation screenings and access to cancer survivorship programs for adults undergoing or recovering from treatment for cancer. Goal Status In FY18, 82 patients were referred to the program with 262 individualized exercise classes and wellness consults provided to address fatigue, de-conditioning, stress reduction, distress management, nutritional services, diabetes education and sleep issues. Goal Description Referrals will be made to appropriate services to continue rehabilitation and improved health outcomes. Goal Status The program referred nearly 90% of patients to additional rehabilitative services including pulmonary, cardiac, nutrition, speech and occupational therapy. Partner Name, Description and Web Address Cape Cod Healthcare - www.capecodhealth.org/classes-events Cape Wellness Collaborative - www.capewellness.org Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Living Fit for You! is a free, structured, and medically-supervised six-week exercise and education program for cancer survivors before, during or after treatment. Activities focus on improving fatigue, de-conditioning and a loss of physical function. The program was founded at Falmouth Hospital and expanded to include Cape Cod Hospital in August of 2018. Moms Do Care Cape Cod Program Type: Community Participation/Capacity Building Initiative, Direct Services, Grant/Donation/Foundation/Scholarship, Health Screening, Outreach to Underserved, School/Health Center Partnership, Support Group. Outreach to Underserved, School/Health Center Partnership, Support Group.
Program Type: Community Participation/Capacity Building Initiative,	Direct Services, Grant/Donation/Foundation/Scholarship, Health Screening, Outreach to Underserved, School/Health Center Partnership, Support Group. Outreach to Underserved, School/Health Center Partnership, Support Group Statewide Priority: Address Unmet Health Needs of the Uninsured, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Housing Stability/Homelessness, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional): Built Environment, Employment, Housing, Social Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Mental Health, Other: Alcohol and Substance Abuse, Other: Family Planning, Other: Homelessness, Other: Language/Literacy, Other: Nutrition, Other: Parenting Skills, Other: Uninsured/Underinsured, Substance Abuse, - Sex: Female- Age Group: All Adults - Ethnic Group: All - Language: English. Goal Description Provide prenatal and postpartum care coordination, access to MAT programs, and addiction recovery services to 75 pregnant women in Barnstable County. Goal Status Moms Do Care enrolled 62 women in the program. Substance use treatment and access to prenatal care services were coordinated by a Certified Addiction Registered Nurse and a Recovery Coach provided peer support services and assistance addressing social determinants of health such as housing and transportation. Goal Description Increase positive health outcomes for the women enrolled in program. Outcomes measured using baseline data included, but was not limited to, overdose rates, use of alcohol and illegal use of drugs and increased utilization of outpatient mental health and Medication-Assisted Treatment. Goal Status Advocates for Human Potential, an organization selected by MA Department of Public Health, served as the evaluator for Moms Do Care Cape Cod and Moms Do Care Worcester projects. From baseline reporting at the time of enrollment through follow-up interviews 6 months after their child was delivered, aggregated data from both sites demonstrated that Moms Do Care participants experienced a reduction in the number of overdoses, a reduction in the use of alcohol or illegal drugs, and increased utilization and adherence to mental health and substance use treatment services. Goal Description Develop a sustainability plan to continue program activities in the community at the project funding conclusion in July 2018. Goal Status CCHC worked closely with collaborators transitioning the program to Duffy Health Center in August of 2018. Duffy Health Center was awarded a MA DPH grant to continue the program starting in October 2018. CCHC provided a bridge grant of $21,000 to support the program during the transition and ensure program activities continued between grant cycles. CCHC remains a committed collaborator on the project and refers to the program from different clinical departments including hospital emergency and maternity departments, behavioral health departments, and obstetrical practices. Partner Name, Description and Web Address The Duffy Health Center - www.duffyhealthcenter.org Gandara Center - www.gandaracenter.org Institute for Health and Recovery - www.healthrecovery.org/projects/moms-do-care/ Massachusetts Department of Public Health: Bureau of Substance Addiction Services - www.mass.gov/orgs/bureau-of-substance-addiction-services Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Hospital received grant funds from the MA Department of Public Health to design and operate a program called Moms Do Care with the objectives of expanding access to substance use treatment, prenatal care and peer-based recovery support services for pregnant women with Opioid Use Disorders living in Barnstable County. Specialty Network for the Uninsured: Harbor Community Health Center Hyannis Program Type Grant/Donation/Foundation/Scholarship, Outreach to Underserved. Statewide Priority Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional) Not Specified. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Arthritis, Other: Asthma/Allergies, Other: Cancer, Other: Cancer - Prostate, Other: Cardiac Disease, Other: Chronic Pain, Other: Colitis/Crohn Disease, Other: Cultural Competency, Other: Diabetes, Other: Family Planning, Other: Hearing, Other: Hepatitis, Other: Hypertension, Other: Language/Literacy, Other: Lyme Disease, Other: Osteoporosis/Menopause, Other: Parkinson's Disease, Other: Pregnancy, Other: Pulmonary Disease/Tuberculosis, Other: Stroke, Other: Uninsured/Underinsured, Other: Vision,- Sex: All - Age Group: All - Ethnic Group: All - Language: All, Portuguese, Spanish. Goal Description Increase access to specialty care for low-income, uninsured and under-insured individuals. Goal Status In FY18, SNU coordinated 518 appointments with local medical specialists for low-income, uninsured or under-insured individuals. The FY18 program experienced an increase of 5% over the number of visits provided in FY17. Goal Description Provide access to specialists for uninsured or under-insured residents who face language barriers to care. Goal Status The number of SNU participants requesting a medical interpreter during a specialty appointment nearly doubled from FY17 (10%) to FY18 (19%). In FY18, 81% of individuals requesting a medical interpreter requested Portuguese translation and 19% requested Spanish translation. Goal Description Analyze program utilization data to identify the specialty services most needed by SNU program participants. Goal Status In FY18, the five most frequently utilized specialty services included urology, ophthalmology, ear, nose and throat (ENT), cardiology and general surgery. Partner Name, Description and Web Address Cape Cod Healthcare - www.capecodhealth.org Community Health Center of Cape Cod - www.chcofcapecod.org Duffy Health Center - www.duffyhealthcenter.org Harbor Community Health Center Hyannis - www.hhsi.us Island Health Care - www.ihimv.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare Community Benefits provides annual grant support to Harbor Community Health Center-Hyannis to coordinate the Specialty Network for the Uninsured (SNU). The SNU program increases access to specialty care for uninsured and under-insured residents of Barnstable County through managing a network of medical specialists who provide office visits, procedures and continued care of uninsured and under-insured individuals. Barnstable County Tick Disease Testing and Education Project Program Type: Grant/Donation/Foundation/Scholarship. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Not Specified. DoN Health Priorities (optional): Not Specified. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Lyme Disease - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Provide up to 1,500 subsidized tick tests for Barnstable County residents. Testing to include: identification of tick species and life stage, high resolution micrographs of tick, assessment of feeding status, and secure private delivery of pathogen testing results. Goal Status As of September 30, 2018, just over 1,110 tick tests were completed and the results provided data and information to aid in personal risk assessment. Goal Description Provide county-wide surveillance data for use by medical providers and public health officials. The detection of one or more pathogens in ticks will be reported. Goal Status Approximately, 32% of the 1,112 tested positive with one or more pathogens. Data and information is shared with the Cape Cod Cooperative Extension. It was also noted that Barnstable residents submitted a relatively low-rate of non-tick samples compared to other regions in MA, signaling that residents assisted by this grant appear more likely to properly detect and identify ticks as opposed to other arthropods or foreign substances. Goal Description The Cape Cod Extension will develop, produce and release an online series of tick disease education and prevention videos for the public featuring a local epidemiologist.
The online videos will be promoted across the county via public locations	including schools, libraries, councils on aging and other civic gathering locations. aging and other civic gathering locations. gathering locations. Goal Status A series of ten tick education videos titled "Tickology" were released to the public on September 25, 2018. Promotion of the videos has been targeted towards libraries, garden centers, businesses, museums, land use organizations, and public health officials. Videos can be accessed on the Cape Cod Extension's website, www.capecodextension.org/ticks/ and YouTube. Partner Name, Description and Web Address Cape Cod Cooperative Extension: www.capecodextension.org UMASS Laboratory of Medical Zoology: www.tickdiseases.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC Community Benefits provided grant funding to subsidize a tick-borne pathogen testing program and expanded tick borne disease prevention education for residents of Barnstable County. Tick-testing and reporting was conducted by the UMASS Laboratory of Medical Zoology. The Cape Cod Cooperative Extension developed, produced and released to the public a 10-part online video series titled "Tickology" providing easily-accessible community education on tick disease prevention by local epidemiologists. Community-Based Interpreter Services Program Type: Outreach to Underserved. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes,Stability/Homelessness, Substance Use Disorders. DoN Health Priorities (optional): Social Environment. Target Population Regions Served: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Arthritis, Other: Asthma/Allergies, Other: Cancer, Other: Cardiac Disease, Other: Chronic Pain, Other: Colitis/Crohn Disease, Other: Cultural Competency, Other: Diabetes, Other: Family Planning, Other: Hepatitis, Other: HIV/AIDS, Other: Hypertension, Other: Lyme Disease, Other: Nutrition, Other: Osteoporosis/Menopause, Other: Parkinson's Disease, Other: Pregnancy, Other: Pulmonary Disease/Tuberculosis, Other: Sexually Transmitted Diseases, Other: Sickle Cell Disease, Other: Smoking/Tobacco, Other: Stroke, Other: Uninsured/Underinsured, Overweight and Obesity, Physical Activity, Substance Abuse, Tobacco Use - Sex: All - Age Group: All Adults - Ethnic Group: All, Portuguese, Spanish - Language: All, Portuguese, Spanish. Goal Description Assist more than 800 individuals with free medical interpreters in community-based primary care and specialty care settings. Goal Status The Community Based Interpreters program served 883 individuals with medical interpretation in community-based health care settings. Goal Description Analyze program utilization data to assess regional medical interpretation needs for program evaluation. Goal Status Over 80% of people served requested Portuguese translation and 19% requested Spanish translation. Overall the number of individuals served was similar to FY17; however the regions of Cape Cod where those served by the program reside shifted slightly. The Mid-Cape region experienced an increase of 5% of the total population served and the Upper Cape region experienced a decrease in people served. In FY17 and FY18, only 1% of individuals served by the program resided in the Outer and Lower regions of Cape Cod. Partner Name, Description and Web Address Community Based Medical Offices on Cape Cod - Various Harbor Community Health Center Hyannis - www.hhsi.us/cape-cod/harbor-community-health-center-hyannis Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description CCHC provides free medical language interpreters to community-based physician offices to assist limited and non-English speaking patients and their families. The availability of proficient and professional interpreter services ensures the delivery of safe, quality health care and positive clinical outcomes. EMS Interpreter's Services Program: A collaboration between Cape Cod Healthcare and the Cape and Islands Emergency Medical Services System Program Type: Direct Services, Grant/Donation/Foundation/Scholarship, Health Professional/Staff Training. Statewide Priority: Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): N/A. DoN Health Priorities (optional): Social Environment. Brief Description or Objective: CCHC Community Benefits provides support to the regional SHINE program to expand information, counseling and assistance with Medicare and health insurance needs at various outposts across Barnstable County. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Cultural Competency, Other: Language/Literacy - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Pilot the program with Hyannis Fire Department and Yarmouth Fire Department; two of the three largest fire and rescue departments in Barnstable County, to assess need, develop training resources and track service utilization. Goal Status According to survey data, over 90% of fire department staff from both towns identified that they had encountered language barriers making it difficult to accurately assess and document health information from a patient who speaks a language other than English prior to arrival at the hospital. In response, CCHC trained firefighters and emergency responders to use phone-based interpreter services and provided a toll free number to access interpreter services from their cell phones. In addition, a language identification poster and a medical visual translator document were provided to each ambulance in the town. In the pilot phase of the program, EMT's utilized the service for 32% of patients who required translation services upon arrival at the hospital. The average translation call was 3.8 minutes and cost less than $4 per call. Goal Description Expand the program beyond two pilot sites to other municipal fire and rescue departments in Barnstable County. Goal Status CCHC Community Benefits provided program funds for ongoing costs of interpreter services and materials for the program, expanding to 13 out of the 15 towns in Barnstable County. Staff from the interpreter services departments at Cape Cod Hospital and Falmouth Hospital provided training to the town departments on use of interpreter services and visual language identifiers. Data collection is ongoing. Partner Name, Description and Web Address Cape and Islands Emergency Medical Services System - www.capeandislandsems.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare (CCHC) and the Cape and Islands Emergency Medical Services System partnered to create a unique program that provides phone-based medical interpreter services offered via the cell phones of paramedics and first responders on ambulances to improve communication with limited-English speaking patients during an emergency and to increase accuracy of information relayed by patients during transport to a hospital. Program Type: Community Participation/Capacity Building Initiative,Grant/Donation/Foundation/Scholarship, Health Screening, Prevention. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes,DoN Health Priorities (optional) Built Environment, Social Environment. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Hypertension, Other: Stroke, Overweight and Obesity, Physical Activity- Sex: All - Age Group: All Ethnic Group: All - Language: All. Goal Description Increase the number of residents participating in the Health Parks, Healthy People seasonal walking program and 5K Run/Walk aimed at improving health knowledge and awareness of free and open spaces for physical activity. Goal Status In FY18, over 285 individuals participated in the summer walking program and 5K Run/Walk at the Cape Cod National Seashore representing a 30% increase in the number of participants over FY17. Partner Name, Description and Web Address Cape Cod National Seashore - www.nps.gov/caco/index.htm National Park Service - www.nps.gov/.../healthy-parks-healthy-people Cape Cod Healthcare - www.capecodhealth.org/wellness-wise/healthy-parks-healthy-people/ www.capecodhealth.org/wellness-wise/healthy-parks-healthy-people/
National Alliance on Mental Illness (NAMI) Cape Cod www.namicapecod.org	Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare collaborated with the Cape Cod National Seashore and the National Park Services to promote community open space for wellness, exercise and physical activity to improve the health of Cape Cod residents and visitors. Prescription Assistance Program for Vulnerable Populations:Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Reducing Health Disparity. Disparity. Disparity. Disparity. Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC Community Benefits provided grant funding to subsidize a tick-borne pathogen testing program and expanded tick borne disease prevention education for residents of Barnstable County. Tick-testing and reporting was conducted by the UMASS Laboratory of Medical Zoology. The Cape Cod Cooperative Extension developed, produced and released to the public a 10-part online video series titled "Tickology" providing easily-accessible community education on tick disease prevention by local epidemiologists. Detailed Description Cape Cod Healthcare collaborated with the Cape Cod National Seashore and the National Park Services to promote community open space for wellness, exercise and physical activity to improve the health of Cape Cod residents and visitors. Prescription Assistance Program for Vulnerable Populations: Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Reducing Health Disparity. Disparity. Disparity. Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Not Specified. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Uninsured/Underinsured- Sex: All Age Group: All Ethnic Group: All Language: All. Goal Description Assist residents who are unable to afford medications to ensure compliance with hospital discharge planning. Goal Status In FY18, Cape Cod Hospital and Falmouth Hospital emergency and behavioral health departments provided prescription vouchers and prescription assistance totaling more than $18,300 for uninsured, under-insured or financially disadvantaged populations. Total spending on the prescription assistance program dropped by approximately 22% from FY17. This reduction is attributed to the hospital pharmacies now providing subsidized prescriptions rather than the previous approach of providing vouchers for patients to purchase prescriptions from large, national retail pharmacies. Partner Name, Description and Web Address Cape Cod Hospital - www.capecodhealth.org Falmouth Hospital - www.capecodhealth.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description The Prescription Assistance Program is an initiative of Cape Cod Hospital and Falmouth Hospital emergency, behavioral health and pharmacy departments as a community benefit assisting uninsured, under-insured and financially disadvantaged patients with no other viable means to pay for medications upon discharge from hospital facilities. Transportation Assistance Program for Vulnerable Populations: Cape Cod Hospital and Falmouth Hospital Program Type Direct Services. Statewide Priority Reducing Health Disparity. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional) Built Environment. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Safety, Other: Uninsured/Underinsured - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Assist residents who are unable to afford or access transportation to ensure compliance with their discharge plan. Goal Status Cape Cod Hospital and Falmouth Hospital emergency and behavioral health departments provided transportation vouchers totaling more than $62,500 for financially disadvantaged patients upon discharge. FY18 hospital transportation assistance increased more than 50% over FY17. Partner Name, Description and Web Address Local Taxi Companies - N/A Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description In an effort to assist low-income and vulnerable populations, Cape Cod Hospital and Falmouth Hospital provided access to transportation upon discharge from emergency and behavioral health departments, to those patients without resources for transportation. Health Education and Support Services for Wellness at Cape Cod Hospital and Falmouth Hospital Program Type Community Education, Direct Services, Health Screening, Outreach to Underserved, Prevention, School/Health Center Partnership, Support Group. Statewide Priority Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional) Built Environment, Education. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Immunization, Mental Health, Other: Alcohol and Substance Abuse, Other: Alzheimer Disease, Other: Arthritis, Other: Asthma/Allergies, Other: Bereavement, Other: Cancer, Other: Cardiac Disease, Other: Cultural Competency, Other: Diabetes, Other: HIV/AIDS, Other: Hypertension, Other: Nutrition, Other: Parenting Skills, Other: Pregnancy, Other: Stroke, Overweight and Obesity, Physical Activity,- Sex: All - Age Group: All - Ethnic Group: All - Language: English, Portuguese, Spanish. Goal Description Provide health education and support activities for the community on a continuum of issues including, but not limited to, chronic disease prevention, screening and self-management for conditions such as cancer, heart disease, and diabetes, breastfeeding and parenting, behavioral health, and cultural competency in care. Goal Status In FY18, over 14,500 staff hours were dedicated to ensuring health education and support services. Classes and support groups were offered and facilitated for individuals, families and the community. Partner Name, Description and Web Address American Cancer Society - www.cancer.org Visiting Nurses Association of Cape Cod - www.vnacapecod.org YMCA Cape Cod - www.ymcacapecod.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description At Cape Cod Hospital and Falmouth Hospital, health education and outreach activities, classes, support groups and services to increase wellness are offered to the community across a number of different health areas. From maternity department tours and new parenting classes, to community-based diabetes and stroke education, fall prevention classes, bereavement support groups and advance care planning presentations, the hospitals dedicate clinical staff and resources to support the wellness of Barnstable County residents. Workforce and Career Development Initiatives: Cape Cod Healthcare Program Type Community Participation/Capacity Building Initiative, Health Professional/Staff Training, Mentorship/Career Training/Internship, Outreach to Underserved, School/Health Center Partnership. Statewide Priority Reducing Health Disparity, Supporting Healthcare Reform. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health. DoN Health Priorities (optional) Education, Employment. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care - Sex: All - Age Group: Adult, Adult-Young - Ethnic Group: All - Language: All. Goal Description CCHC staff in various departments will provide clinical oversight and supervision to students engaged in allied health programs and various job training initiatives in the region. CCHC staff in various departments will provide clinical oversight and supervision to students engaged in allied health programs and various job training initiatives in the region.
Goal Status	In FY18, over 26,000 staff hours were devoted to workforce and career development partnership efforts including supervision of student training, job shadowing and clinical oversight. Staff hours allocated to workforce development initiatives increased by more than 30% over FY17. This increase is reflective of growth in strategic partnerships aimed at increasing educational and employment opportunities in our region. increasing educational and employment opportunities in our region. Partner Name, Description and Web Address Barnstable High School - www.barnstable.k12.ma.us Cape Cod Community College - www.capecod.edu/ Cape Cod Regional Technical High School - www.capetech.us MA College of Pharmacy and Health Sciences - www.mcphs.edu The Riverview School - www.riverviewschool.org University of Massachusetts - www.massachusetts.edu/ Upper Cape Regional Technical School - www.uppercapetech.com/ Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC invests in partnerships with local high schools, vocational schools, community colleges, and allied health programs for job training and shadowing and internships with health care providers in various hospital departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. CCHC invests in partnerships with local high schools, vocational schools, community colleges, and allied health programs for job training and shadowing and internships with health care providers in various hospital departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. well-compensated jobs in our region.
FUNCTIONAL EXPENSE NOTE	FORM 990, PART I AND PART IX FUNDRAISING IS CONDUCTED ON BEHALF OF CAPE COD HEALTHCARE, INC. BY CAPE COD HEALTHCARE FOUNDATION, INC. CERTAIN OFFICERS ARE COMPENSATED BY CAPE COD HEATHCARE, INC. FUNDS RAISED ARE REPORTED AT CAPE COD HEALTHCARE, INC. AND AFFILIATES. FORM 990, PART I, LINE 6 CAPE COD HEALTHCARE, INC.'S VOLUNTEERS INCLUDE ITS TRUSTEES. FORM 990, PART VI, LINE 2 TRUSTEES AND OFFICERS SIT ON THE BOARDS OF THE FOLLOWING: EMERALD PHYSICIANS MEMBER TRUST: PHILIP MCLOUGHLIN JOEL CROWELL CAPE HEALTH INSURANCE COMPANY: MICHAEL K LAUF MICHAEL L CONNORS MICHAEL G JONES BRUCE JOHNSTON PHILIP MCLOUGHLIN THE MEMBERS OF CAPE COD HEALTHCARE, INC.'S BOARD ALSO SIT ON THE BOARD OF CAPE COD MEDICAL OFFICE BUILDING AND EMERALD PHYSICIAN SERVICES, LLC, FOR-PROFIT RELATED ORGANIZATIONS. FORM 990, PART VI, LINE 4 The organization's bylaws were amended to include the following items: deletion of the development and philanthropy committee as a standing board committee as the function has been absorbed by Cape Cod Healthcare Foundation; deletion of a minimum number of members; prior automatic removal as a member for failing to attend three consecutive annual meetings have been removed; trustees may serve a maximum of three consecutive 3-year terms instead of four; physician trustees may serve three consecutive 2-year terms instead of four, establishment of a requirement for the Compliance Officer to make an annual compliance report to the Board of Trustees, and proxy votes may be submitted by facsimile transmission. FORM 990, PART VI, LINES 6&7(A) THE ORGANIZATION HAS MEMBERS/INCORPORATORS WHO ELECT THE ORGANIZATION'S TRUSTEES. FORM 990, PART VI, LINE 7(B) THE DECISIONS OF THE GOVERNING BODY THAT NEED APPROVAL BY ITS MEMBERS/INCORPORATORS INCLUDE APPROVAL OF CHANGES MADE TO THE CORPORATION'S BYLAWS AND APPROVAL WHEN THERE IS A DIVESTING OF ONE OF THE MAJOR AFFILIATES OF THE ORGANIZATION. FORM 990, PART VI, LINE 11 THE ORGANIZATION'S FORM 990 IS REVIEWED AT SEVERAL LEVELS. THE ORGANIZATION ENGAGES A PUBLIC ACCOUNTING FIRM TO ASSIST IN THE PREPARATION AND REVIEW OF ITS FORM 990 AND WHO SIGNS AS PAID PREPARER. SENIOR MANAGEMENT OF THE ORGANIZATION IS RESPONSIBLE FOR THE TIMELY PREPARATION OF FORM 990. THE COMPLETED FORM 990, WITH THE EXCEPTION OF AN ANONYMOUS DONOR, IS PROVIDED TO THE FINANCE COMMITTEE AND THE ENTIRE BOARD IN ADVANCE OF THE FILING DEADLINE. FORM 990, PART VI, LINE 12 THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY AND REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THIS POLICY. ON AN ANNUAL BASIS, EACH TRUSTEE, OFFICER AND EMPLOYEE AT THE SENIOR MANAGEMENT LEVEL COMPLETES A CONFLICT OF INTEREST DISCLOSURE FORM. THE FORMS ARE REVIEWED BY CAPE COD HEALTHCARE, INC.'S ("CCHC") DIRECTOR OF CLINICAL AND RESEARCH COMPLIANCE WHO PREPARES A SUMMARY FOR CCHC'S COMPLIANCE OFFICER. ANY MATERIAL INTERESTS SO DISCLOSED ARE PRESENTED TO THE CORPORATION'S GOVERNANCE COMMITTEE FOR REVIEW AND RESOLUTION. ALL DISCLOSURE STATEMENTS SUBMITTED BY EMPLOYEES WILL BE REVIEWED BY HUMAN RESOURCES AND/OR CCHC'S DIRECTOR OF CLINICAL AND RESEARCH COMPLIANCE. FOR ANY DISCLOSURE THAT IS CONSIDERED SUBSTANTIVE THE EMPLOYEE'S AREA MANAGER WILL BE CONSULTED TO DETERMINE IF THE SITUATION IS GENERALLY ACCEPTABLE, REQUIRES FURTHER EXAMINATION AND POSSIBLE ACTION OR IS GENERALLY NOT ACCEPTABLE. ANY ACTION PLAN CREATED TO MANAGE A CONFLICT OF INTEREST WILL BE MONITORED BY THE EMPLOYEE'S AREA MANAGER OR SUPERVISOR. FORM 990, PART VI, LINE 15 THE ANNUAL PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, OFFICERS, EXECUTIVES AND KEY EMPLOYEES INCLUDE THE FOLLOWING: CEO - COMPENSATION WILL BE DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, AND WILL INCLUDE CONSIDERATION OF RELEVANT MARKET DATA FURNISHED BY A DISINTERESTED COMPENSATION CONSULTANT, AND A REVIEW OF JOB PERFORMANCE. OFFICERS, EXECUTIVES AND KEY EMPLOYEES - OFFICER, EXECUTIVE AND KEY EMPLOYEE COMPENSATION WILL BE DETERMINED BY THE CEO AND WILL INCLUDE CONSIDERATION OF RECENT RELEVANT MARKET DATA FURNISHED BY A DISINTERESTED COMPENSATION CONSULTANT, AND A REVIEW OF JOB PERFORMANCE. THE CEO'S DETERMINATION OF SUCH COMPENSATION WILL BE SUBJECT TO THE APPROVAL OF THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE PROCESS AND CONCLUSIONS ARE DOCUMENTED IN THE MEETING MINUTES.
FORM 990, PART VI, LINE 19	THE ORGANIZATION MAKES ITS BYLAWS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE ANNUALLY FILED FORM PC, A PUBLICLY DISCLOSED TAX-EXEMPT ORGANIZATION FILING FOR THE STATE OF MASSACHUSETTS.
FORM 990, PART VII, COLUMN (B)	THE INDIVIDUALS REPORTED AS RECEIVING COMPENSATION FROM A RELATED ORGANIZATION IN COLUMNS (E) AND (F) IN PART VII ARE EMPLOYEES AT CAPE COD HEALTHCARE, INC., A TAX-EXEMPT RELATED ORGANIZATION. FORM 990, PART VII, SECTION A TITLE FOR JOEL CROWELL: TRUSTEE, SERVED AS TREASURER/CLERK/TRUSTEE UNTIL 5/18 TITLE FOR MICHAEL G. JONES, ESQ: SR. VP & CHIEF LEGAL OFFICER / CLERK FROM 5/18 FORM 990, PART VII, SECTION B WITH THE EXCEPTION OF REPORTING FOR VISITING NURSE ASSOCIATION OF CAPE COD, INC, CAPE COD HEALTHCARE, INC. PAYS INDEPENDENT CONTRACTORS ON BEHALF OF ITS AFFILIATES WHO FILE AS PART OF A GROUP FORM 990 AS CAPE COD HEALTHCARE, INC. AND AFFILIATES.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES ($3,069,833) NET ASSETS RELEASED FROM RESTRICTION (563,057) TRANSFER TO/FROM AFFILIATES 575,802 CHANGE IN VALUE SPLIT INTEREST AGREEMENT 492,634 CHANGE IN VALUE BENEFICIAL INTEREST (174,493) TRANSFER OF NET ASSETS 2,736,781 CONTRIBUTIONS ELIMINATIONS (53,989) INCLUSION OF CCRI TO GROUP EXEMPTION ------------- ($56,155) OTHER CHANGES IN NET ASSETS OR FUND BALANCES

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CAPE COD HEALTHCARE INC & AFFILIATES

Employer identification number

90-0054984

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)CAPE COD HEALTHCARE INC 297 NORTH STREET BLDG 3 HYANNIS,MA02601 22-2600704	PARENT CORP	MA	501(c) (3)	10	NA	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CAPE AND ISLAND ENDOSCOPY CENTER 700 ATTUCKS LANE HYANNIS,MA02601	ENDOSCOPY CENTER	MA	NA

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) CAPE HEALTH INSURANCE COMPANY PO BOX 1051GT GRAND CAYMAN CJ 98-1230418	INSURANCE	CJ	CAPE COD HLTHCR	C CORP	0	0		Yes
(2) CAPE COD MEDICAL OFFICE BUILDING INC 27 PARK STREET HYANNIS,MA02601 04-2423073	RENTAL SRVCE	MA	NA	C CORP	0	15,000	100.000 %	Yes
(3) POOLED INCOME FUNDS (2)	SUPPORT	MA	NA					Yes
(4) EMERALD PHYSICIAN SERVICES LLC 25 COMMUNICATION WAY HYANNIS,MA02601 04-3369730	PRIMARY CARE	MA	EMERALD TRUST	S CORP	26,802,932	13,385,182	100.000 %	Yes
(5) EMERALD PHYSICIANS MEMBER TRUST 297 NORTH STREET BLDG 3 HYANNIS,MA02601 46-7220648	EMRLD SHAREHO	MA	MACC	TRUST	0	0	100.000 %	Yes
(6) CHARITABLE REMAINDER TRUSTS (20)	SUPPORT	MA	NA					Yes

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CAPE HEALTH INSURANCE COMPANY	R	2,957,963	FMV

Schedule R (Form 990) 2019

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

TY 2017 AffiliateListing

Name:

CAPE COD HEALTHCARE INC & AFFILIATES

EIN:

90-0054984

Name	Address	EIN	Name control
CAPE COD HOSPITAL	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-2103600	CAPE
VISITING NURSE ASSN OF CAPE COD INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-2104159	CAPE
FALMOUTH HOSPITAL ASSOCIATION INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-2220716	CAPE
CAPE COD HUMAN SERVICES INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-2323506	CAPE
MEDICAL AFFILIATES OF CAPE COD INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-3187299	CAPE
CAPE COD HEALTHCARE FOUNDATION INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-3475950	CAPE
CAPE & ISLANDS HEALTH SERVICES II	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-3572408	CAPE
FALMOUTH ASSISTED LIVING INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	22-3379395	CAPE
JML CARE CENTER INC	297 NORTH ST BLDG 3 HYANNIS, MA 02601	04-2995795	CAPE

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	5,684
6	Total number of volunteers (estimate if necessary) .............	6	696
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,555,937
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-544,982

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	15,341,766	15,447,109
9	Program service revenue (Part VIII, line 2g) .........	844,858,980	884,728,875
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,432,277	13,029,571
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,195,757	2,414,588
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	870,828,780	915,620,143
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	1,094,878
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)	445,642,426	476,686,163
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	86,247	68,237
b	Total fundraising expenses (Part IX, column (D), line 25) 3,581,359
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	377,540,307	391,316,079
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	823,268,980	869,165,357
19	Revenue less expenses. Subtract line 18 from line 12.......	47,559,800	46,454,786
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	963,305,006	1,023,990,733
21	Total liabilities (Part X, line 26).............	258,793,996	269,099,333
22	Net assets or fund balances. Subtract line 21 from line 20.....	704,511,010	754,891,400

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 789,043,793 including grants of $ 1,094,878 ) (Revenue $ 884,728,875 )
	PATIENT SERVICES - SEE SCHEDULES H AND O

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses789,043,793

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,478,688	9,528,009	1,878,916

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	9,350
d	Related organizations		1d
e	Government grants (contributions)		1e	1,154,606

f	All other contributions, gifts, grants, and similar amounts not included above		1f	14,283,153

g	Noncash contributions included in lines 1a - 1f:$		1g	1,163,954

h Total. Add lines 1a-1f.......		15,447,109

		Business Code
2a	PATIENT SERVICE REVENUE	900099	857,487,495	857,487,495
b	LABORATORY SERVICES	621500	8,011,151	6,455,214	1,555,937
c	PROGRAM RELATED RENTAL INCOME	900099	3,501,400	3,501,400
d	JOINT VENTURE REVENUE	900099	2,953,856	2,953,856
e	QUALITY EARNED PAYMENTS	900099	8,747,405	8,747,405
f	All other program service revenue.		4,027,568	4,027,568
g	Total. Add lines 2a–2f .....		884,728,875

3 Investment income (including dividends, interest, and othersimilar amounts) ......			7,272,965			7,272,965
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		5,756,606	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)		5,756,606	7c
d	Net gain or (loss).........			5,756,606			5,756,606
8a	Gross income from fundraising events (not including $ 9,350of contributions reported on line 1c). See Part IV, line 18 ....
			8a	588,687
b	Less: direct expenses ...		8b	232,753
c	Net income or (loss) from fundraising events..			355,934			355,934
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CAFETERIA INCOME		900099	1,954,744			1,954,744
b	MEDICAL RECORDS		900099	103,910			103,910
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,058,654
12	Total revenue. See instructions.....			915,620,143	883,172,938	1,555,937	15,444,159

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,094,878	1,094,878
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	2,974,982	2,974,982
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	116,158	116,158
7	Other salaries and wages........	377,078,029	339,720,279	35,892,202	1,465,548
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	11,080,193	9,585,883	1,435,688	58,622
9	Other employee benefits .......	60,870,167	54,776,086	5,873,681	220,400
10	Payroll taxes ...........	24,566,634	21,708,767	2,745,753	112,114
11	Fees for services (non-employees):
a	Management ......	6,676,786	3,297,281	3,379,505
b	Legal .........	177,215	7,316	169,899
c	Accounting ...........	995,236	200,853	794,383
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	68,237			68,237
f	Investment management fees ......	677,706	67,562	610,144
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	35,254,478	34,068,162	1,186,316
12	Advertising and promotion ....	980,284	908,046	72,238
13	Office expenses .......	5,253,527	4,847,418	359,340	46,769
14	Information technology ......	11,824,044	10,739,327	999,064	85,653
15	Royalties ..	0
16	Occupancy ...........	14,165,997	13,159,581	859,072	147,344
17	Travel ............	6,580,980	6,076,619	455,813	48,548
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	8,228			8,228
20	Interest ...........	6,419,305	5,797,389	621,916
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	28,412,585	25,720,184	2,682,117	10,284
23	Insurance ...	3,003,255	2,788,863	214,392
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	130,295,787	130,295,787
b	PURCHASED SERVICES	44,454,194	41,295,528	3,109,599	49,067
c	ADMIN OFFICE OVERHEAD	53,528,156	40,379,657	12,602,411	546,088
d	BAD DEBT	14,392,093	14,392,093
e	All other expenses	28,216,223	25,025,094	2,476,672	714,457
25	Total functional expenses. Add lines 1 through 24e	869,165,357	789,043,793	76,540,205	3,581,359
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			23,129,902	1	28,046,133
2	Savings and temporary cash investments .........			1,413,064	2	1,418,491
3	Pledges and grants receivable, net ......			12,662,460	3	11,232,170
4	Accounts receivable, net .............			86,022,740	4	92,397,934
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			3,997,612	7	5,999,843
8	Inventories for sale or use ............			10,914,440	8	11,471,320
9	Prepaid expenses and deferred charges ......			2,406,916	9	4,889,655
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	662,447,460
b	Less: accumulated depreciation	10b	364,005,606	289,207,589	10c	298,441,854
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			474,804,154	12	505,577,304
13	Investments—program-related. See Part IV, line 11 ..			5,124,965	13	-562,504
14	Intangible assets ...............			9,346,552	14	10,089,047
15	Other assets. See Part IV, line 11 ...........			44,274,612	15	54,989,486
16	Total assets. Add lines 1 through 15 (must equal line 33)...			963,305,006	16	1,023,990,733

17	Accounts payable and accrued expenses .....	54,459,109	17	67,602,305
18	Grants payable ...	0	18	0
19	Deferred revenue .........	429,407	19	387,349
20	Tax-exempt bond liabilities .........	150,522,013	20	132,147,783
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	13,407,900	23	20,887,363
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	39,975,567	25	48,074,533
26	Total liabilities. Add lines 17 through 25..	258,793,996	26	269,099,333

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	704,511,010	32	754,891,400
33	Total liabilities and net assets/fund balances ........	963,305,006	33	1,023,990,733

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No