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	5.0 ................. 55.0	X	X	2,672,978	0	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	2.0 ................. 40.0	X		0	791,933	60,781
(14) WILLIAM AGEL MD...................................................................... TRUSTEE	2.0 ................. 40.0	X		0	523,405	44,677
(15) RAMANI AYER...................................................................... TRUSTEE (FROM 5/18)	2.0 ................. 2.0	X		0	0	0
(16) THEODORE CALIANOS MD...................................................................... TRUSTEE	2.0 ................. 40.0	X		0	378,974	43,167
(17) PAUL HOULE MD...................................................................... TRUSTEE	2.0 ................. 40.0	X		0	1,099,091	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/TREAS (FROM 5/18/18)	2.0 .......................2.0	X	X			0	0	0
(19) MICHAEL L CONNORS........................................................................ SENIOR VP FINANCE/CFO	5.0 .......................55.0		X			539,912	0	92,817
(20) MICHAEL G JONES ESQ........................................................................ SEE SCH O FOR TITLE	5.0 .......................55.0		X			412,450	0	78,339
(21) CHRISTIAN BROWN........................................................................ SR. VP MANAGED CARE	5.0 .......................45.0			X		393,040	0	79,946
(22) JEANNE FALLON........................................................................ SR. VP & CIO (UNTIL 4/11/17)	5.0 .......................45.0			X		316,781	0	22,488
(23) PATRICK J KANE........................................................................ SVP OF MRKTG,COMMUN AND DEVLP	5.0 .......................45.0			X		395,113	0	31,505
(24) THERESA M AHERN........................................................................ SVP, STRAT, COMMUNITY/GOV REL.	5.0 .......................45.0			X		334,682	0	63,062
(25) EMILY SCHORER........................................................................ SVP HUMAN RESOURCES	5.0 .......................45.0			X		331,273	0	58,910
(26) KEVIN RALPH........................................................................ SVP DEVELOPMENT	5.0 .......................45.0			X		297,026	0	60,128
(27) NOELENE CERVIN........................................................................ VP BUDGETING & OPER. SUPPORT	5.0 .......................45.0			X		262,379	0	58,866
(28) JEFFREY S DYKENS........................................................................ VP OF FINANCE & OPERATIONS	5.0 .......................45.0			X		310,981	0	64,327
(29) ALEXANDER HEARD MD........................................................................ CHIEF MEDICAL OFFICER - FH	5.0 .......................45.0				X	611,313	84,330	67,672
(30) DONALD GUADAGNOLI MD........................................................................ CMO CAPE COD HOSPITAL	5.0 .......................45.0				X	529,045	0	85,338
(31) MICHAEL N BUNDY........................................................................ COO	5.0 .......................45.0				X	452,973	0	57,273
(32) KEVIN J MULROY........................................................................ SVP CHIEF QUALITY & SAFETY OFF	5.0 .......................45.0				X	474,478	0	75,112
(33) WILLIAM LITTERER III MD........................................................................ MD - PHO	5.0 .......................45.0				X	390,029	0	35,087

(A) Name and business address	(B) Description of services	(C) Compensation
CAPE COD EMERGENCY ASSOCIATES, 220 WEST MAIN ST HYANNIS,MA02601	MEDICAL SERVICES	16,093,000
BRIGHAM WOMENS PHYSICIANS ORG, PO BOX 3684 BOSTON,MA022413684	MEDICAL SERVICES	4,499,627
ALLSCRIPTS HEALTHCARE INC, 24630 NETWORK PLACE CHICAGO,IL606731246	SOFTWARE & SUPPORT	4,390,657
ESOTERIX GENETIC LABORATORIES, PO BOX 12140 BURLINGTON,NC272162140	MEDICAL SERVICES	2,276,389
ECLINICAL WORKS LLC, PO BOX 847950 BOSTON,MA022847950	SOFTWARE & SUPPORT	2,211,323
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 68

- 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

Employer identification number

22-2600704

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.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 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)) .........

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

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.") .	0	0	0	127,250	286,192	413,442
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	54,050,333	45,017,881	59,790,580	71,484,837	80,915,461	311,259,092
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....						0
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge						0
6	Total. Add lines 1 through 5	54,050,333	45,017,881	59,790,580	71,612,087	81,201,653	311,672,534
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons						0
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.						0
c	Add lines 7a and 7b..						0
8	Public support. (Subtract line 7c from line 6.)						311,672,534

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...	54,050,333	45,017,881	59,790,580	71,612,087	81,201,653	311,672,534
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	1,927,657	4,186,009	2,666,046	2,873,769	3,637,942	15,291,423
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	1,927,657	4,186,009	2,666,046	2,873,769	3,637,942	15,291,423
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.	0	127,879	103,278	146,807	327,193	705,157
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..						0
13	Total support. (Add lines 9, 10c, 11, and 12.)..	55,977,990	49,331,769	62,559,904	74,632,663	85,166,788	327,669,114

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)) .........

95.118 %

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

95.291 %

Section D. Computation of Investment Income Percentage

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

4.667 %

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

4.570 %

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

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

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

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

Schedule A (Form 990 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
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

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
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
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.
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.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

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

Employer identification number

22-2600704

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

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		Employer identification number 22-2600704

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			Employer identification number 22-2600704
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

Employer identification number

22-2600704

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

257,058

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

257,058

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1I	A. Cape Cod Healthcare, Inc. made payments to Smith & Rauschenbach of $71,660, Law Offices of O'Neill, Athy and Casey of $130,301 and McDermott, Will & Emery of $6,750 for lobbying and public policy consulting services such as monitoring the Federal and Massachusetts legislatures for matters relating to healthcare reform and informing Cape Cod Healthcare Inc. on changes that could effect the Cape Cod Healthcare, Inc. B. Cape Cod Healthcare, Inc. paid membership dues of $29,167 to the Massachusetts Council of Community Hospitals which are considered 100% expended for lobbying purposes, and the American Hospital Association, which AHA determined was 22.73% engage in lobbying activities or $19,180 of the $84,385 dues paid.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1I

A. Cape Cod Healthcare, Inc. made payments to Smith & Rauschenbach of $71,660, Law Offices of O'Neill, Athy and Casey of $130,301 and McDermott, Will & Emery of $6,750 for lobbying and public policy consulting services such as monitoring the Federal and Massachusetts legislatures for matters relating to healthcare reform and informing Cape Cod Healthcare Inc. on changes that could effect the Cape Cod Healthcare, Inc. B. Cape Cod Healthcare, Inc. paid membership dues of $29,167 to the Massachusetts Council of Community Hospitals which are considered 100% expended for lobbying purposes, and the American Hospital Association, which AHA determined was 22.73% engage in lobbying activities or $19,180 of the $84,385 dues paid.

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

Employer identification number

22-2600704

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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)

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

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 .....	0	4,104,455		4,104,455
b	Buildings ....	0	11,595,321	432,301	11,163,020
c	Leasehold improvements	0	8,510,280	1,405,810	7,104,470
d	Equipment ....	0	67,766,281	25,110,291	42,655,990
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					65,027,935

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) TEMP RESTRICTED INVESTMENTS	12,988,170	F
(B) PERM RESTRICTED INVESTMENTS	12,302,541	F
(C) BENEFICIAL INTEREST IN TRUSTS	21,588,412	F
(D) LONG TERM INVESTMENTS	142,631,157	F
(E) SHORT TERM INVESTMENTS	7,497,456	F
(F) INVESTMENT - 457 PLANS	2,306,858	F
(G) FUNDS HELD UNDER BOND INDENTUR	9,336,374	F
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	208,650,968

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)INSURANCE RECOVERY RECEIVABLE				26,419,352
(2)SHARES OF HBCS STOCK				365,666
(3)SPLIT DOLLAR LIFE				0
(4)DUE FROM AFFILIATES				54,500,380
(5)PERPETUAL CRUT				192,976
(6)BENEFICIAL INTEREST				168,823
(7)HEALTH INS DEPOSIT RECEIVABLE				2,033,014
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				83,680,211

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
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	105,557,712
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 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

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

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

Employer identification number
22-2600704

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) Barnstable County PO BOX 427 Barnstable,MA02630	04-6001419	GOV'T	158,000	FMV	N/A	Access to Healthcare
(2) Cape Cod Baseball League Inc 14 Elishas Pond Rd Yarmouthport,MA02675	42-2687718	501(c)(3)	25,000	FMV	N/A	Youth
(3) CAPE COD COUNCIL OF CHURCHES INC PO Box 758 Hyannis,MA02601	04-2382479	501(c)(3)	55,629	FMV	N/A	General Support
(4) Cape Cod Young Professionals Inc PO BOX 634 Barnstable,MA02630	30-0455198	501(c)(3)	7,500	FMV	N/A	Access to Healthcare
(5) Cape Cod Wellness Collaborative 11 Potter Ave Hyannis,MA02601	47-2360979	501(c)(3)	10,000	FMV	N/A	Chronic Disease
(6) Housing Assistance Corporation 460 W MAIN ST Hyannis,MA02601	23-7431255	501(c)(3)	10,500	FMV	N/A	Housing
(7) Nami Cape Cod Inc 5 MARK LANE Hyannis,MA02601	04-2785229	501(c)(3)	6,000	FMV	N/A	Behavioral Health
(8) New Balance Falmouth Road Race 20 GEST ST Boston,MA02135	04-2460172		30,000	FMV	N/A	Prevention & Wellness
(9) PASTORAL MINISTRY TO THE SICK 786 DARTMOUTH ST Dartmouth,MA02748	04-3096332	501(c)(3)	30,000	FMV	N/A	General Support
(10) Riverview School Inc 551 ROUTE 6A East Sandwich,MA02537	04-2240919	501(c)(3)	12,000	FMV	N/A	Youth
(11) Sandwich Chamber of Commerce PO BOX 744 Sandwich,MA02563	22-3900406	501(c)(6)	5,450	FMV	N/A	Access to Healthcare

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 II	CAPE COD HEALTHCARE, INC. MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES IS THE RESPONSIBILITY OF THE DIRECTOR OF COMMUNITY BENEFITS AND GRANT ADMINISTRATION.

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

Employer identification number

22-2600704

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)	991,489 ------------- 0	1,488,900 ------------- 0	192,589 ------------- 0	249,053 ------------- 0	40,291 ------------- 0	2,962,322 ------------- 0	102,000 ------------- 0
2ROBERT WILSTERMAN MD TRUSTEE	(i) (ii)	0 ------------- 770,101	0 ------------- 19,060	0 ------------- 2,772	0 ------------- 25,080	0 ------------- 35,701	0 ------------- 852,714	0 ------------- 0
3WILLIAM AGEL MD TRUSTEE	(i) (ii)	0 ------------- 448,809	0 ------------- 58,422	0 ------------- 16,174	0 ------------- 10,800	0 ------------- 33,877	0 ------------- 568,082	0 ------------- 0
4THEODORE CALIANOS MD TRUSTEE	(i) (ii)	0 ------------- 370,781	0 ------------- 6,387	0 ------------- 1,806	0 ------------- 10,800	0 ------------- 32,367	0 ------------- 422,141	0 ------------- 0
5PAUL HOULE MD TRUSTEE	(i) (ii)	0 ------------- 932,685	0 ------------- 165,440	0 ------------- 966	0 ------------- 27,506	0 ------------- 34,701	0 ------------- 1,161,298	0 ------------- 0
6MICHAEL L CONNORS SENIOR VP FINANCE/CFO	(i) (ii)	431,607 ------------- 0	77,850 ------------- 0	30,455 ------------- 0	55,606 ------------- 0	37,211 ------------- 0	632,729 ------------- 0	19,481 ------------- 0
7MICHAEL G JONES ESQ SEE SCH O FOR TITLE	(i) (ii)	316,680 ------------- 0	76,632 ------------- 0	19,138 ------------- 0	43,278 ------------- 0	35,061 ------------- 0	490,789 ------------- 0	15,965 ------------- 0
8CHRISTIAN BROWN SR. VP MANAGED CARE	(i) (ii)	300,781 ------------- 0	69,769 ------------- 0	22,490 ------------- 0	46,069 ------------- 0	33,877 ------------- 0	472,986 ------------- 0	13,000 ------------- 0
9JEANNE FALLON SR. VP & CIO (UNTIL 4/11/17)	(i) (ii)	77,946 ------------- 0	0 ------------- 0	238,835 ------------- 0	13,364 ------------- 0	9,124 ------------- 0	339,269 ------------- 0	12,650 ------------- 0
10PATRICK J KANE SVP OF MRKTG,COMMUN AND DEVLP	(i) (ii)	304,840 ------------- 0	70,684 ------------- 0	19,589 ------------- 0	28,480 ------------- 0	3,025 ------------- 0	426,618 ------------- 0	15,540 ------------- 0
11THERESA M AHERN SVP, STRAT, COMMUNITY/GOV REL.	(i) (ii)	250,297 ------------- 0	68,625 ------------- 0	15,760 ------------- 0	40,619 ------------- 0	22,443 ------------- 0	397,744 ------------- 0	11,500 ------------- 0
12EMILY SCHORER SVP HUMAN RESOURCES	(i) (ii)	257,318 ------------- 0	62,220 ------------- 0	11,735 ------------- 0	24,581 ------------- 0	34,329 ------------- 0	390,183 ------------- 0	10,345 ------------- 0
13KEVIN RALPH SVP DEVELOPMENT	(i) (ii)	242,777 ------------- 0	49,688 ------------- 0	4,561 ------------- 0	24,086 ------------- 0	36,042 ------------- 0	357,154 ------------- 0	3,646 ------------- 0
14NOELENE CERVIN VP BUDGETING & OPER. SUPPORT	(i) (ii)	216,358 ------------- 0	39,050 ------------- 0	6,971 ------------- 0	25,269 ------------- 0	33,597 ------------- 0	321,245 ------------- 0	0 ------------- 0
15ALEXANDER HEARD MD CHIEF MEDICAL OFFICER - FH	(i) (ii)	442,806 ------------- 84,330	167,877 ------------- 0	630 ------------- 0	28,695 ------------- 3,066	35,911 ------------- 0	675,919 ------------- 87,396	0 ------------- 0
16DONALD GUADAGNOLI MD CMO CAPE COD HOSPITAL	(i) (ii)	412,488 ------------- 0	83,475 ------------- 0	33,082 ------------- 0	54,775 ------------- 0	30,563 ------------- 0	614,383 ------------- 0	21,001 ------------- 0
17MICHAEL N BUNDY COO	(i) (ii)	368,843 ------------- 0	83,500 ------------- 0	630 ------------- 0	24,508 ------------- 0	32,765 ------------- 0	510,246 ------------- 0	0 ------------- 0
18KEVIN J MULROY SVP CHIEF QUALITY & SAFETY OFF	(i) (ii)	368,757 ------------- 0	80,782 ------------- 0	24,939 ------------- 0	40,051 ------------- 0	35,061 ------------- 0	549,590 ------------- 0	15,875 ------------- 0
19WILLIAM LITTERER III MD MD - PHO	(i) (ii)	327,044 ------------- 0	57,750 ------------- 0	5,235 ------------- 0	10,800 ------------- 0	24,287 ------------- 0	425,116 ------------- 0	0 ------------- 0
20JEFFREY S DYKENS VP OF FINANCE & OPERATIONS	(i) (ii)	246,358 ------------- 0	41,876 ------------- 0	22,747 ------------- 0	28,158 ------------- 0	36,169 ------------- 0	375,308 ------------- 0	12,000 ------------- 0

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. 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 - $17,334 MICHAEL L. CONNORS - $19,258 CHRISTIAN BROWN - $13,853 JEANNE FALLON - $36,138 PATRICK KANE - $16,817 THERESA AHERN - $12,988 EMILY SCHORER - $11,105 DONALD GUADAGNOLI MD - $22,232 KEVIN MULROY - $16,762 JEFFREY S. DYKENS - $12,704 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) AS OF THE BEGINNING OF 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 $100,146 AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN (C). IN ADDITION, OPEN 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).

Schedule J (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

Employer identification number

22-2600704

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 1.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. 2.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. 3.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. 4.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. 5.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. Not Specified 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. 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. 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. 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. 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 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 Disparity, Supporting Healthcare Reform.	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/ 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 CodHospital 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. 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. 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. 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.
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 BOARDS 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 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, 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 NET ASSETS RELEASED FROM RESTRICTION $(5,596,482) TRANSFER TO/FROM AFFILIATES $(12,709,696) CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT $ 598,383 CHANGE IN VALUE BENEFICIAL INTEREST $ 492,636 TRANSFER OF NET ASSETS $ 325,911 OTHER CHANGES IN NET ASSETS $(16,889,248)

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

Employer identification number

22-2600704

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

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 & ISLANDS ENDOSCOPY CENTER 700 ATTUCKS LANE HYANNIS,MA02169 26-3910955	ENDOSCOPY CENTER	MA	NA	RELATED	609,646	216,337		No	0	Yes		33.000 %

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	NA	C CORP	1,453,832	39,010,441	100.000 %	Yes
(2) CAPE COD MEDICAL OFFICE BUILDING INC 27 PARK STREET HYANNIS,MA02601 04-2423073	RENTAL SVCS	MA	Cape Cod Hsptl	C CORP	0	0		Yes
(3) EMERALD PHYSICIAN SERVICES LLC 433 WEST MAIN STREET HYANNIS,MA02601 04-3369730	PRIMARY CARE	MA	EMERALD TRUST	S CORP	0	0		Yes
(4) EMERALD PHYSICIANS MEMBER TRUST 27 PARK STREET HYANNIS,MA02601 46-7220648	EMRLD SHAREHO	MA	MACC	TRUST	0	0		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 .....................

Yes

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) ............................

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) VISITING NURSE ASSOCIATION OF CAPE COD INC	S	450,000	FMV
(2) CAPE COD HOSPITAL	S	37,807,232	FMV
(3) MEDICAL AFFILIATES OF CAPE COD INC	S	1,822,991	FMV
(4) FALMOUTH HOSPITAL ASSOCIATION INC	S	12,602,411	FMV
(5) JML CARE CENTER INC	S	75,000	FMV
(6) FALMOUTH ASSISTED LIVING INC	S	75,000	FMV
(7) Emerald Physician Services LLC	S	270,280	FMV
(8) CAPE COD HEALTHCARE FOUNDATION INC	Q	1,553,551	FMV
(9) CAPE COD HOSPITAL	Q	313,167,703	FMV
(10) FALMOUTH HOSPITAL ASSOCIATION INC	Q	70,820,337	FMV
(11) CAPE AND ISLANDS HEALTH SERVICES II INC	Q	2,450,457	FMV
(12) CAPE COD HUMAN SERVICES INC	Q	946,763	FMV
(13) JML CARE CENTER INC	Q	7,667,851	FMV
(14) FALMOUTH ASSISTED LIVING INC	Q	1,840,356	FMV
(15) MEDICAL AFFILIATES OF CAPE COD INC	Q	36,193,407	FMV
(16) VISITING NURSE ASSOCIATION OF CAPE COD INC	Q	14,154,893	FMV
(17) EMERALD PHYSICIAN SERVICES LLC	Q	372,046	FMV
(18) Emerald Physician Services LLC	A	314,411	FMV
(19) CAPE HEALTH INSURANCE COMPANY	S	463,846	FMV
(20) FALMOUTH HOSPITAL ASSOCIATION INC	J	138,837	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:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	127,250	286,192
9	Program service revenue (Part VIII, line 2g) .........	71,484,837	80,915,461
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,791,184	39,046,563
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	77,403,271	120,248,216
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,000,000	348,922
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)	30,372,336	29,637,289
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	40,693,781	51,525,314
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	72,066,117	81,511,525
19	Revenue less expenses. Subtract line 18 from line 12.......	5,337,154	38,736,691
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	346,544,186	397,483,660
21	Total liabilities (Part X, line 26).............	133,803,032	161,872,878
22	Net assets or fund balances. Subtract line 21 from line 20.....	212,741,154	235,610,782

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 59,658,017 including grants of $ 348,922 ) (Revenue $ 80,915,461 )
	ORGANIZE AND MANAGE HEALTH CARE RELATED ACTIVITIES FOR THE EXCLUSIVE BENEFIT OF CAPE COD HOSPITAL, FALMOUTH HOSPITAL, INC. AND ITS OTHER AFFILIATES. ALSO SEE SCHEDULE 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 expenses59,658,017

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,724,453	2,877,733	1,431,046

		Business Code
2a	HOME OFFICE COSTS	900099	53,073,239	53,073,239
b	PHYSICIAN ORG ADM SUPPORT REV	900099	4,794,166	4,794,166
c	PROGRAM RELATED RENTAL INCOME	900099	377,533	377,533
d	RETAIL PHARMACY	900099	13,725,470		258,171	13,467,299
e	EMPLOYEE PHARMACY	900099	8,188,633			8,188,633
f	All other program service revenue.		756,420		314,411	442,009
g	Total. Add lines 2a–2f .....		80,915,461

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	265
6	Total number of volunteers (estimate if necessary) .............	6	17
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	593,243
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	327,193

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	286,192

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

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

h Total. Add lines 1a-1f.......		286,192

3 Investment income (including dividends, interest, and othersimilar amounts) ......			3,632,014		-5,928	3,637,942
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		35,414,549	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)		35,414,549	7c
d	Net gain or (loss).........			35,414,549		26,589	35,387,960
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			120,248,216	58,244,938	593,243	61,123,843

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	348,922	348,922
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 ...........	9,180,317		9,180,317
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	14,478,130	14,138,213	339,917
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	780,550	399,741	380,809
9	Other employee benefits .......	3,527,716	2,108,152	1,419,564
10	Payroll taxes ...........	1,670,576	942,278	728,298
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	957,701		957,701
c	Accounting ...........	13,673		13,673
d	Lobbying ...........	208,711	174,975	33,736
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	254,988		254,988
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	3,383,984	55,340	3,328,644
12	Advertising and promotion ....	1,427,405	1,141,924	285,481
13	Office expenses .......	369,903	295,922	73,981
14	Information technology ......	4,300,390	3,440,312	860,078
15	Royalties ..	0
16	Occupancy ...........	1,019,619	815,695	203,924
17	Travel ............	245,372	196,298	49,074
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	471,854	377,483	94,371
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	7,846,491	6,277,193	1,569,298
23	Insurance ...	46,800	37,440	9,360
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	19,858,103	19,858,103
b	PURCHASED SERVICES	7,522,502	6,018,002	1,504,500
c	COMMUNITY BENEFITS	1,117,772	1,117,772
d	REPAIRS & MAINTENANCE	529,048	423,238	105,810
e	All other expenses	1,950,998	1,491,014	459,984
25	Total functional expenses. Add lines 1 through 24e	81,511,525	59,658,017	21,853,508	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,411,834	1	11,648,824
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			0	4	0
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 ...........			18,115,833	7	16,087,872
8	Inventories for sale or use ............			1,592,950	8	1,808,921
9	Prepaid expenses and deferred charges ......			5,067,150	9	4,694,178
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	91,976,337
b	Less: accumulated depreciation	10b	26,948,402	48,093,961	10c	65,027,935
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			205,679,503	12	208,650,968
13	Investments—program-related. See Part IV, line 11 ..			5,321,608	13	5,884,751
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			57,261,347	15	83,680,211
16	Total assets. Add lines 1 through 15 (must equal line 33)...			346,544,186	16	397,483,660

17	Accounts payable and accrued expenses .....	81,823,601	17	52,111,944
18	Grants payable ...	0	18	0
19	Deferred revenue .........	224,119	19	176,009
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to 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 ..	1,670,903	23	4,027,213
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	50,084,409	25	105,557,712
26	Total liabilities. Add lines 17 through 25..	133,803,032	26	161,872,878

	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 ...........	212,741,154	32	235,610,782
33	Total liabilities and net assets/fund balances ........	346,544,186	33	397,483,660