2019-08-15T08:56:54-05:00 2018-09-30 PricewaterhouseCoopers LLP 101 SEAPORT BLVD SUITE 500 BOSTON MA 02210 990 2017-10-01 900054984 CAPE COD HEALTHCARE INC & AFFILIATES % MICHAEL L CONNORS CAPE 5087711800 297 NORTH ST Suite BLDG 3 HYANNIS MA 02601 MICHAEL L CONNORS SR VP FINANCE/ CFO 2019-08-14 true GWEN SPENCER P00641463 6175305000 2019-08-07 167.68.125.77 04363820192275000031 2019-08-15 P 502E9D7DF2DC237FB1436A97DBD0F14D19F2DD5A 1563161100844465C8187993E1FFC143BF1C91FB 2017 2019-02-21 02:37:17Z MICHAEL K LAUF 88 LEWIS BAY ROAD HYANNIS MA 02601 915852896 true true 3901 X WWW.CAPECODHEALTH.org X SEE SCHEDULE O 17 11 5684 696 1555937 -544982 15341766 15447109 844858980 884728875 8432277 13029571 2195757 2414588 870828780 915620143 0 1094878 0 0 445642426 476686163 86247 68237 3581359 377540307 391316079 823268980 869165357 47559800 46454786 963305006 1023990733 258793996 269099333 704511010 754891400 X SEE SCHEDULE O false false 789043793 1094878 884728875 PATIENT SERVICES - SEE SCHEDULES H AND O 789043793 true true false true false false false false false true true true false true true false false true false true true false false true true false true true true false true true false false false false false false false false true false true false false false true true true true false false true 116 0 true 5684 true true true false false false false true true false false false false X 17 11 true false true false true true true true true false false false true true true true true false true true true MA X MICHAEL L CONNORS 7744705537 297 NORTH STREET BLDG 3 HYANNIS MA 02601 X PHILIP MCLOUGHLIN TRUSTEE (UNTIL 5/18) 2.0 2.0 X 0 0 0 MICHAEL K LAUF PRESIDENT/CEO/TRUSTEE 55.0 5.0 X X 0 2672978 289344 NATE RUDMAN MD TRUSTEE 2.0 2.0 X 0 0 0 JOEL CROWELL SEE SCH O FOR TITLE 2.0 2.0 X X 0 0 0 SUZANNE FAY GLYNN ESQ TRUSTEE 2.0 2.0 X 0 0 0 DEWITT DAVENPORT CHAIRMAN 2.0 2.0 X X 0 0 0 DIANE COLETTI TRUSTEE 2.0 2.0 X 0 0 0 WILLIAM ZAMMER TRUSTEE 2.0 2.0 X 0 0 0 SUMNER B TILTON JR TRUSTEE 2.0 2.0 X 0 0 0 E JAMES MULCAHY JR TRUSTEE 2.0 2.0 X 0 0 0 ROBERT TALERMAN TRUSTEE 2.0 2.0 X 0 0 0 GARY VACON VICE CHAIR/TRUSTEE 2.0 2.0 X X 0 0 0 ROBERT WILSTERMAN MD TRUSTEE 40.0 2.0 X 791933 0 60781 WILLIAM AGEL MD TRUSTEE 40.0 2.0 X 523405 0 44677 RAMANI AYER TRUSTEE (FROM 5/18) 2.0 2.0 X 0 0 0 THEODORE CALIANOS MD TRUSTEE 40.0 2.0 X 378974 0 43167 PAUL HOULE MD TRUSTEE 40.0 2.0 X 1099091 0 62207 BRUCE JOHNSTON TRUSTEE/TREASURER (FROM 5/18) 2.0 2.0 X X 0 0 0 MICHAEL L CONNORS SENIOR VP FINANCE/CFO 55.0 5.0 X 0 539912 92817 MICHAEL G JONES ESQ SEE SCH O FOR TITLE 55.0 5.0 X 0 412450 78339 MICHAEL BUNDY COO 45.0 5.0 X 0 452973 57273 DONALD A GUADAGNOLI MD CMO CAPE COD HOSPITAL 45.0 5.0 X 0 529045 85338 ALEXANDER HEARD MD CHIEF MEDICAL OFFICER - FH 45.0 5.0 X 84330 611313 67672 PATRICK J KANE SVP OF MRKTG,COMMUN AND DEVLP 45.0 5.0 X 0 395113 31505 CHRISTIAN BROWN SR VP MANAGED CARE 45.0 5.0 X 0 393040 79946 EMILY SCHORER SVP HUMAN RESOURCES 45.0 5.0 X 0 331273 58910 KEVIN RALPH SVP DEVELOPMENT 45.0 5.0 X 0 297026 60128 THERESA M AHERN SVP, STRAT, COMMUNITY/GOV REL. 45.0 5.0 X 0 334682 63062 KEVIN J MULROY SVP CHIEF QUALITY & SAFETY OFF 45.0 5.0 X 0 474478 75112 JEANNE FALLON SR VP & CIO (UNTIL 4/11/17) 45.0 5.0 X 0 316781 22488 JEFFREY S DYKENS VP FINANCE & OPERATIONS 45.0 5.0 X 0 310981 64327 NOELENE CERVIN VP BUDGETING & OPER. SUPPORT 45.0 5.0 X 0 262379 58866 LORI JEWETT CEO - FH 45.0 5.0 X 0 287208 42343 DIANNE C KOLB PRESIDENT VNA (UNTIL 8/8/17) 45.0 5.0 X 0 168574 38377 CARTER HUNT ADMIN SPEC&HOSP BASED CARE 45.0 5.0 X 0 216135 64415 VICTOR OLIVEIRA VP PATIENT SVCS(UNTIL 3/17) 45.0 5.0 X 0 241943 36133 JUDITH C QUINN VP OF PATIENT CARE 45.0 5.0 X 0 279725 49841 RICHARD B ZELMAN MD PHYSICIAN 40.0 0.0 X 1549782 0 48011 ACHILLES PAPAVASILIOU MD PHYSICIAN 40.0 0.0 X 1122283 0 63501 NICHOLAS COPPA MD PHYSICIAN 40.0 0.0 X 1082702 0 65372 GORDON NAKATA MD PHYSICIAN 40.0 0.0 X 1073238 0 62639 PHILLIP J DOMBROWSKI MD PHYSICIAN 40.0 0.0 X 772950 0 12325 8478688 9528009 1878916 785 false true false CAPE COD HEALTHCARE INC 297 NORTH STREET BLDG 3 HYANNIS MA 02601 PURCHASED SERVICES 52832634 QUALITY IN REAL TIME 15 VERBENA AVENUE SUITE 210 FLORAL PARK NY 11001 CODING REVIEW 490660 CORE MEDICAL GROUP 3000 GOFFS FALLS RD SUITE 101 MANCHESTER NH 03103 CONTRACT RN, PT, OT 396003 DELTA HEALTH 400 LAKEMONT PARK BLVD ALTOONA PA 16602 MIS-SUPPORT 275159 MEDTRONIC CARE MANAGEMENT 7980 CENTURY BLVD CHANHASSEN MN 55317 PATIENT SUPPORT SVCS 140178 10 9350 1154606 14283153 1163954 15447109 PATIENT SERVICE REVENUE 900099 857487495 857487495 LABORATORY SERVICES 621500 8011151 6455214 1555937 PROGRAM RELATED RENTAL INCOME 900099 3501400 3501400 JOINT VENTURE REVENUE 900099 2953856 2953856 QUALITY EARNED PAYMENTS 900099 8747405 8747405 4027568 4027568 884728875 7272965 7272965 0 0 0 0 0 5756606 5756606 5756606 5756606 588687 9350 232753 355934 355934 0 0 0 0 0 0 CAFETERIA INCOME 900099 1954744 1954744 MEDICAL RECORDS 900099 103910 103910 2058654 915620143 883172938 1555937 15444159 X 1094878 1094878 0 0 0 2974982 2974982 116158 116158 377078029 339720279 35892202 1465548 11080193 9585883 1435688 58622 60870167 54776086 5873681 220400 24566634 21708767 2745753 112114 6676786 3297281 3379505 177215 7316 169899 995236 200853 794383 0 68237 68237 677706 67562 610144 35254478 34068162 1186316 980284 908046 72238 5253527 4847418 359340 46769 11824044 10739327 999064 85653 0 14165997 13159581 859072 147344 6580980 6076619 455813 48548 0 8228 8228 6419305 5797389 621916 0 28412585 25720184 2682117 10284 3003255 2788863 214392 MEDICAL SUPPLIES 130295787 130295787 PURCHASED SERVICES 44454194 41295528 3109599 49067 ADMIN OFFICE OVERHEAD 53528156 40379657 12602411 546088 BAD DEBT 14392093 14392093 28216223 25025094 2476672 714457 869165357 789043793 76540205 3581359 23129902 28046133 1413064 1418491 12662460 11232170 86022740 92397934 0 0 0 0 3997612 5999843 10914440 11471320 2406916 4889655 662447460 364005606 289207589 298441854 0 0 474804154 505577304 5124965 -562504 9346552 10089047 44274612 54989486 963305006 1023990733 54459109 67602305 0 0 429407 387349 150522013 132147783 0 0 0 0 13407900 20887363 0 0 39975567 48074533 258793996 269099333 X 630388180 681649081 41022954 39258698 33099876 33983621 704511010 754891400 963305006 1023990733 X 46454786 3981759 -56155 X false true X true true true X 9458675 15572146 13584232 15341766 15447109 69403928 0 0 9458675 15572146 13584232 15341766 15447109 69403928 2821753 66582175 3486933 4951534 5368273 5985405 7272965 27065110 1059076 1000152 798057 408 -544982 2312711 2189718 2271023 2353977 2422397 2647341 11884456 110666205 4036039797 0.60165 0.65282 X false false false false false 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 false false false false false false false false true 963629 963629 false PART II-B, LINE 1I Cape Cod Hospital and Falmouth Hospital Association, Inc. pay membership dues to the Massachusetts Hospital Association which engages in lobbying purposes as defined by Medicare. Per the MHA advisory, 90.14% of dues paid should be allocated to lobbying activity. MHA determined that of the 90.14%, 9.51% was related to federal lobbying and 80.63% was related to state-based lobbying. Please note that the increase in the percentage, as compared to previous years, was due primarily to MHA's activities surrounding the 2018 Massachusetts ballot question. The increase only impacted the FY 2018 dues that were paid to MHA in the fall of 2017. For FY18 for Cape Cod Hospital and Falmouth Hospital Association, Inc. combined, the lobbying portion equals $963,629. 41606730 504886 1353728 1014678 42450666 38809089 30699 3061173 759148 -464917 41606730 37495620 57261 2000285 744077 38809089 38872003 1523222 -2217064 682541 37495620 36060986 1925651 1613999 728633 38872003 0.00000 0.80760 0.19240 false true true 23627542 23627542 404720923 183625388 221095535 4024463 1748550 2275913 226940276 177709553 49230723 3134256 922115 2212141 298441854 LONG-TERM INVESTMENTS 417657717 F FUNDS HELD UNDER BOND 3410362 F TEMP RESTRICTED INVESTMENTS 24888547 F PERM RESTRICTED INVESTMENTS 33785042 F SHORT TERM INVESTMENTS - FDN 25835636 F 505577304 DUE FROM AFFILIATES 54989486 54989486 0 DUE TO AFFILIATES 26643493 EST. SETTLEMENTS W 3RD PARTIES 19778364 OTHER CURRENT LIABILITIES 808193 ABANDONED PROPERTY 185604 INTEREST RATE SWAPS 658879 48074533 SCHEDULE D, PART V, LINE 4 THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO FURTHER THE HEALTHCARE MISSION OF CAPE COD HEALTHCARE AND ITS AFFILIATES. SCHEDULE D, PART X, LINE 2 THE ORGANIZATION DOES NOT HAVE A FIN 48 FOOTNOTE AS ANY UNCERTAIN TAX POSITIONS WERE DEEMED IMMATERIAL. Central America and the Caribbean 1 Program Services CAPTIVE INSURANCE 2957963 1 1 2957963 2957963 false false false false false false SCHEDULE F, PART I, COLUMN F EXPENSES ARE CODED IN THE GENERAL LEDGER TO THE CAPTIVE INSURANCE COMPANY. X X X X X true Borns GroupVDM 503 BROWN COUNTY 19N ABERDEEN SD 57401 DIRECT MAIL false 220016 68237 151779 220016 68237 151779 CA CT FL IL KS MA MI MO NH NJ NY NC PA RI SC WI GALA EVENT 598037 9350 588687 0 43000 6800 74539 16351 92063 0 598037 9350 588687 0 43000 6800 74539 16351 92063 232753 355934 true true X true X true X true true false true true 6681622 2121069 4560553 0.00530 105176811 87175941 18000870 0.02110 10286642 8366669 1919973 0.00220 122145075 97663679 24481396 0.02860 2642379 0 2642379 0.00310 1786163 211678 1574485 0.00180 333989928 300109808 33880120 0.03960 0 0 0 0.00000 1078867 0 1078867 0.00130 339497337 300321486 39175851 0.04580 461642412 397985165 63657247 0.07440 36166 36166 705572 705572 741738 741738 true 14392093 9003313 278629043 260616527 18012516 X true true 2 1 CAPE COD HOSPITAL 27 PARK STREET HYANNIS MA 02601 SEE PART V, SECTION C 2135 X X X A 2 FALMOUTH HOSPITAL ASSOCIATION INC 100 TER HEUN DRIVE FALMOUTH MA 02540 SEE PART V, SECTION C 2289 X X X A A false false true X X X X X X X X X 15 true true false true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 400. X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X true X false false PART V, SECTION A WEBSITES PART V, SECTION A, LINE 1 - CAPE COD HOSPITAL WWW.CAPECODHEALTH.ORG/LOCATIONS/CAPE-COD-HOSPITAL PART V, SECTION A, LINE 2 - FALMOUTH HOSPITAL WWW.CAPECODHEALTH.ORG/LOCATIONS/FALMOUTH-HOSPITAL PART V, SECTION B, LINE 5 OVER 20 DATA SOURCES WERE UTILIZED TO COLLECT BARNSTABLE COUNTY AND TOWN-LEVEL HEALTH STATISTICS ON DISEASE INCIDENCE AND PREVALENCE, HOSPITAL UTILIZATION, MORBIDITY AND MORTALITY, BARRIERS TO ACCESSING CARE, AND BEHAVIORAL RISK FACTORS. REGIONAL STATISTICS WERE ANALYZED AND COMPARED TO STATE AND NATIONAL STATISTICS TO IDENTIFY WHERE DEMOGRAPHIC AND HEALTH DISPARITIES EXIST. ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL SELECTED JOHN SNOW, INC. (JSI) A PUBLIC HEALTH RESEARCH FIRM, TO CONDUCT PRIMARY RESEARCH INCLUDING HEALTH DATA RESEARCH, KEY INFORMANT INTERVIEWS AND FACILITATION OF COMMUNITY AND PROVIDER FORUMS. JSI INTERVIEWED OVER 25 REGIONAL LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY AND WHO OFFER INFORMATION OR EXPERTISE RELATIVE TO THE SIGNIFICANT HEALTH NEEDS OF VULNERABLE POPULATIONS. THEY INCLUDED SUCH ENTITIES AS MUNICIPAL PUBLIC HEALTH DEPARTMENTS,HUMAN SERVICE AGENCIES, SCHOOLS AND LAW ENFORCEMENT AGENCIES, FEDERALLY QUALIFIED HEALTH CENTERS,COMMUNITY ORGANIZATIONS SERVING LOW-INCOME, VULNERABLE AND MEDICALLY UNDERSERVED POPULATIONS, ELECTED OFFICIALS, AND HOSPITAL CLINICIANS AND ADMINISTRATORS. FIVE COMMUNITY INPUT FORUMS WERE HELD ACROSS BARNSTABLE COUNTY. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS ATTENDED. THESE FORUMS PROVIDED AN OPPORTUNITY TO PRESENT STATISTICAL HEALTH FINDINGS TO PARTICIPANTS AND IDENTIFY GAPS IN SERVICES. ADDITIONALLY, THE FORUMS FACILITATED DIALOGUE ON ISSUES NOT IDENTIFIED AND TARGET POPULATIONS MOST IMPACTED BY HEALTH ISSUES. A POST-FORUM SURVEY WAS PROVIDED TO PARTICIPANTS TO IDENTIFY AND RANK HEALTH PRIORITIES IN THE REGION. FEEDBACK AND INPUT FROM THE KEY INFORMANT INTERVIEWS AND FROM ATTENDEES OF THE COMMUNITY AND PROVIDER FORUMS WAS USED TO INFORM THE SELECTION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS. THE FOLLOWING ORGANIZATIONS PARTICIPATED IN THE COMMUNITY INPUT ACTIVITIES THROUGHOUT THE PHASES OF THE PROJECT: PUBLIC HEALTH EXPERTS, HEALTH CARE PROVIDERS AND HEALTH SERVICE ORGANIZATIONS AIDS SUPPORT GROUP OF CAPE COD ALZHEIMER'S FAMILY SUPPORT CENTER OF CAPE COD ARBOR COUNSELING SERVICES BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT BARNSTABLE COUNTY DEPARTMENT OF HUMAN SERVICES BARNSTABLE COUNTY PUBLIC NURSING DIVISION CCHC EMERGENCY SERVICES CCHC CENTERS FOR BEHAVIORAL HEALTH CAPE & ISLANDS EMERGENCY MEDICAL SERVICES SYSTEM CARON TREATMENT CENTER COMMUNITY HEALTH CENTER OF CAPE COD DUFFY HEALTH CENTER EMERALD PHYSICIANS FALMOUTH HUMAN SERVICES GOSNOLD ON CAPE COD HARBOR COMMUNITY HEALTH CENTER-HYANNIS HOPE HEALTH HOPE DEMENTIA & ALZHEIMER'S SERVICES OF CAPE COD MASHPEE WAMPANOAG HEALTH SERVICE UNIT OUTER CAPE HEALTH SERVICES SPAULDING REHABILITATION HOSPITAL CAPE COD SPECIALTY NETWORK FOR THE UNINSURED TOWN OF BREWSTER HEALTH DEPARTMENT TOWN OF FALMOUTH HEALTH DEPARTMENT TOWN OF MASHPEE HUMAN SERVICES VINFEN VISITING NURSE ASSOCIATION OF CAPE COD ORGANIZATIONS SERVING LOW-INCOME, MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS: BARNSTABLE PUBLIC SCHOOL SYSTEM BOYS & GIRLS CLUB OF CAPE COD CAPE COD CENTER FOR WOMEN CAPE COD CHILD DEVELOPMENT CAPE COD COUNCIL OF CHURCHES CAPE COD WIC CAPE COD NEIGHBORHOOD SUPPORT COALITION CHILD AND FAMILY SERVICES COALITION FOR CHILDREN COMMUNITY ACTION COMMITTEE OF CAPE COD & THE ISLANDS CHILDREN'S COVE COMMUNITY DEVELOPMENT PARTNERSHIP ELDER SERVICES OF CAPE COD & THE ISLANDS FALMOUTH PUBLIC SCHOOL SYSTEM FALMOUTH SERVICE CENTER FALMOUTH TOGETHER WE CAN FALMOUTH VOLUNTEERS IN PUBLIC SCHOOLS THE FAMILY PANTRY OF CAPE COD GLENNA KOHL FUND FOR HOPE HEALTH IMPERATIVES HEALTHY LIVING CAPE COD HELPING OUR WOMEN HOMELESS PREVENTION COUNCIL HOUSING ASSISTANCE CORPORATION INDEPENDENCE HOUSE JUSTICE RESOURCE INSTITUTE LYME AWARENESS OF CAPE COD OUTER CAPE WOMEN INFANTS AND CHILDREN (WIC) MOTHER AND INFANT RECOVERY NETWORK NATIONAL ALLIANCE ON MENTAL ILLNESS CAPE COD SAMARITANS ON CAPE COD AND THE ISLANDS SANDPIPER NURSERY SCHOOL SANDWICH PUBLIC SCHOOL SYSTEM SHINE (SERVING HEALTH INFORMATION NEEDS OF EVERYONE) SIGHT LOSS SERVICES TOWN OF FALMOUTH COUNCIL ON AGING TOWN OF MASHPEE COUNCIL ON AGING TOWN OF PROVINCETOWN COUNCIL ON AGING TOWN OF SANDWICH COUNCIL ON AGING TOWN OF TRURO COUNCIL ON AGING WE CAN YMCA OF CAPE COD COUNTY, TOWN, OR MUNICIPAL ENTITIES AND REGIONAL TASK FORCES: CAPE & ISLANDS UNITED WA CAPE COD COMMUNITY COLLEGE CAPE COD DISTRICT ATTORNEY'S OFFICE CAPE COD FOUNDATION CAPE & ISLANDS SUICIDE PREVENTION COALITION YARMOUTH POLICE DEPARTMENT MA DEPARTMENT OF MENTAL HEALTH MA DEPARTMENT OF PUBLIC HEALTH MASHPEE WAMPANOAG TRIBE HEALTH SERVICES COMMUNITY HEALTH NETWORK AREA 27 BEHAVIORAL HEALTH PROVIDER COALITION OF CAPE COD & THE ISLANDS BARNSTABLE COUNTY REGIONAL SUBSTANCE ABUSE COUNCIL BARNSTABLE TOWN COUNCIL SUBSTANCE USE IN PREGNANCY TASK FORCE PART V, SECTION B, LINE 6 (A) CAPE COD HOSPITAL AND FALMOUTH HOSPITAL JOINTLY CONDUCTED THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. PART V, SECTION B, LINE 7(A) https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/ PART V, SECTION B, LINE 10(A) https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/ PART V, SECTION B, LINE 11 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA INCLUDE CHRONIC AND INFECTIOUS DISEASE, BEHAVIORAL HEALTH, ACCESS TO CARE AND DISEASE PREVENTION AND WELLNESS. CAPE COD HOSPITAL (CCH) AND FALMOUTH HOSPITAL (FH) WILL ADDRESS THESE SPECIFIC ISSUES THROUGH A COMPREHENSIVE SET OF IMPLEMENTATION STRATEGIES THAT INCLUDE HOSPITAL-BASED PROGRAMS, COLLABORATIVE EFFORTS WITH NUMEROUS REGIONAL HEALTH PARTNERS AND PROVIDING GRANTS TO COMMUNITY BASED ORGANIZATIONS WITH INITIATIVES THAT ALIGN WITH COMMUNITY HEALTH IMPROVEMENT STRATEGIES. THREE SPECIFIC ISSUES IDENTIFIED THROUGH THE ASSESSMENT FALL OUTSIDE OF THE CORE COMPETENCIES OF THE HOSPITALS AND WERE NOT INCLUDED IN THE CCH AND FH IMPLEMENTATION STRATEGIES. THE ISSUES ARE TRANSPORTATION, HOUSING AND HOMELESSNESS, AND EMPLOYMENT. THESE ISSUES ARE LONG-STANDING REGIONAL CHALLENGES AND WERE IDENTIFIED IN THE PREVIOUS CHNA AS ISSUES OUTSIDE THE SCOPE OF SIGNIFICANT HEALTH NEEDS THAT THE HOSPITALS CAN REASONABLY ADDRESS. RESIDENTS IMPACTED BY THESE ISSUES WILL BE SERVED BY THE HOSPITALS SINCE IT IS THEIR MISSION TO SERVE ALL WITHOUT REGARD TO SEX, RACE, CREED, RESIDENCE, NATIONAL ORIGIN, SEXUAL ORIENTATION, OR ABILITY TO PAY. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL RECOGNIZE THAT THERE ARE REGIONAL ENTITIES WITH THE CORE COMPETENCIES, KNOWLEDGE, STAFF AND FUNDING SOURCES TO SPECIFICALLY ADDRESS THE ISSUES OF TRANSPORTATION, HOUSING AND HOMELESSNESS, AND EMPLOYMENT. THE HOSPITALS WILL COLLABORATE ON ACTIVITIES THAT ARE LED BY THE APPROPRIATE AGENCIES. PART V, SECTION B, LINE 13(B) IN SOME CASES, THE MASSACHUSETTS HEALTHCONNECTOR CALCULATOR OR MODIFIED ADJUSTED GROSS INCOME IS USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. PART V, SECTION B, LINE 13(H) STATE REGULATIONS PART V, SECTION B, LINE 16(A), 16(B), 16(C) HTTPS://WWW.CAPECODHEALTH.ORG/PATIENTS-VISITORS/PAYING-FOR-CARE/FINANCIAL- ASSISTANCE/ 83 Visiting Nurse Association of Cape Cod 255 Independence Drive Hyannis MA 02601 home health CAPE COD HEALTHCARE INC 297 NORTH STREET BLDG 3 HYANNIS MA 02601 ADMINISTRATIVE Fontaine Medical Center 525 Long Pond Drive HARWICH MA 02645 medical group practice CAPE COD HEALTHCARE NEUROSURGER 46 NORTH ST STE 4 HYANNIS MA 02601 medical group practice Bramblebush Medical Group 21 Bramblebush Park FALMOUTH MA 02540 medical group practice Seaside Pediatrics 150 Ansel Hallet Road West Yarmouth MA 02673 medical group practice Manning Jr William J MD 700 Attucks Lane Suite 1A HYANNIS MA 02601 medical group practice Fontaine OUTPATIENT CENTER 525 Long Pond Drive Harwich MA 02645 medical group practice Guo X Y David MD PhD-GASTROENTEROLOGY 90 TER HEUN DRIVE STE 302 Falmouth MA 02540 medical group practice BAYSIDE INTERNAL MEDICINE 2 Jan Sebastian Way Suite 100 Sandwich MA 02563 medical group practice SHAPIRO GARY& YAMIN JUSTIN MD-GASTRO 700 ATTUCKS LANE STE 1C Hyannis MA 02601 medical group practice Theodore A Calianos II MD-PL&RECON 160 Falmouth Road Suite B MASHPEE MA 02649 medical group practice CAPE COD OBSTETRICS & GYNECOLOGY 90 Ter Heun Drive SUITE 100 Falmouth MA 02540 medical group practice Chatham Medical Group 1629 Main Street Chatham MA 02633 medical group practice Endocrine Center of Cape Cod 1030 FALMOUTH RD STE 201 Hyannis MA 02601 medical group practice Fal Specialty Care Practice 90 Ter Heun Drive Suite 302 Falmouth MA 02540 medical group practice NEUROLOGISTS OF CAPE COD 46 North Street SUITE 7 Hyannis MA 02601 medical group practice Nauset Family Practice 81 Old Colony Way STE D ORLEANS MA 02653 medical group practice Devin McManus Medical Practice 10 BrambleBush Drive FALMOUTH MA 02540 medical group practice Cape Health Insurance Company - FOREIGN 297 NORTH ST 3 HYANNIS MA 02601 administrative Healthcare Foundation 32 MAIN STREET Hyannis MA 02601 administrative Healthcare Foundation 348 GIFFORD ST STE 4 FALMOUTH MA 02540 ADMINISTRATIVE JML Care Center 184 Ter Heun Drive falmouth MA 02540 skilled nur & rehab Cape & Islands Health Services II 14 Yellow Brick Road HYANNIS MA 02601 COLLECTION CENTER Cape & Islands Health Services II 5 Industrial Drive Suite 102 MASHPEE MA 02649 COLLECTION CENTER Cape & Islands Health Services II 200 Jones Road FALMOUTH MA 02540 COLLECTION CENTER Cape & Islands Health Services II 525 Long Pond Drive HARWICH MA 02645 COLLECTION CENTER Cape & Islands Health Services II 81 Old Colony Way ORLEANS MA 02653 COLLECTION CENTER Cape & Islands Health Services II 2 Jan Sebastian Way Route 130 SANDWICH MA 02563 COLLECTION CENTER Cape & Islands Health Services II 860 Route 134 Unit 2 South Dennis MA 02660 COLLECTION CENTER Cape & Islands Health Services II 1 Trowbridge Road Bourne MA 02532 COLLECTION CENTER Cape & Islands Health Services II 68B Route 6A SANDWICH MA 02563 COLLECTION CENTER Cape & Islands Health Services II 1629 MAIN STREET CHATHAM MA 02633 COLLECTION CENTER Cape & Islands Health Services II 27 PARK STREET HYANNIS MA 02601 COLLECTION CENTER Heritage at Falmouth 140 Ter Heun Drive FALMOUTH MA 02540 ASSISTED LIVING Cape Cod Human Services 460 West Main Street HYANNIS MA 02601 outpatient clinic Cape Cod Human Services 525 Long Pond Drive HARWICH MA 02645 outpatient clinic Cape Cod Medical Office Building Inc 20 Gleason Street HYANNIS MA 02601 administrative Orleans Medical CENTER 204 Main Street Orleans MA 02653 Medical Group Practice CAPE COD Dermatology 150 Ansel Hallett Road W Yarmouth MA 02673 Medical Group Practice Cape Cod Rheumatology Center 1030 FALMOUTH RD STE 201 HYANNIS MA 02601 MEDICAL GROUP PRACTICE CCHC Cardiovascular Center 25 Main Street HYANNIS MA 02601 MEDICAL GROUP PRACTICE Ziad Farah MD-Fontaine Medical Center 525 Long Pond Drive HARWICH MA 02645 MEDICAL GROUP PRACTICE Fontaine Urgent Care Center 525 Long Pond Drive HARWICH MA 02645 MEDICAL GROUP PRACTICE Park Street Primary Care 62 Park Street HYANNIS MA 02601 MEDICAL GROUP PRACTICE Sandwich Medical Group STONEMAN OUTPATIENT2 Jan Sebastian SANDWICH MA 02563 MEDICAL GROUP PRACTICE Sandwich Primary Care 2 JAN SEBASTIAN WAY SUITE 202 SANDWICH MA 02563 MEDICAL GROUP PRACTICE Upper Cape Orthopedics 26 Edgerton Drive Suite C NORTH FALMOUTH MA 02556 MEDICAL GROUP PRACTICE Michael Barnett MD Practice 348 Gifford Street FALMOUTH MA 02540 MEDICAL GROUP PRACTICE Vascular And Vein Center Of Cape Cod 90 Ter Heun Drive 3RD Fl MOB STE Falmouth MA 02540 Medical Group Practice CCHC General & Specialty Surgery 105 Park Street Hyannis MA 02601 Medical Group Practice Cape Cod Sports Medicine 360 Gifford Street Unit 2B Falmouth MA 02540 Medical Group Practice CARDIOVASCULAR CENTER - FALMOUTH 90 TER HEUN DRIVE SUITE 300 FALMOUTH MA 02540 Medical Group Practice GASTROENTEROLOGY HYANNIS - PARK STREET 105 PARK STREET HYANNIS MA 02601 Medical Group Practice STONEMAN OUTPATIENT CENTER - URGENT CARE 2 JAN SEBASTIAN DRIVE SUITE 101 SANDWICH MA 02563 Medical Group Practice MASHPEE SURGICAL CENTER 160 FALMOUTH ROAD MASHPEE MA 02649 MEDICAL GROUP PRACTICE SOUTHEASTERN SURGICAL ASSOCIATES 100 CAMP STREET HYANNIS MA 02601 MEIDCAL GROUP PRACTICE FALMOUTH URGENT CARE 273 TEATICKET HIGHWAY FALMOUTH MA 02536 MEDICAL GROUP PRACTICE HYANNIS URGENT CARE 1220 IYANNOUGH ROAD HYANNIS MA 02601 MEDICAL GROUP PRACTICE UPPER CAPE EAR NOSE THROAT 200 A JONES ROAD FALMOUTH MA 02540 MEDICAL GROUP PRACTICE ORTHOPEDIC SPECIALISTS 5 BRAMBLEBUSH DRIVE FALMOUTH MA 02540 MEDICAL GROUP PRACTICE CCHC DEMENTIA&ALZHEIMER'S CAREGIVER SUPP 4 BAYVIEW ST WEST YARMOUTH MA 02673 ADMINISTRATIVE CCHC PODIATRIC MEDICINE & FOOT SURGERY 1030 FALMOUTH RD 202 HYANNIS MA 02601 MEDICAL GROUP PRACTICE IDCS-INFECTIOUS DISEASE CLINICAL SERV 34 PARK ST HYANNIS MA 02601 MEDICAL GROUP PRACTICE CCH OBGYN SATELLITE 60A PARK ST HYANNIS MA 02601 MEDICAL GROUP PRACTICE MACCMSSP REFERRAL DEPT 25 COMMUNICATION WAY HYANNIS MA 02601 ADMINISTRATIVE DIABETIC EDUCATION 22 LEWIS BAY RD STE 102 HYANNIS MA 02601 EDUCATIONAL DIABETIC EDUCATION 1629 MAIN ST CHATHAM MA 02633 EDUCATIONAL TRADEWINDS ADULT DAY HEALTH OF VNA OF CC 290 ROUTE 130 SANDWICH MA 02563 ADULT DAY HEALTH COMPASS ADULT DAY HEALTH 1 AUSTON RD F HARWICH MA 02645 ADULT DAY HEALTH VNA OF CAPE COD - EASTHAM 3960 STATE HWY RD 6 2 EASTHAM MA 02642 HOME HEALTH VNA OF CAPE COD - FALMOUTH 67 TER HEUN DR FALMOUTH MA 02540 HOME HEALTH VNA OF CAPE COD - MARTHA'S VINEYARD 49 STATE RD VINEYARD HAVEN MA 02568 HOME HEALTH VNA OF CAPE COD - NANTUCKET 2 SANFORD RD 2 NANTUCKET MA 02554 HOME HEALTH VNA OF CAPE COD -PLYMOUTH 57 OBERY ST U3 PLYMOUTH MA 02360 HOME HEALTH VNA OF CAPE COD - PROVINCETOWN 26 ALDEN ST PROVINCETOWN MA 02657 HOME HEALTH VNA OF CAPE COD - SOUTH DENNIS 434 ROUTE 134 BLDG D 3 SOUTH DENNIS MA 02660 HOME HEALTH VNA OF CAPE COD - WAREHAM 185 MAIN ST WAREHAM MA 02571 HOME HEALTH VNA THRIFTIQUE 1074 RTE 28 SOUTH YARMOUTH MA 02664 THRIFT STORE CCH THRIFT STORE 690 MAIN ST HYANNIS MA 02601 THRIFT STORE CAPE & ISLANDS HEALTH SERVICES II 35 WILKENS LANE HYANNIS MA 02601 COLLECTION CENTER ORLEANS MEDICAL CENTER 204 MAIN ST ORLEANS MA 02653 OUTPATIENT CLINIC CAPE COD RESEARCH INSTITUTE 27 PARK ST HYANNIS MA 02601 RESEARCH PART I, LINE 3C N/A PART I, LINE 6A N/A PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN LINE 7, COLUMN F WAS $ 14,392,093. THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AND BY FOLLOWING THE FORM 990, SCHEDULE H INSTRUCTIONS. THE TOTAL PERCENTAGE OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST IN THE TABLE WAS CALCULATED ON A GROUP RETURN BASIS AS REQUIRED BY THE FORM 990 INSTRUCTIONS, AND NOT ON A HOSPITAL-ONLY BASIS. PART II LINE 6 AND LINE 8 COALITION BUILDING Cape Cod Healthcare clinical, Community Benefits and support staff participated in a variety of coalition building activities within the service area to address and improve care related to women's health, behavioral health, chronic and infectious disease prevention and management and substance use and misuse in the region. Regional coalitions serve as alliances for combined and coordinated action to improve key health issues. Coalition activities ranged from implementation of new programs to offering community trainings and educational on important health topics to the development of multi-sector partnerships. WORKFORCE DEVELOPMENT CAPE COD HEALTHCARE'S PHYSICIAN RECRUITMENT PROGRAM STRIVES TO IDENTIFY AREAS OF UNMET NEED AND IMPROVE ACCESS TO PRIMARY AND SPECIALTY CARE FOR VULNERABLE POPULATIONS, ESPECIALLY THOSE OVER 65 WITH PUBLIC HEALTH INSURANCE COVERAGE. THROUGH RIGOROUS EFFORTS HIGHLY QUALIFIED PHYSICIANS AND PHYSICIAN EXTENDERS ARE RECRUITED AND RETAINED TO MEET THE HEALTH CARE NEEDS OF RESIDENTS OF CAPE COD. PART III, LINES 2-3 THE ORGANIZATION IS REPORTING $9,003,313 OF BAD DEBT EXPENSE THAT MEETS ITS FINANCIAL ASSISTANCE POLICY. THIS AMOUNT IS RELATED TO BAD DEBT FROM BOTH HOSPITALS DURING FY18 OF UNINSURED PATIENTS WHO WERE SEEN IN THE ER AND RECEIVED MEDICALLY NECESSARY SERVICES. CAPE COD HEALTHCARE RECEIVES PAYMENTS FOR SERVICES RENDERED FROM FEDERAL AND STATE AGENCIES (UNDER THE MEDICARE AND MEDICAID PROGRAMS), MANAGED CARE PAYORS, COMMERCIAL INSURANCE COMPANIES, AND PATIENTS. PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF CONTRACTUAL ALLOWANCES AND RESERVES FOR DENIALS, UNCOMPENSATED CARE, AND DOUBTFUL ACCOUNTS. THE LEVEL OF RESERVES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL AND PRIVATE EMPLOYER HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. IF A PATIENT IS INELIGIBLE FOR CHARITY CARE BECAUSE HIS OR HER INCOME EXCEEDS THE ELIGIBILITY GUIDELINES, ANY UNCOLLECTIBLE ACCOUNTS RECEIVABLE BALANCE IS WRITTEN OFF TO BAD DEBT AS REPORTED IN PART III, LINE 2. PART III, LINE 4 REFER TO PAGES 14-15 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR FOOTNOTES RELATED TO ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT. PART III LINE 9(B) HOSPITAL FINANCIAL ASSISTANCE PROGRAMS PATIENTS WHO ARE ELIGIBLE FOR ENROLLMENT IN A STATE PUBLIC ASSISTANCE PROGRAM, LIKE THE MASSACHUSETTS MASSHEALTH OR HEALTH SAFETY NET PROGRAMS, ARE DEEMED ENROLLED IN A FINANCIAL ASSISTANCE PROGRAM. FOR ALL PATIENTS THAT ARE ENROLLED IN THESE STATE PUBLIC ASSISTANCE PROGRAMS, THE HOSPITAL MAY ONLY BILL THOSE PATIENTS FOR THE SPECIFIC CO-PAYMENT, CO-INSURANCE, OR DEDUCTIBLE THAT IS OUTLINED IN THE APPLICABLE STATE REGULATIONS AND WHICH MAY FURTHER BE INDICATED ON THE STATE MEDICAID MANAGEMENT INFORMATION SYSTEM. THE HOSPITAL WILL SEEK A SPECIFIED PAYMENT FOR THOSE PATIENTS THAT DO NOT QUALIFY FOR ENROLLMENT IN A MASSACHUSETTS STATE PUBLIC ASSISTANCE SUCH AS OUT-OF-STATE RESIDENTS, BUT WHO MAY OTHERWISE MEET THE GENERAL FINANCIAL ELIGIBILITY CATEGORIES OF A STATE PUBLIC ASSISTANCE PROGRAM. FOR THESE PATIENTS, THE PAYMENT AMOUNT WILL BE SET AT THE HOSPITAL, WHEN REQUESTED BY THE PATIENT AND BASED ON AN INTERNAL REVIEW OF EACH PATIENT'S FINANCIAL STATUS, MAY OFFER A PATIENT AN ADDITIONAL DISCOUNT ON AN UNPAID BILL. ANY SUCH REVIEW SHALL BE PART OF A SEPARATE HOSPITAL FINANCIAL ASSISTANCE PROGRAM THAT IS APPLIED ON A UNIFORM BASIS TO PATIENTS, AND WHICH TAKES INTO CONSIDERATION THE PATIENT'S DOCUMENTED FINANCIAL SITUATION AND THE PATIENT'S INABILITY TO MAKE A PAYMENT AFTER REASONABLE COLLECTION ACTIONS. ANY DISCOUNT THAT IS PROVIDED BY THE HOSPITAL IS CONSISTENT WITH FEDERAL AND STATE REQUIREMENTS, AND DOES NOT INFLUENCE A PATIENT TO RECEIVE SERVICES FROM THE HOSPITAL. POPULATIONS EXEMPT FROM COLLECTION ACTIVITIES: THERE ARE SEVERAL SITUATIONS WHERE A PATIENT CAN BE EXEMPTED FROM FURTHER BILLING AND COLLECTION PROCEDURES ONCE THE DETERMINATION IS MADE THAT THE PATIENT IS EXEMPT PURSUANT TO STATE REGULATIONS: A) PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN, OR DESIGNATED A "LOW INCOME PATIENT" BY THE OFFICE OF MEDICAID, SUBJECT TO THE FOLLOWING EXCEPTIONS: (I) THE HOSPITAL MAY SEEK TO BILL AND COLLECT THE CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM. (II) THE HOSPITAL MAY ALSO INITIATE BILLING AND COLLECTION EFFORTS FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM, (INCLUDING RECEIPT OR VERIFICATION OF THE SIGNED APPLICATION) THE HOSPITAL SHALL CEASE ITS BILLING AND COLLECTION ACTIVITIES. (III) THE HOSPITAL WILL NOT CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED BY THE HOSPITAL DURING THE PERIOD FOR WHICH HE OR SHE HAS BEEN DETERMINED TO BE A LOW INCOME PATIENT BY THE OFFICE OF MEDICAID. HOWEVER, THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON A LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED, EXPIRED, OR NOT OTHERWISE IDENTIFIED ON THE STATE'S VIRTUAL GATEWAY OR RECIPIENT ELIGIBILITY VERIFICATION SYSTEM. ONCE A LOW INCOME PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN COMMONWEALTH CARE PROGRAMS, THE HOSPITAL WILL CEASE ITS BILLING AND COLLECTION EFFORTS FOR SERVICES PROVIDED PRIOR TO THE BEGINNING OF THEIR ELIGIBILITY. (IV) THE HOSPITALS MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE. PART VI, LINE 2 NEEDS ASSESSMENT: THE 2017-2019 CAPE COD HOSPITAL AND FALMOUTH HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT REPORT (CHNA REPORT) AND IMPLEMENTATION PLAN WAS RELEASED AND MADE WIDELY AVAILABLE TO THE PUBLIC ON SEPTEMBER 30, 2016. THE GOALS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROJECT ARE TO MONITOR REGIONAL HEALTH DATA, ENGAGE HOSPITAL STAKEHOLDERS, PROMOTE PARTNERSHIPS BETWEEN THE HOSPITALS AND COMMUNITY ORGANIZATIONS AND DEVELOP MULTI-YEAR IMPLEMENTATION STRATEGIES TO GUIDE HOSPITAL INITIATIVES TO IMPROVE THE HEALTH OF BARNSTABLE COUNTY RESIDENTS. THE METHODOLOGY FOR CONDUCTING THE ASSESSMENT INCLUDED THE COLLECTION AND ANALYSIS OF PRIMARY AND SECONDARY HEALTH DATA, GATHERING SIGNIFICANT INPUT FROM THE COMMUNITY, AND THE IDENTIFICATION AND PRIORITIZATION OF KEY HEALTH NEEDS FOR THE REGION. OVER 20 DATA SOURCES WERE UTILIZED TO COLLECT BARNSTABLE COUNTY AND TOWN-LEVEL HEALTH STATISTICS ON DISEASE INCIDENCE AND PREVALENCE, HOSPITAL UTILIZATION, MORBIDITY AND MORTALITY, BARRIERS TO ACCESSING CARE, AND BEHAVIORAL RISK FACTORS. REGIONAL STATISTICS WERE ANALYZED AND COMPARED TO STATE AND NATIONAL STATISTICS TO IDENTIFY WHERE DEMOGRAPHIC AND HEALTH DISPARITIES EXIST. ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS REPRESENTING LOW-INCOME, MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS PROVIDED CRITICAL INSIGHT AND FEEDBACK ON THE REGIONAL HEALTH NEEDS THROUGH KEY INFORMATION INTERVIEWS AND COMMUNITY INPUT FORUMS. THROUGH THIS COLLECTION OF DATA AND COMMUNITY INPUT THE SIGNIFICANT HEALTH NEEDS OF BARNSTABLE COUNTY RESIDENTS WERE DISTINGUISHED AND PRIORITIZED BASED ON THE FREQUENCY, URGENCY, SCOPE, SEVERITY AND MAGNITUDE OF THE IDENTIFIED ISSUES. THE SIGNIFICANT HEALTH NEEDS AND ASSOCIATED TARGET POPULATIONS IDENTIFIED THROUGH THE CHNA REPORT WILL SERVE AS THE FOUNDATION FOR COMMUNITY BENEFITS AND HOSPITAL PLANNING SPANNING FISCAL YEARS 2017-2019. THE FOLLOWING SOURCES WERE UTILIZED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTS: - CAPE COD HOSPITAL AND FALMOUTH HOSPITAL UTILIZATION DATA - BARNSTABLE COUNTY DEPARTMENT OF HUMAN SERVICES: ANALYSIS OF SUBSTANCE ABUSE ON CAPE COD, A BASELINE ASSESSMENT, BARNSTABLE COUNTY BEHAVIORAL HEALTH WEB PORTAL, BARNSTABLE COUNTY PUBLIC HEALTH AND WELLNESS WEB PORTAL - CAPE COD FOUNDATION CONNECT CAPE COD - UNIVERSITY OF MASSACHUSETTS (UMASS) DONAHUE INSTITUTE LONG-TERM PROJECTIONS FOR MASSACHUSETTS REGIONAL AND MUNICIPALITIES - MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH: MASSACHUSETTS COMMUNITY HEALTH INFORMATION PROFILE (MASS CHIP), MASSACHUSETTS BEHAVIORAL HEALTH RISK FACTOR SURVEILLANCE SYSTEM - US CENSUS BUREAU: US CENSUS 2010, AMERICAN COMMUNITY SURVEY ONCE COLLECTED, STATISTICAL DATA WAS VETTED AND AUGMENTED WITH COMMUNITY INPUT. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL SELECTED JOHN SNOW, INC. (JSI) A PUBLIC HEALTH RESEARCH FIRM, TO CONDUCT PRIMARY RESEARCH INCLUDING HEALTH DATA RESEARCH, KEY INFORMANT INTERVIEWS AND FACILITATION OF COMMUNITY AND PROVIDER FORUMS. JSI INTERVIEWED OVER 25 REGIONAL LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY AND WHO OFFER INFORMATION OR EXPERTISE RELATIVE TO THE SIGNIFICANT HEALTH NEEDS OF VULNERABLE POPULATIONS. THEY INCLUDED SUCH ENTITIES AS MUNICIPAL PUBLIC HEALTH DEPARTMENTS, HUMAN SERVICE AGENCIES,SCHOOLS AND LAW ENFORCEMENT AGENCIES, FEDERALLY QUALIFIED HEALTH CENTERS, COMMUNITY ORGANIZATIONS SERVING LOW-INCOME, VULNERABLE AND MEDICALLY UNDERSERVED POPULATIONS, ELECTED OFFICIALS, AND HOSPITAL CLINICIANS AND ADMINISTRATORS. FIVE COMMUNITY INPUT FORUMS WERE HELD ACROSS BARNSTABLE COUNTY. MORE THAN 140 INDIVIDUALS AND 90 COMMUNITY ORGANIZATIONS ATTENDED. THESE FORUMS PROVIDED AN OPPORTUNITY TO PRESENT STATISTICAL HEALTH FINDINGS TO PARTICIPANTS AND IDENTIFY GAPS IN SERVICES. ADDITIONALLY, THE FORUMS FACILITATED DIALOGUE ON ISSUES NOT IDENTIFIED AND TARGET POPULATIONS MOST IMPACTED BY HEALTH ISSUES. A POST-FORUM SURVEY WAS PROVIDED TO PARTICIPANTS TO IDENTIFY AND RANK HEALTH PRIORITIES IN THE REGION. FEEDBACK AND INPUT FROM THE KEY INFORMANT INTERVIEWS AND FROM ATTENDEES OF THE COMMUNITY AND PROVIDER FORUMS WAS USED TO INFORM THE SELECTION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: FOR THOSE PATIENTS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER THEIR UNPAID HOSPITAL BILLS. IN ORDER TO ASSIST UNINSURED AND UNDERINSURED PATIENTS IN FINDING AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL WILL PROVIDE ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS AS WELL AS IN GENERAL NOTICES POSTED THROUGHOUT THE HOSPITAL. THE GOAL OF THESE NOTICES IS TO INFORM PATIENTS THAT THEY MAY BE ELIGIBLE TO APPLY FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM, SUCH AS, BUT NOT LIMITED TO, MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, HEALTH SAFETY NET, OR MEDICAL HARDSHIP THROUGH THE HEALTH SAFETY NET. THE HOSPITAL WILL PROVIDE, UPON REQUEST, SPECIFIC INFORMATION ABOUT THE ELIGIBILITY PROCESS TO BE DESIGNATED A LOW INCOME PATIENT UNDER EITHER THE STATE HEALTH SAFETY NET PROGRAM OR THROUGH THE HOSPITAL'S OWN INTERNAL CHARITY CARE PROGRAM. THE HOSPITAL WILL ALSO NOTIFY THE PATIENT ABOUT PAYMENT PLANS THAT MAY BE AVAILABLE TO HIM OR HER BASED ON THE SIZE OF HIS OR HER FAMILY AND FAMILY INCOME. PART VI, LINE 4 DEMOGRAPHICS OF THE SERVICE AREA CAPE COD HEALTHCARE IS THE COMMUNITY SAFETY-NET PROVIDER OF HEALTH CARE SERVICES FOR THE YEAR-ROUND RESIDENTS AND MILLIONS OF ANNUAL VISITORS TO BARNSTABLE COUNTY, ALSO KNOWN AS "CAPE COD." CAPE COD HOSPITAL AND FALMOUTH HOSPITAL, THE ONLY TWO ACUTE-CARE, NON-PROFIT HOSPITALS IN THE REGION, TOGETHER SHARE THE 15 TOWNS OF BARNSTABLE COUNTY AS THEIR PRIMARY SERVICE AREA. THE UPPER CAPE REGION INCLUDES THE MASHPEE WAMPANOAG TRIBAL REGION. CAPE COD HOSPITAL, LOCATED IN HYANNIS, MA, IS A 259-BED ACUTE-CARE, NON-PROFIT HOSPITAL. FALMOUTH HOSPITAL, LOCATED IN FALMOUTH, MA, IS A 95-BED ACUTE-CARE, NON-PROFIT HOSPITAL. BARNSTABLE COUNTY IS A GEOGRAPHICALLY ISOLATED REGION LOCATED ON THE EASTERN SEABOARD OF MASSACHUSETTS. THE NARROW PENINSULA SPANS OVER 70 MILES IN LENGTH AND HOSTS A YEAR-ROUND POPULATION OF 215,449 RESIDENTS. BARNSTABLE COUNTY CONSISTS OF 15 TOWNS THAT VARY IN YEAR-ROUND POPULATION SIZE FROM ABOUT 45,000 RESIDENTS (BARNSTABLE) TO SLIGHTLY MORE THAN 1,700 RESIDENTS (TRURO). IN ADDITION TO SERVING YEAR-ROUND RESIDENTS,THE REGIONAL COMMUNITY INFRASTRUCTURE, INCLUDING CAPE COD HOSPITAL AND FALMOUTH HOSPITAL, MUST MEET THE DEMANDS OF A SIGNIFICANT INFLUX OF SEASONAL RESIDENTS AND VISITORS EACH YEAR. THE CAPE COD COMMISSION PRODUCED ESTIMATES, USING SURVEY DATA FROM SECOND HOMEOWNERS TO INDICATE THAT THE POPULATION OF SUMMER RESIDENTS ON CAPE COD, WHEN AVERAGED OVER A FULL YEAR, IS EQUIVALENT TO AN ADDITIONAL 68,856 FULL-TIME RESIDENTS. THIS COUPLED WITH DAY VISITORS AND SHORT TERM TRAVELER VOLUME RESULTS IN AN ESTIMATED 7 MILLION VISITORS AND RESIDENTS ON CAPE COD IN A GIVEN SUMMER SEASON. THIS SEASONAL POPULATION EXPANSION AND CONTRACTION CREATES UNIQUE CHALLENGES FOR THE CAPE'S HEALTH CARE SYSTEM, TRANSPORTATION NETWORK, WORKFORCE, BUSINESS COMMUNITY, AND HOUSING MARKET. POPULATION TRENDS AND AGE DEMOGRAPHIC ANALYSIS REVEALS TWO STRIKING TRENDS THAT WILL IMPACT BARNSTABLE COUNTY IN THE NEAR FUTURE. CURRENT DATA AND FUTURE DEMOGRAPHIC PREDICTIONS FOR THE REGION DEMONSTRATE THAT BARNSTABLE COUNTY'S OVERALL POPULATION IS DECLINING AND INCREASING IN AGE. ACCORDING TO THE LONG-TERM POPULATION PROJECTIONS FOR MASSACHUSETTS REGIONS AND MUNICIPALITIES, A PUBLICATION BY THE UMASS DONAHUE INSTITUTE, ALL REGIONS IN MA WILL EXPERIENCE POSITIVE POPULATION GROWTH FROM 2010-2035 EXCEPT FOR BARNSTABLE COUNTY AND THE ISLANDS OF NANTUCKET AND MARTHA'S VINEYARD. A PROJECTED NET LOSS OF 13% OF THE OVERALL POPULATION OF BARNSTABLE COUNTY IS PREDICTED BETWEEN 2010 AND 2035. BY 2035, THE TOTAL YEAR-ROUND POPULATION IS EXPECTED TO DECREASE TO APPROXIMATELY 188,000 RESIDENTS, A POPULATION SIMILAR TO HISTORIC 1990 NUMBERS. THIS DECLINE IS ATTRIBUTED TO TWO FACTORS, AN OUTFLOW OF YOUNG PEOPLE FROM THE REGION, AND DEATHS CONTINUING TO OUTNUMBER BIRTHS. IN ADDITION TO THE DECLINING POPULATION, THE YEAR-ROUND POPULATION OF BARNSTABLE COUNTY WILL CONTINUE TO HAVE A SIGNIFICANTLY LARGER PROPORTION OF SENIORS OVER THE AGE OF 65 THAN THE STATE OF MASSACHUSETTS (MA) AND THE UNITED STATES (U.S.). ACCORDING TO 2009-2013 AMERICAN COMMUNITY SURVEY ESTIMATES, NEARLY 26% OF THE YEAR-ROUND POPULATION OF BARNSTABLE COUNTY IS OVER THE AGE OF 65 COMPARED TO 14% IN MA AND 13% IN THE U.S. IT IS PREDICTED THAT BY THE YEAR 2035, NEARLY 35% OF THE POPULATION OF BARNSTABLE COUNTY WILL BE OVER THE AGE OF 65.4. IN MA, 58% OF THE OVERALL POPULATION IS COMPRISED OF RESIDENTS BETWEEN THE AGES OF 0-44 YEARS COMPARED TO ONLY 42% IN BARNSTABLE COUNTY. 'BABY BOOMERS', WHO ARE CURRENTLY INCLUDED IN THE AGE BRACKET OF 45 TO 64 YEAR-OLD RESIDENTS, REPRESENT AN ADDITIONAL 32% OF THE CAPE'S POPULATION. THESE COMBINED POPULATION STATISTICS SKEW BARNSTABLE COUNTY'S MEDIAN AGE TO OVER 50 YEARS OLD, THE HIGHEST FOR ALL COUNTIES IN MASSACHUSETTS. THIS IS MORE THAN A DECADE OLDER THAN THE MA MEDIAN AGE OF 39 YEARS AND THE U.S. MEDIAN AGE OF 37 YEARS. A COMMON THEME DISCUSSED IN STAKEHOLDER INTERVIEWS AND COMMUNITY/PROVIDER FORUMS WAS THAT PERSONS OVER THE AGE OF 65 AND YOUTH (15-24 YEARS OLD)REPRESENTED TWO OF THE MOST VULNERABLE POPULATIONS IN THE SERVICE AREA.YOUTH WERE IDENTIFIED AS A TARGET POPULATION DUE TO CONCERNS RELATED TO EARLY ONSET OF MENTAL HEALTH CONDITIONS, SUBSTANCE USE AND RISKY HEALTH BEHAVIORS. BARNSTABLE COUNTY'S GENDER DEMOGRAPHICS MIRROR THOSE OF MA; 52% OF RESIDENTS ARE FEMALE AND 48% ARE MALE. NEARLY 12% OF BARNSTABLE COUNTY RESIDENTS OVER THE AGE OF 18 ARE VETERANS WHICH IS HIGHER THAN THE PERCENTAGE IN BOTH MA (7%) AND THE U.S. (9%). IN BARNSTABLE COUNTY, 13% OF RESIDENTS REPORT THAT THEY ARE LIVING WITH A DISABILITY COMPARED TO 11% IN MA. BARNSTABLE COUNTY MUST MEET THE UNIQUE HEALTH NEEDS OF VETERANS AND PERSONS LIVING WITH DISABILITIES WHO MAY BE AT A GREATER RISK OF DEVELOPING COMORBID CONDITIONS AND OFTEN ENCOUNTER LIMITED ACCESS OR BARRIERS TO CARE. INCOME AND POVERTY ALTHOUGH BARNSTABLE COUNTY HAS A LOWER PROPORTION OF LOW-INCOME RESIDENTS THAN DOES MA (9% VS. 11%), REPRESENTATIVES OF ORGANIZATIONS THAT SERVE VULNERABLE, LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS REPORT A GROWING NUMBER OF RESIDENTS WHO STRUGGLE TO SECURE AND MAINTAIN STABLE EMPLOYMENT. THEY ALSO RELY ON PUBLIC ASSISTANCE PROGRAMS TO AFFORD HEALTH INSURANCE, FOOD AND HOUSING. ACCORDING TO FIVE-YEAR CENSUS ESTIMATES (2009-2013), THE MEDIAN HOUSEHOLD INCOME OF BARNSTABLE COUNTY RESIDENTS WAS $60,526 COMPARED TO $66,866 FOR ALL MASSACHUSETTS RESIDENTS. IN 2014, A HIGHER PERCENT OF PER CAPITA INCOME WAS DERIVED FROM TRANSFER PAYMENTS (SOCIAL SECURITY, DISABILITY PENSIONS, HOUSING AND FOOD SUBSIDY PROGRAMS, AND UNEMPLOYMENT BENEFITS) IN BARNSTABLE COUNTY (19%) COMPARED TO MA (15%) AND THE U.S. (17%). VULNERABLE POPULATIONS ARE FURTHER CHALLENGED BY EMPLOYMENT OPPORTUNITIES ON CAPE COD WHICH DECREASE DURING WINTER MONTHS DUE TO CHARACTERISTICS INHERENT IN A SEASONAL ECONOMY DEPENDENT ON TOURISM AND OTHER FACTORS. IN 2015, THE UNEMPLOYMENT RATE IN BARNSTABLE COUNTY RANGED FROM 9% IN JANUARY TO 5% IN JULY COMPARED TO A STEADY ANNUAL RATE OF 6% UNEMPLOYMENT FOR MA OVERALL. ACCORDING TO FIVE-YEAR ESTIMATES (2009-2013) OF THE AMERICAN COMMUNITY SURVEY: - MORE THAN 48% OF BARNSTABLE COUNTY RESIDENTS WHO RENT AND 38% WHO OWN A HOUSING UNIT ARE COST-BURDENED, SPENDING 35% OR MORE OF THEIR TOTAL INCOME ON HOUSING. ACCORDING TO THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, FAMILIES WHO PAY MORE THAN 30% OF THEIR INCOME FOR HOUSING ARE CONSIDERED COST-BURDENED AND MAY HAVE DIFFICULTY AFFORDING NECESSITIES SUCH AS FOOD, CLOTHING, TRANSPORTATION AND MEDICAL CARE. - 42% OF BARNSTABLE COUNTY RESIDENTS RECEIVE PUBLICLY-FUNDED HEALTH INSURANCE COVERAGE COMPARED TO 32% OF RESIDENTS IN MA OVERALL, AND 42% OF RESIDENTS RECEIVE SOCIAL SECURITY PAYMENTS COMPARED TO 28% IN MA OVERALL. COMBINED TOGETHER, THESE INDICATORS PAINT A PICTURE OF MANY RESIDENTS IN NEED. THE COMMUNITY INPUT COLLECTION PHASE OF THE PROJECT IDENTIFIED NUMEROUS TARGET POPULATIONS IN NEED OF HEALTH INTERVENTIONS. THESE INCLUDED FINANCIALLY DISADVANTAGED POPULATIONS, INCLUDING INDIVIDUALS WITH TRANSITIONAL EMPLOYMENT, CHILDREN UNDER THE AGE OF 18, INDIVIDUALS/FAMILIES WITH HOUSING INSECURITIES, AND THOSE LIVING ON FIXED INCOMES. RACE, ETHNICITY AND LANGUAGE IN ADDITION TO AGE AND INCOME, RACE, ETHNICITY, AND LANGUAGE PLAY A ROLE IN DETERMINING HEALTH OUTCOMES FOR RESIDENTS. COMPARED TO MA, BARNSTABLE COUNTY HAS A RELATIVELY HOMOGENEOUS POPULATION WITH 92% IDENTIFYING AS CAUCASIAN IN 2009-2013 CENSUS ESTIMATES. MASSACHUSETTS IS MORE RACIALLY DIVERSE WITH ONLY 76% OF RESIDENTS IDENTIFYING AS CAUCASIAN. ACCORDING TO FIVE-YEAR ESTIMATES OF THE AMERICAN COMMUNITY SURVEY (2009-2013) THE LARGEST RACIAL/ETHNIC MINORITY GROUPS ON CAPE COD ARE HISPANICS/LATINOS AND AFRICAN-AMERICAN RESIDENTS WITH EACH GROUP REPRESENTING ABOUT 2% OF THE POPULATION. IN THAT SAME TIME PERIOD, 7% OF THE POPULATION LIVING IN BARNSTABLE COUNTY WAS FOREIGN-BORN, COMPARED TO 15% FOR THE COMMONWEALTH OF MASSACHUSETTS. SLIGHTLY MORE THAN 8% OF THE POPULATION FIVE YEARS OR OLDER IN BARNSTABLE COUNTY SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME COMPARED TO 22% IN THE COMMONWEALTH. WHILE DIVERSITY MAY BE LOW COMPARATIVELY, PUBLIC HEALTH EXPERTS AND INDIVIDUALS REPRESENTING LOW-INCOME, VULNERABLE, AND MEDICALLY UNDERSERVED POPULATIONS ON CAPE COD CITE THAT FOREIGN-BORN RESIDENTS AND RACIAL/ETHNIC MINORITIES ON CAPE COD (E.G., HISPANICS, AFRICAN AMERICANS, AND PORTUGUESE-SPEAKING BRAZILIANS) WERE MOST LIKELY TO EXPERIENCE BARRIERS TO ACCESSING CARE AND ARE DISPROPORTIONALLY IDENTIFIED WITHIN HIGH NEEDS POPULATIONS AS COMPARED TO OTHERS. INSURANCE STATUS MASSACHUSETTS LEADS THE NATION AS THE STATE WITH THE LOWEST RATE OF UNINSURED RESIDENTS. IN 2014, ONLY 4% OF RESIDENTS IN THE COMMONWEALTH LACKED MEDICAL HEALTH INSURANCE, COMPARED TO 10% NATIONALLY, DUE TO THE STATE'S EARLY HEALTH REFORM EFFORTS WHICH BEGAN IN 2006. HOWEVER, THERE IS VARIATION IN INSURED POPULATIONS ACROSS THE STATE OF MA ACCORDING TO THE GEOGRAPHY OF UNINSURANCE IN MASSACHUSETTS 2009-2013, A PUBLICATION BY THE BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION AND THE URBAN INSTITUTE. ACCORDING TO THE STUDY, BARNSTABLE COUNTY, AT 3.4%, HAS THE HIGHEST PERCENTAGE OF UNINSURED CHILDREN (0-17 YEARS) IN THE STATE COMPARED TO ALL OTHER COUNTIES. BARNSTABLE COUNTY, WITH AN OVERALL 5% UNINSURED RATE (ADULTS AND CHILDREN), IS ALSO THE 4TH HIGHEST RANKING COUNTY IN MA FOR THE NUMBER OF UNINSURED PERSONS OF ALL AGES. INPUT FROM PUBLIC HEALTH EXPERTS AND INDIVIDUALS REPRESENTING LOW-INCOME, VULNERABLE, AND MEDICALLY-UNDERSERVED POPULATIONS ON CAPE COD NOTE THAT BEYOND INDIVIDUALS AND CHILDREN WHO ARE UNINSURED, THERE ARE MANY RESIDENTS WHO ARE 'UNDER-INSURED'. THIS POPULATION STRUGGLES WITH THE COST OF PUBLICLY AVAILABLE HEALTH PLANS, COVERAGE OF DEDUCTIBLES AND PRESCRIPTIONS, AND WITH MAINTAINING INSURANCE COVERAGE UNDER CONTINUOUS ENROLLMENT CHANGES. CAPE COD HOSPITAL AND FALMOUTH HOSPITAL DERIVE APPROXIMATELY 67% OF PATIENT SERVICE REVENUES FROM PUBLIC PAYERS. FROM FY2013 TO FY2015 THE HOSPITALS' PERCENTAGE OF MEDICAID AND MEDICARE STEADILY INCREASED WHILE THE PERCENTAGE FROM NON-GOVERNMENT SOURCES STEADILY DECREASED. AS BOTH STATE AND FEDERAL PAYERS FACE BUDGETING CONCERNS, PUBLIC PAYER REIMBURSEMENT IS FORECASTED TO REMAIN FLAT OR DECLINE. MANY OF THE KEY SERVICES USED BY VULNERABLE POPULATIONS SUCH AS BEHAVIORAL HEALTH ARE POORLY REIMBURSED. THESE TRENDS DEMONSTRATE CONTINUED RELIANCE ON SOURCES OF PUBLIC HEALTH COVERAGE AS THE AREA DEMOGRAPHICS BECOME MORE CHALLENGING. CONCLUSION UNDERSTANDING THE COMMUNITY NEED AND HEALTH STATUS OF BARNSTABLE COUNTY RESIDENTS BEGINS WITH IDENTIFYING THE DEMOGRAPHIC PROFILE AND UNDERLYING SOCIO-ECONOMIC DRIVERS THAT IMPACT HEALTH AND HEALTH EQUITY. ASSESSING SOCIAL DETERMINANTS OF HEALTH SUCH AS AGE, INCOME, RACE/ETHNICITY,LANGUAGE, INCOME, POVERTY, UNEMPLOYMENT, INSURANCE COVERAGE, AND HOUSING STATUS PROVIDES CRITICAL INFORMATION FOR IDENTIFYING TARGET POPULATIONS AND COMMUNITY SETTINGS FOR HEALTH IMPROVEMENT INTERVENTIONS AND ACTIVITIES. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: Cape Cod Healthcare, Inc., (CCHC) through its Community Benefits initiatives, is committed to enhancing the quality of and access to comprehensive health care services for all residents of Cape Cod. Through continuous assessment of community needs, coordinated planning and the allocation of resources, this commitment includes a special focus on the unmet needs of the financially disadvantaged and underserved populations. We will take a leadership role in collaborative efforts joining our resources, talent, and commitment with that of other providers, organizations and community members. The Community Benefits Mission Statement was affirmed by the CCHC Community Health Committee and the Board of Trustees in 2000 and remains in effect. THE FOLLOWING IS A LIST OF FY 18 TARGET POPULATIONS: - Individuals managing or at risk of developing chronic and infectious diseases such as cancer, cardiovascular disease, Alzheimer's disease and dementia, Hepatitis C, and tick-borne diseases. - Residents facing barriers to care due to language, cost, or age, including those who are uninsured or under-insured. - Individuals with mental health disorders, substance use disorders, and co-occurring disorders. - Senior population, ages 65 and older. - Youth and young adults, ages 15 to 24 years old. Key Accomplishments of Reporting Year The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan served as the foundation for CCHC's FY18 Community Benefits program. CCHC's Community Benefits activities focused on the four health priorities identified in the report: chronic and infectious disease, behavioral health, access to care, and disease prevention and wellness. New and expanded hospital programs were developed in alignment with implementation goals, objectives and strategies for each priority. CCHC supported partnerships with over 50 local non-profit health and human service organizations, and a network of federally qualified health centers, through project support and grant investments to improve the health of Barnstable County residents. Hospital staff dedicated time and expertise to strategic partnerships, coalitions, and task force efforts locally, regionally, and across Massachusetts. Chronic and Infectious Disease Prevention, screening, detection, and management of chronic and infectious diseases were supported through a variety of CCHC Community Benefits activities. Hospital cancer support services including counseling, support groups, and survivorship activities for patients and caregivers were complemented with a new Oncology Nutrition program, which started in February 2018. The successful Living Fit for You! Cancer Wellness Program at Falmouth Hospital was expanded in August 2018 to include Cape Cod Hospital's campus. The program provides free of charge rehabilitation, wellness consultations, exercise, and education services to help adults undergoing cancer treatment manage fatigue, de-conditioning and loss of physical function. CCHC Community Benefits also provided grants to the Cape Wellness Collaborative and YMCA Cape Cod LIVESTRONG program to ensure that patients undergoing and recovering from cancer treatment had access to community-based wellness programs and complementary services such as massage, acupuncture, yoga and nutritional counseling. The CCHC Integrated Cancer Committee, comprised of physicians, nurses and support staff, conducted educational campaigns and community outreach events. These events informed youth about the risks of tobacco use and the general public about skin cancer prevention, including high-risk screening opportunities. CCHC clinical teams provided disease education, rehabilitation and pathways to chronic disease self- management for individuals living with congestive heart failure, chronic pulmonary diseases, and diabetes. A Community Benefits grant to the Cape Cod Times Needy Fund provided assistance for basic needs such as housing and utility payments, transportation, adaptive medical equipment, and child care specifically for individuals managing a chronic disease. A CCHC Community Benefits grant supported the Alzheimer's Family Caregiver Support Centers expanding free counseling for families and caregivers in outposts across the Outer, Lower, Mid, and Upper regions of Cape Cod. In addition, the organization now hosts concurrent weekly support group meetings for individuals with Alzheimer's disease and their caregivers at Cape Cod Hospital. CCHC provided funding for two innovative community-based programs to support tick-borne disease education in FY18. Through a partnership with the UMASS Laboratory of Medical Zoology, CCHC was the only hospital system in MA to subsidize tick testing for residents within a hospital service area. CCHC also partnered with the Cape Cod Cooperative Extension to produce a 10-part online video series titled "Tickology" to provide easily accessible community education on tick disease prevention. CCHC Infectious Disease Clinical Services is the recipient of federal and state Ryan White grant funding to support comprehensive primary medical care and medical case management for individuals with HIV/AIDS living in Barnstable County. CCHC, through partnerships with other local organizations, aligned local efforts to meet National HIV/AIDS Strategy and the Massachusetts Integrated HIV Prevention and Care Plan to reduce the number of new HIV infections, increase access to care, improve health outcomes for individuals living with HIV/AIDS, and reduce HIV-related health inequities and disparities. Behavioral Health CCHC Community Benefits expanded hospital-based services and collaborations with local federally qualified health centers and behavioral health providers to strengthen regional services and community resources for individuals with mental health and substance use disorders. CCHC's Centers for Behavioral Health joined the MA Department of Public Health and MA Department of Mental Health on the Zero Suicide Initiative to increase suicide prevention and reduce suicide deaths on Cape Cod. CCHC also provides a Community Crisis Line, staffed by clinicians, offering free and confidential emotional support and referral assistance for individuals in crisis and their families. CCHC Community Benefits funded a community wide Mental Health First Aid Training project in partnership with the National Alliance on Mental Illness (NAMI) Cape Cod, which resulted in 13 certified instructors to train exponentially more people in the evidence-based program in our community. CCHC Community Benefits provided grants to three federally qualified health centers on Cape Cod. Duffy Health Center, Harbor Community Health Center- Hyannis, and Outer Cape Health Services received grants supporting integrated behavioral health services, establishing an Office Based Addiction Treatment program and continuation of a community navigator program that assists individuals most at risk in our region. Through a partnership with, and grant to Gosnold, Inc., CCHC Community Benefits expanded the Recovery Specialist program in the emergency departments at Cape Cod Hospital and Falmouth Hospital. The program provides peer-led recovery engagement services for patients with Substance Use Disorders. Recovery Specialists work as part of the emergency departments' care teams to motivate patients to accept treatment upon discharge from the emergency departments. Additional funding to Gosnold, Inc. provided Recovery Coaching scholarships for 30 individuals who completed treatment for their Substance Use Disorder. Recovery Coaches assist individuals with building recovery support systems and improving outcomes related to employment, housing, legal and life skills. Cape Cod Hospital received grant funding from Massachusetts Department of Public Health to provide assistance to pregnant women with Opioid Use Disorders through the Moms Do Care program. The program provides peer-led services to obtain prenatal care, substance use treatment, and address social determinant of health issues. At the conclusion of the grant, CCHC supported transitioning the program to the Duffy Health Center with a Community Benefits grant, and CCHC remains a strategic collaborator on the project. CCHC staff from the maternity and pediatric departments at Cape Cod Hospital and Falmouth Hospital actively participated in statewide initiatives by the Neonatal Quality Improvement Collaborative of MA. Initiatives included staff development and piloting new models of care for newborns and families impacted by perinatal opioid use and neonatal abstinence syndrome. Access to Care In FY18, CCHC continued to invest significantly in expanding access to care for vulnerable and medically underserved populations in Barnstable County. CCHC Community Benefits continued its grant support of the Specialty Network for the Uninsured (SNU) program in Barnstable County. The SNU program coordinates appointments and follow-up care with local medical specialists for uninsured and under-insured patients in our region, reducing barriers to local access and addressing gaps in specialty services not offered by local community health centers. Through the Community Based Interpreters program, CCHC Community Benefits funding provided free medical interpreter services for limited-English speaking patients in community-based primary and specialty care offices across the region. In partnership with the Cape and Islands Emergency Medical Services System, CCHC expanded the impact of medical interpreter services in pre-hospital settings. CCHC provides training and funding for phone-based interpreter services that connect paramedics and first responders to interpreters via cell phones in ambulances to improve communication with limited-English speaking patients during transport to a hospital. Hospital social workers and case managers assisted low-income and vulnerable patients in need through direct referrals to community services, prescription assistance, and transportation vouchers upon discharge. Financial counselors at Cape Cod Hospital and Falmouth Hospital were available to all Barnstable County residents to assist with health insurance questions and needs including Mass Health and Medicare coverage applications and renewal assistance. CCHC has been at the forefront of establishing strategic relationships ensuring a strong and skilled future allied health workforce in our region. Cape Cod Community College and Cape Cod Healthcare Nursing Education Collaborative is a program that expands opportunities for education, clinical training, and employment, as well as RN student debt relief and career exploration pathways for high school students. In several clinical departments including behavioral health, radiology, and laboratory services across both hospitals, clinicians provide supervision, training, and job shadowing for students from UMASS Medical School, regional community colleges, and local vocational and technical schools. Disease Prevention and Wellness In FY18, Cape Cod Healthcare efforts focused on building partnerships and support for community based prevention and wellness initiatives impacting residents across the lifespan from infants to seniors. CCHC Community Benefits expanded efforts supporting new families. Expanded efforts included prenatal and parenting classes in English and Portuguese, support groups for new mothers, fatherhood initiatives, and a breastfeeding warmline that provided families with phone support for questions related to breastfeeding. CCHC also partnered with a local Early Intervention program to provide pre-discharge meetings with Early Intervention staff. Early Intervention staff educated parents about services and supports available to infants, young children and their families through the program. Through a partnership with the Cape & Islands United Way, CCHC Community Benefits supported the Strong from the Start Initiative aimed at improving the social, emotional and developmental outcomes for children ages 0-3 years in Barnstable County. The objectives of Strong from the Start is to strengthen families, reduce achievement and word gaps and provide children with the social, emotional and language skills to thrive in school and in life. CCHC Community Benefits built a coalition of more than 50 community organizations to support the Quality of Life Initiative. The initiative provided guest speakers, materials and helpful tools to educate the community about the importance of advance care planning. In addition, CCHC Community Benefits joined a coalition of more than 30 organizations called Healthy Aging Cape Cod. Led by Barnstable County Department of Human Services, the purpose of the coalition is to undertake regional planning that supports our aging demographic and aligns local efforts with statewide efforts to build an Age and Dementia-friendly Massachusetts. Healthy Parks, Healthy People, a program supported through a collaboration between Cape Cod Healthcare, the US National Park Service, and the Cape Cod National Seashore, continued with its focus on promoting open space for physical activity and wellness. Activities included educational events by CCHC physicians and physical therapists, a walking program, and a 5K walk/run for residents and visitors of Cape Cod. CCHC Community Benefits grants supported elder suicide prevention trainings through the Samaritans of Cape Cod, HPV vaccination and cervical cancer education for providers, parents and youth by Team Maureen and chronic disease and mindfulness programs at local family homeless shelters by Housing Assistance Corporation on Cape Cod. In addition to these FY18 hospital initiatives, community collaborations, and grant investments, CCHC Community Benefits continued to play leadership roles in health and human service organizations and coalitions across our region. These included, but were not limited to, the Barnstable County Economic Development Council, Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Cape Cod Chamber of Commerce, and the Cape & Islands Community Health Area Network (CHNA 27) Steering Committee. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEMS ROLES: THE HOSPITALS ARE PART OF AN AFFILIATED HEALTHCARE SYSTEM AND THEIR RESPECTIVE ROLES ARE: CAPE COD HOSPITAL - A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN HYANNIS,MASSACHUSETTS FALMOUTH HOSPITAL ASSOCIATION, INC. - A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN FALMOUTH, MASSACHUSETTS CAPE COD HEALTHCARE, INC. - A NOT-FOR-PROFIT CORPORATION THAT SERVES AS THE PARENT COMPANY OF VARIOUS ENTITIES PROVIDING HEALTH CARE SERVICES TO THE POPULATION OF CAPE COD, MASSACHUSETTS CAPE COD HEALTHCARE FOUNDATION,INC. - A NOT-FOR-PROFIT CORPORATION ORGANIZED TO PROVIDE DEVELOPMENT AND FUNDRAISING SUPPORT TO CAPE COD HEALTHCARE CAPE AND ISLANDS HEALTH SERVICES II, INC. - A NOT-FOR-PROFIT CORPORATION ORGANIZED TO PROVIDE VARIOUS NON-HOSPITAL HEALTH CARE SERVICES MEDICAL AFFILIATES OF CAPE COD, INC. - A NOT-FOR-PROFIT MEDICAL GROUP PRACTICE VISITING NURSE ASSOCIATION OF CAPE COD - A NOT-FOR-PROFIT PROVIDER OF HOME HEALTH SERVICES CAPE COD HUMAN SERVICES, INC. - A NOT-FOR-PROFIT PROVIDER OF OUTPATIENT MENTAL HEALTH SERVICES FALMOUTH ASSISTED LIVING, INC., D/B/A HERITAGE AT FALMOUTH - A NOT-FOR-PROFIT CORPORATION THAT OWNS AN ASSISTED LIVING FACILITY JML CARE CENTER, INC. - A NOT-FOR-PROFIT SKILLED NURSING AND REHABILITATION FACILITY CAPE COD RESEARCH INSTITUTE - A NOT-FOR-PROFIT THAT CONDUCTS CLINICAL RESEARCH AND RELATED EDUCATIONAL ACTIVITIES CAPE HEALTH INSURANCE COMPANY - A CAPTIVE INSURANCE COMPANY THAT PROVIDES MEDICAL PROFESSIONAL AND GENERAL LIABILITY INSURANCE TO CAPE COD HEALTHCARE CAPE COD HOSPITAL MEDICAL OFFICE BUILDING - A PROVIDER OF LEASED AND SUBLEASED SPACE TO CAPE COD HOSPITAL AND RELATED AFFILIATIONS PART VI, LINE 7 ALL STATES WHERE ORGANIZATION FILES A COMMUNITY BENEFITS REPORT: MA true Cape Cod Council of Churches 81 Willow Ave Hyannis MA 02601 042382479 501(c)(3) 5400 FMV N/A Behavioral Health AIDS Support Group of Cape Cod PO BOX 1522 Provincetown MA 02657 042908722 501(c)(3) 28013 FMV N/A Chronic and Infectious Disease Alzheimer's Family Caregiver Support Center Inc 309 Waverly Oaks Rd Waltham MA 02452 133039601 501(c)(3) 30000 FMV N/A Chronic and Infectious Disease TOWN OF BARNSTABLE 367 MAIN ST Hyannis MA 02601 046001079 GOV'T 22000 FMV N/A Access to Healthcare BC Sheriff Dept Community Mental Health Initiative 6000 SHERIFFS PL Bourne MA 02532 466002284 GOV'T 60000 FMV N/A Behavioral Health Cape Cod Coop ExtBCHS RSAC PO BOX 427 Barnstable MA 02630 046001419 GOV'T 42000 FMV N/A Behavioral Health & Chronic Disease C&I United Way Strong from Start Initiative PO BOX 367 CENTERVILLE MA 02632 042271714 501(c)(3) 17500 FMV N/A Prevention and Wellness Cape Cod Healthcare Inc 297 North St Hyannis MA 02601 222600704 501(c)(3) 24945 FMV N/A General Support Cape Cod Times Needy Fund PO BOX 804 Hyannis MA 02601 222480332 501(c)(3) 15000 FMV N/A Chronic and Infectious Disease Cape Wellness Collaborative 11 Potter Ave Hyannis MA 02601 472360979 501(c)(3) 30000 FMV N/A Chronic and Infectious Disease CC Child Development - Hospital to Home Program 83 Pearl St Hyannis MA 02601 237324732 501(c)(3) 12300 FMV N/A Behavioral Health CYRACOM LLC 5780 N SWAN RD Tucson AZ 85718 271261982 28537 FMV N/A Access to Healthcare Duffy Health Center 94 MAIN ST Hyannis MA 02601 043373741 501(c)(3) 91000 FMV N/A Behavioral Health Prevention and Wellness Gosnold on Cape Cod 200 TER HEUN DRIVE Falmouth MA 02540 042502970 501(c)(3) 125000 FMV N/A Behavioral Health Harbor Health Services Inc 1135 MORTON ST MATTAPAN MA 02126 237100550 501(c)(3) 134000 FMV N/A Behavioral Health Helping our Women 34 CONWELL ST Provincetown MA 02657 043179955 501(c)(3) 6000 FMV N/A Chronic Disease Housing Assistance Corp 460 W MAIN ST Hyannis MA 02601 237431255 501(c)(3) 17743 FMV N/A Prevention and Wellness NAMI Cape Cod 5 MARK LANE Hyannis MA 02601 042785229 501(c)(3) 30000 FMV N/A Prevention and Wellness Outer Cape Health Services PO BOX 1413 WELLFLEET MA 02667 042509828 501(c)(3) 61500 FMV N/A Access to Healthcare Samaritans on Cape Cod & the Islands PO BOX 65 Falmouth MA 02541 042738811 501(c)(3) 12168 FMV N/A Prevention and Wellness Team Maureen PO Box 422 N Falmouth MA 02556 452473500 501(c)(3) 27650 FMV N/A Chronic and Infectious Disease Town of Yarmouth Health Dept 1146 ROUTE 28 S Yarmouth MA 02664 046001377 GOV'T 5660 FMV N/A Prevention and Wellness Umass Lab of Medical Zoology 333 South St Ste 450 Shrewsbury MA 01545 043167352 501(c)(1) 29580 FMV N/A Chronic Disease Wellstrong 385 Welliott Rd Centerville MA 02632 811935657 501(c)(3) 10000 FMV N/A Behavioral Health YMCA Cape Cod - Livestrong 12245 IYANNOUGH RD W Barnstable MA 02668 042394925 501(c)(3) 29500 FMV N/A Chronic and Infectious Disease 23 2 SCHEDULE I, PART I, LINE 2 THE ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN THE U.S. CONSISTS OF FOLLOWING THE HUD GUIDELINES SET BY THEM. true true false false false false false true false MICHAEL K LAUF PRESIDENT/CEO/TRUSTEE 0 991489 0 1488900 0 192589 0 249053 0 40291 0 2962322 0 102000 ROBERT WILSTERMAN MD TRUSTEE 770101 0 19060 0 2772 0 25080 0 35701 0 852714 0 0 0 WILLIAM AGEL MD TRUSTEE 448809 0 58422 0 16174 0 10800 0 33877 0 568082 0 0 0 THEODORE CALIANOS MD TRUSTEE 370781 0 6387 0 1806 0 10800 0 32367 0 422141 0 0 0 PAUL HOULE MD TRUSTEE 932685 0 165440 0 966 0 27506 0 34701 0 1161298 0 0 0 MICHAEL L CONNORS SENIOR VP FINANCE/CFO 0 431607 0 77850 0 30455 0 55606 0 37211 0 632729 0 19481 MICHAEL G JONES ESQ SEE SCH O FOR TITLE 0 316680 0 76632 0 19138 0 43278 0 35061 0 490789 0 15965 MICHAEL BUNDY COO 0 368843 0 83500 0 630 0 24508 0 32765 0 510246 0 0 DONALD A GUADAGNOLI MD CMO CAPE COD HOSPITAL 0 412488 0 83475 0 33082 0 54775 0 30563 0 614383 0 21001 ALEXANDER HEARD MD CHIEF MEDICAL OFFICER - FH 84330 442806 0 167877 0 630 3066 28695 0 35911 87396 675919 0 0 PATRICK J KANE SVP OF MRKTG,COMMUN AND DEVLP 0 304840 0 70684 0 19589 0 28480 0 3025 0 426618 0 15450 CHRISTIAN BROWN SR VP MANAGED CARE 0 300781 0 69769 0 22490 0 46069 0 33877 0 472986 0 13000 EMILY SCHORER SVP HUMAN RESOURCES 0 257318 0 62220 0 11735 0 24581 0 34329 0 390183 0 10345 KEVIN RALPH SVP DEVELOPMENT 0 242777 0 49688 0 4561 0 24086 0 36042 0 357154 0 3646 THERESA M AHERN SVP, STRAT, COMMUNITY/GOV REL. 0 250297 0 68625 0 15760 0 40619 0 22443 0 397744 0 11500 KEVIN J MULROY SVP CHIEF QUALITY & SAFETY OFF 0 368757 0 80782 0 24939 0 40051 0 35061 0 549590 0 15875 JEANNE FALLON SR VP & CIO (UNTIL 4/11/17) 0 77946 0 0 0 238835 0 13364 0 9124 0 339269 0 12650 JEFFREY S DYKENS VP FINANCE & OPERATIONS 0 246358 0 41876 0 22747 0 28158 0 36169 0 375308 0 12000 NOELENE CERVIN VP BUDGETING & OPER. SUPPORT 0 216358 0 39050 0 6971 0 25269 0 33597 0 321245 0 0 LORI JEWETT CEO - FH 0 239990 0 37800 0 9418 0 40818 0 1525 0 329551 0 4000 DIANNE C KOLB PRESIDENT VNA (UNTIL 8/8/17) 0 131411 0 0 0 37163 0 22480 0 15897 0 206951 0 10403 CARTER HUNT ADMIN SPEC&HOSP BASED CARE 0 194445 0 18713 0 2977 0 27409 0 37006 0 280550 0 0 VICTOR OLIVEIRA VP PATIENT SVCS(UNTIL 3/17) 0 61085 0 0 0 180858 0 22988 0 13145 0 278076 0 11575 RICHARD B ZELMAN MD PHYSICIAN 1393164 0 100000 0 56618 0 10800 0 37211 0 1597793 0 0 0 ACHILLES PAPAVASILIOU MD PHYSICIAN 932608 0 189045 0 630 0 28800 0 34701 0 1185784 0 0 0 NICHOLAS COPPA MD PHYSICIAN 930737 0 151545 0 420 0 28800 0 36572 0 1148074 0 0 0 GORDON NAKATA MD PHYSICIAN 932608 0 140000 0 630 0 27938 0 34701 0 1135877 0 0 0 PHILLIP J DOMBROWSKI MD PHYSICIAN 697101 0 50000 0 25849 0 10800 0 1525 0 785275 0 0 0 JUDITH C QUINN VP OF PATIENT CARE 0 217129 0 39228 0 23368 0 24308 0 25533 0 329566 0 10700 SCHEDULE J, PART I, LINE 4A Jeanne Fallon, Sr. VP and CIO until 4/11/17, received severance payments of $173,208 during calendar year 2017. The arrangement provides for continued payment of the individual's salary and benefits for a period of 15 months, including medical and dental insurance coverage. Victor Oliveira, VP of Patient Services until 3/17, received severance payments of $124,000 during calendar year 2017. The arrangement provides for continued payment of the individual's salary and benefits for a period of 12 months, including medical and dental insurance coverage. SCHEDULE J, PART I, LINE 4B - 457(F) CAPE COD HEALTHCARE, INC. AND AFFILIATES SPONSORS A 457(F) VOLUNTARY PERSONAL DEFERRAL PLAN ("THE PLAN") FOR KEY EXECUTIVES. VESTING IS DEFERRED FOR AT LEAST TWO YEARS FROM THE DATE OF THE AWARD. THE PLAN OFFERS PARTICIPATING EMPLOYEES AN ANNUAL DEFERRAL OF CASH COMPENSATION. AMOUNTS DEFERRED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND AMOUNTS PAID UNDER THE PLAN DURING CALENDAR YEAR 2017 WERE AS FOLLOWS: - MICHAEL K. LAUF - $72,613 - MICHAEL G. JONES - $17,333 - MICHAEL L. CONNORS - $19,258 - DIANNE C. KOLB - $31,969 - JEANNE FALLON - $36,138 - JEFFREY S. DYKENS - $12,704 - PATRICK KANE - $16,817 - THERESA AHERN - $12,988 - VICTOR OLIVEIRA - $36,745 - DONALD GUADAGNOLI MD - $22,232 - EMILY SCHORER - $11,105 - KEVIN MULROY - $16,762 - CHRISTIAN BROWN - $13,853 - LORI JEWETT - $4,173 - JUDITH C. QUINN - $11,327 - KEVIN RALPH - $3,931 CAPE COD HEALTHCARE, INC. AND AFFILIATES ALSO SPONSOR A NONQUALIFIED PENSION RESTORATION ACCOUNT PLAN FOR KEY EXECUTIVES. THE ORGANIZATION MAKES CONTRIBUTIONS OF TWO PERCENT OF THE INDIVIDUAL'S ANNUAL SALARY (INCLUDING BONUS) THROUGHOUT THE PLAN YEAR. AMOUNTS DEFERRED ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND UNDER THE PLAN, PARTICIPANTS ARE ENTITLED TO CERTAIN BENEFITS UPON RETIREMENT, TERMINATION, OR DEATH. During calendar year 2017, Michael Lauf also participated in a Section 457(f) plan. Twelve percent of his base salary was contributed and each contribution is subject to a three year vesting schedule. The amount deferred in calendar year 2017 was $120,000 and is included in Schedule J, Part II, Column (C). IN ADDITION, $100,146 WAS PAID OUT FROM HIS CEO SUPPLEMENTAL PLAN, AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III). SCHEDULE J, PART I, LINE 7 Discretionary bonuses are awarded annually based upon both the performance of the organization and the individual. Bonuses are reflected in Schedule J, Part II, Column B(ii). THE INDIVIDUALS REPORTED IN SCHEDULE J, PART II REPORTED AS BEING PAID FROM A RELATED ORGANIZATION WERE EMPLOYEES OF, AND COMPENSATED BY CAPE COD HEALTHCARE, INC., THE PARENT CORPORATION. A MHEFA REVENUE BONDS SERIES E 042456011 000000000 2012-01-12 29440000 REISSUE SER E (6/18/08 & 2/12/09) false false false B MHEFA REVENUE BONDS SERIES 2012A 043431814 000000000 2012-02-24 25800000 REFUND SER B(8/15/98)& C(11/15/01) false false false C MDFA REVENUE BONDS SERIES 2013 043431814 57584VAH8 2013-07-11 50831729 REFUND SER C(10/9/01) & CAP.IMPR. false false false D MDFA REVENUE BONDS SERIES 2014 043431814 000000000 2014-09-29 24000000 RENOVATION & REAL ESTATE PURCHASE false false false A 19626666 0 29440000 0 0 0 0 0 0 0 29440000 0 2012 true false true true B 15480000 0 25800000 0 0 0 336100 0 0 0 25463900 0 2012 true false true true C 0 0 50843109 0 1295804 0 803269 0 0 27999812 20735223 0 2014 true false true true D 1400000 0 24001267 0 0 0 0 241456 0 0 23759811 0 2015 false false true true A 0 true B 0 true C false false false 0 false false false true D false false false 0 false false false true A false false true true true false 0 false 0 false true B false false true true false false 0 false 0 false true C false false true true false false 0 false 0 false true D false false false true false false 0 false 0 false true A true B true C true D true PART IV, LINE 2(C) THE DATE THE REBATE COMPUTATIONS WERE LAST PERFORMED FOR EACH BOND ARE BELOW: MDFA, REVENUE BONDS, SERIES E - 07/12/2012 MDFA, REVENUE BONDS, SERIES 2012A - 06/30/2016 MDFA, REVENUE BONDS, SERIES 2013 - 06/30/2018 MDFA, REVENUE BONDS, SERIES 2014 - 08/31/2015 SINCE THE BOND PROCEEDS HAVE BEEN SPENT FOR EACH BOND AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. A MDFA REVENUE BONDS SERIES 2017 043431814 000000000 2017-02-01 52315359 REFUND SERIES D(2/16/2010) false false false A 2888555 0 53492970 0 0 48449645 302138 0 0 106973 4634214 0 2017 false true true true A false false false 0 false false false true A false true false false true false 0 false 0 false true A true DR KATIE RUDMAN SPOUSE OF TRUSTEE 116158 MACC EMPLOYEE false Sarah K Guadagnoli RN DAUGHTER OF KEY EMPLOYEE 65484 CCH EMPLOYEE false X 79 1163954 VALUE OF STOCK REC'D 0 false true true SCHEDULE M, PART I, COLUMN (B) THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS RECEIVED. SCHEDULE M, PART I, LINE 32(A) ON OCCASION THE ORGANIZATION UTILIZES A BROKER TO DISPOSE OF NONCASH CONTRIBUTIONS (OTHER THAN PUBLICLY TRADED SECURITIES). FORM 990, PART I, LINE 1 AND PART III, LINE 1 WE WILL BE THE HEALTH SERVICE PROVIDER OF CHOICE FOR CAPE COD RESIDENTS BY ACHIEVING AND MAINTAINING THE HIGHEST STANDARDS IN HEALTH CARE DELIVERY AND SERVICE QUALITY. TO DO SO, WE WILL PARTNER WITH OTHER HEALTH AND HUMAN SERVICE PROVIDERS AS WELL AS INVEST IN NEEDED MEDICAL TECHNOLOGIES, HUMAN RESOURCES AND CLINICAL SERVICES. ABOVE ALL, WE WILL HELP IDENTIFY AND RESPOND TO THE NEEDS OF OUR COMMUNITY. Community Benefits Mission Statement Cape Cod Healthcare, Inc., (CCHC) through its Community Benefits initiatives, is committed to enhancing the quality of and access to comprehensive health care services for all residents of Cape Cod. Through continuous assessment of community needs, coordinated planning and the allocation of resources, this commitment includes a special focus on the unmet needs of the financially disadvantaged and underserved populations. We will take a leadership role in collaborative efforts joining our resources, talent, and commitment with that of other providers, organizations and community members. The Community Benefits Mission Statement was affirmed by the CCHC Community Health Committee and the Board of Trustees in 2000 and remains in effect. Target Populations Name of target population: Individuals managing or at risk of developing chronic and infectious diseases such as cancer, cardiovascular disease, Alzheimer's disease and dementia, Hepatitis C, diabetes and tick-borne diseases. Basis for Selection: Aligned with state and national health priorities, Barnstable County residents managing chronic diseases are at the greatest risk of declined health and death. Cancer, cardiovascular disease, Alzheimer's disease/dementia, Hepatitis C, diabetes and tick-borne diseases were identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report as diseases of particular concern for the region. Name of target population: Residents facing barriers to care due to language, cost, or age, including those who are uninsured or under-insured. Basis for Selection: The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report identified specific target populations that encounter barriers to care or gaps in coverage despite high rates of insured residents in Barnstable County. The report specifically identified children ages 0-17 years, individuals lacking year-round employment, seniors living on a fixed income, seasonal workers, and foreign-born residents who do not meet eligibility criteria for Mass Health enrollment. Name of target population: Individuals with mental health disorders, substance use disorders and co-occurring disorders. Basis for Selection: Access to, and availability of, community-based behavioral health care in Barnstable County is an area of concern. This is evidenced by high rates of patients presenting with mental health and substance use disorders in hospital emergency departments. Specific challenges reported by the community and included in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report include a shortage of psychiatric providers, wait times for outpatient appointments, limited inpatient treatment options for substance use, and insurance barriers to care. Name of target population: Senior population, ages 65 and older. Basis for Selection: According to the U.S. Census Bureau, American Community Survey five year population estimates (2012-2016), nearly 28% of the year round population in Barnstable County is over the age of 65. Increasing consumption of and need for health care services, concerns of social isolation, availability of appropriate housing and transportation, and access to healthy and adequate food were specific challenges identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report for residents over the age of 65. Name of target population: Youth and young adults, ages 15 to 24 years old. Basis for Selection: Youth and young adults, ages 15-24 years old, were identified in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report as a specific at-risk population due to increasing rates of substance use treatment admissions and concerning health risk behaviors. Publication of Target Populations Annual Report Hospital/HMO Web Page Publicizing Target Pop. https://www.capecodhealth.org/about/caring-for-our-community/community-hea lth-needs-assessment-implementation-plans/ Key Accomplishments of Reporting Year The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan served as the foundation for CCHC's FY18 Community Benefits program. CCHC's Community Benefits activities focused on the four health priorities identified in the report: chronic and infectious disease, behavioral health, access to care, and disease prevention and wellness. New and expanded hospital programs were developed in alignment with implementation goals, objectives and strategies for each priority. CCHC supported partnerships with over 50 local non-profit health and human service organizations, and a network of federally qualified health centers, through project support and grant investments to improve the health of Barnstable County residents. Hospital staff dedicated time and expertise to strategic partnerships, coalitions, and task force efforts locally, regionally, and across Massachusetts. Chronic and Infectious Disease Prevention, screening, detection, and management of chronic and infectious diseases were supported through a variety of CCHC Community Benefits activities. Hospital cancer support services including counseling, support groups, and survivorship activities for patients and caregivers were complemented with a new Oncology Nutrition program, which started in February 2018. The successful Living Fit for You! Cancer Wellness Program at Falmouth Hospital was expanded in August 2018 to include Cape Cod Hospital's campus. The program provides free of charge rehabilitation, wellness consultations, exercise, and education services to help adults undergoing cancer treatment manage fatigue, de-conditioning and loss of physical function. CCHC Community Benefits also provided grants to the Cape Wellness Collaborative and YMCA Cape Cod LIVESTRONG program to ensure that patients undergoing and recovering from cancer treatment had access to community-based wellness programs and complementary services such as massage, acupuncture, yoga and nutritional counseling. The CCHC Integrated Cancer Committee, comprised of physicians, nurses and support staff, conducted educational campaigns and community outreach events. These events informed youth about the risks of tobacco use and the general public about skin cancer prevention, including high-risk screening opportunities. CCHC clinical teams provided disease education, rehabilitation and pathways to chronic disease self- management for individuals living with congestive heart failure, chronic pulmonary diseases, and diabetes. A Community Benefits grant to the Cape Cod Times Needy Fund provided assistance for basic needs such as housing and utility payments, transportation, adaptive medical equipment, and child care specifically for individuals managing a chronic disease. A CCHC Community Benefits grant supported the Alzheimer's Family Caregiver Support Centers expanding free counseling for families and caregivers in outposts across the Outer, Lower, Mid, and Upper regions of Cape Cod. In addition, the organization now hosts concurrent weekly support group meetings for individuals with Alzheimer's disease and their caregivers at Cape Cod Hospital. CCHC provided funding for two innovative community-based programs to support tick-borne disease education in FY18. Through a partnership with the UMASS Laboratory of Medical Zoology, CCHC was the only hospital system in MA to subsidize tick testing for residents within a hospital service area. CCHC also partnered with the Cape Cod Cooperative Extension to produce a 10-part online video series titled "Tickology" to provide easily accessible community education on tick disease prevention. CCHC Infectious Disease Clinical Services is the recipient of federal and state Ryan White grant funding to support comprehensive primary medical care and medical case management for individuals with HIV/AIDS living in Barnstable County. CCHC, through partnerships with other local organizations, aligned local efforts to meet National HIV/AIDS Strategy and the Massachusetts Integrated HIV Prevention and Care Plan to reduce the number of new HIV infections, increase access to care, improve health outcomes for individuals living with HIV/AIDS, and reduce HIV-related health inequities and disparities. Behavioral Health CCHC Community Benefits expanded hospital-based services and collaborations with local federally qualified health centers and behavioral health providers to strengthen regional services and community resources for individuals with mental health and substance use disorders. CCHC's Centers for Behavioral Health joined the MA Department of Public Health and MA Department of Mental Health on the Zero Suicide Initiative to increase suicide prevention and reduce suicide deaths on Cape Cod. CCHC also provides a Community Crisis Line, staffed by clinicians, offering free and confidential emotional support and referral assistance for individuals in crisis and their families. CCHC Community Benefits funded a community wide Mental Health First Aid Training project in partnership with the National Alliance on Mental Illness (NAMI) Cape Cod, which resulted in 13 certified instructors to train exponentially more people in the evidence-based program in our community. CCHC Community Benefits provided grants to three federally qualified health centers on Cape Cod. Duffy Health Center, Harbor Community Health Center- Hyannis, and Outer Cape Health Services received grants supporting integrated behavioral health services, establishing an Office Based Addiction Treatment program and continuation of a community navigator program that assists individuals most at risk in our region. Through a partnership with, and grant to Gosnold, Inc., CCHC Community Benefits expanded the Recovery Specialist program in the emergency departments at Cape Cod Hospital and Falmouth Hospital. The program provides peer-led recovery engagement services for patients with Substance Use Disorders. Recovery Specialists work as part of the emergency departments' care teams to motivate patients to accept treatment upon discharge from the emergency departments. Additional funding to Gosnold, Inc. provided Recovery Coaching scholarships for 30 individuals who completed treatment for their Substance Use Disorder. Recovery Coaches assist individuals with building recovery support systems and improving outcomes related to employment, housing, legal and life skills. Cape Cod Hospital received grant funding from Massachusetts Department of Public Health to provide assistance to pregnant women with Opioid Use Disorders through the Moms Do Care program. The program provides peer-led services to obtain prenatal care, substance use treatment, and address social determinant of health issues. At the conclusion of the grant, CCHC supported transitioning the program to the Duffy Health Center with a Community Benefits grant, and CCHC remains a strategic collaborator on the project. CCHC staff from the maternity and pediatric departments at Cape Cod Hospital and Falmouth Hospital actively participated in statewide initiatives by the Neonatal Quality Improvement Collaborative of MA. Initiatives included staff development and piloting new models of care for newborns and families impacted by perinatal opioid use and neonatal abstinence syndrome. Access to Care In FY18, CCHC continued to invest significantly in expanding access to care for vulnerable and medically underserved populations in Barnstable County. CCHC Community Benefits continued its grant support of the Specialty Network for the Uninsured (SNU) program in Barnstable County. The SNU program coordinates appointments and follow-up care with local medical specialists for uninsured and under-insured patients in our region, reducing barriers to local access and addressing gaps in specialty services not offered by local community health centers. Through the Community Based Interpreters program, CCHC Community Benefits funding provided free medical interpreter services for limited-English speaking patients in community-based primary and specialty care offices across the region. In partnership with the Cape and Islands Emergency Medical Services System, CCHC expanded the impact of medical interpreter services in pre-hospital settings. CCHC provides training and funding for phone-based interpreter services that connect paramedics and first responders to interpreters via cell phones in ambulances to improve communication with limited-English speaking patients during transport to a hospital. Hospital social workers and case managers assisted low-income and vulnerable patients in need through direct referrals to community services, prescription assistance, and transportation vouchers upon discharge. Financial counselors at Cape Cod Hospital and Falmouth Hospital were available to all Barnstable County residents to assist with health insurance questions and needs including Mass Health and Medicare coverage applications and renewal assistance. CCHC has been at the forefront of establishing strategic relationships ensuring a strong and skilled future allied health workforce in our region. Cape Cod Community College and Cape Cod Healthcare Nursing Education Collaborative is a program that expands opportunities for education, clinical training, and employment, as well as RN student debt relief and career exploration pathways for high school students. In several clinical departments including behavioral health, radiology, and laboratory services across both hospitals, clinicians provide supervision, training, and job shadowing for students from UMASS Medical School, regional community colleges, and local vocational and technical schools. Disease Prevention and Wellness In FY18, Cape Cod Healthcare efforts focused on building partnerships and support for community based prevention and wellness initiatives impacting residents across the lifespan from infants to seniors. CCHC Community Benefits expanded efforts supporting new families. Expanded efforts included prenatal and parenting classes in English and Portuguese, support groups for new mothers, fatherhood initiatives, and a breastfeeding warm-line that provided families with phone support for questions related to breastfeeding. CCHC also partnered with a local Early Intervention program to provide pre-discharge meetings with Early Intervention staff. Early Intervention staff educated parents about services and supports available to infants, young children and their families through the program. Through a partnership with the Cape & Islands United Way, CCHC Community Benefits supported the Strong from the Start Initiative aimed at improving the social, emotional and developmental outcomes for children ages 0-3 years in Barnstable County. The objectives of Strong from the Start is to strengthen families, reduce achievement and word gaps and provide children with the social, emotional and language skills to thrive in school and in life. CCHC Community Benefits built a coalition of more than 50 community organizations to support the Quality of Life Initiative. The initiative provided guest speakers, materials and helpful tools to educate the community about the importance of advance care planning. In addition, CCHC Community Benefits joined a coalition of more than 30 organizations called Healthy Aging Cape Cod. Led by Barnstable County Department of Human Services, the purpose of the coalition is to undertake regional planning that supports our aging demographic and aligns local efforts with statewide efforts to build an Age and Dementia-friendly Massachusetts. Healthy Parks, Healthy People, a program supported through a collaboration between Cape Cod Healthcare, the US National Park Service, and the Cape Cod National Seashore, continued with its focus on promoting open space for physical activity and wellness. Activities included educational events by CCHC physicians and physical therapists, a walking program, and a 5K walk/run for residents and visitors of Cape Cod. CCHC Community Benefits grants supported elder suicide prevention trainings through the Samaritans of Cape Cod, HPV vaccination and cervical cancer education for providers, parents and youth by Team Maureen and chronic disease and mindfulness programs at local family homeless shelters by Housing Assistance Corporation on Cape Cod. In addition to these FY18 hospital initiatives, community collaborations, and grant investments, CCHC Community Benefits continued to play leadership roles in health and human service organizations and coalitions across our region. These included, but were not limited to, the Barnstable County Economic Development Council, Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Cape Cod Chamber of Commerce, and the Cape & Islands Community Health Area Network (CHNA 27) Steering Committee. Plans for Next Reporting Year Annual Community Benefits plans for Cape Cod Hospital, Falmouth Hospital and Cape Cod Healthcare reflect the priorities, goals and objectives embedded in the three-year implementation strategies included in the 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan. CCHC Community Benefits FY17-FY19 Goals: 1.Improve chronic and infectious disease prevention and management to meet the growing needs of an aging and at-risk population. 2.Strengthen regional health services and community resources for individuals with mental health conditions, substance use, co-occurring disorders, and comorbidities. 3.Reduce barriers to care and strengthen the regional health safety net for vulnerable populations. 4.Improve the health and disease prevention of all residents of Barnstable County and sustain the wellness of seniors and caregivers. 5.Support regional health efforts through direct grant funding and a competitive RFP grants program with funding guidelines that are aligned WITH COMMUNITY BENEFITS PRIORITIES AND TARGET POPULATIONS. 6.Strengthen regional collaboration and maintain leadership roles with the following community-based coalitions: Barnstable County Human Services Advisory Council, Barnstable County Regional Substance Use Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Community Health Area Network (CHNA 27) and Healthy Aging Cape Cod. Community Benefits Process Community Benefits Leadership/Team Cape Cod Healthcare, Cape Cod Hospital and Falmouth Hospital, along with our affiliates, strive to be the health service provider of choice for Barnstable County residents and visitors by achieving and maintaining the highest standards in healthcare delivery and service quality. To do so, we partner with other health and human service providers from across the region and invest in needed medical technologies, developing the current and future workforce and clinical services. The development of Cape Cod Healthcare's strategic initiatives and community collaborations, including the Community Benefits program, is led by Michael K. Lauf, Chief Executive Officer and Theresa M. Ahern, Senior Vice President, Strategy, Community and Governmental Affairs. Michael L. Connors, Cape Cod Healthcare's Chief Financial Officer, provides fiscal oversight of the Community Benefits reporting process. The Community Health Committee, a designated subcommittee of Cape Cod Healthcare's Board of Trustees, serves as the Community Benefits Advisory Council and provides strategic oversight to the program. The Committee is comprised of leaders of health and human services organizations, community health centers, county government, and community-based organizations representing residents across a spectrum of ages, socioeconomic status, and racial, cultural and ethnic diversity, as well as current members of the CCHC Board of Trustees. The Committee develops and recommends policies to the Cape Cod Healthcare Board of Trustees regarding Community Benefits programs, sets priorities, awards priority grant funding to community organizations, and advises on community health issues and initiatives including community health needs assessments and ongoing community engagement. FY18 Community Health Committee Members: Suzanne Fay Glynn, Esq. (Chair) CCHC Board Member Glynn Law Offices 49 Locust Street, Falmouth, MA 02540 508.548.8282 dar@glynnlawoffices.com Representing: CCHC Board of Trustees Elizabeth Albert Director Barnstable County Human Services P.O. Box 427, Barnstable, MA 02630 508.375.6626 balbert@barnstablecounty.org Representing: Regional health and human services community, regional network on homelessness, countywide substance use coalition and regional planning for aging demographics. Leo Blandford Director of Community-Based Coordinated Care Outer Cape Health Services 710 MA Route 28 Harwich Port, MA 02646 lblandford@outercape.org 508-905-2814 Representing: Federally Qualified Health Centers, Lower and Outer Cape region, behavioral health and substance use disorder services. Eleanor Claus Kinlin Grover Real Estate 927 Route 6A, Yarmouthport, MA 02675 508-362-3000 x203 eclaus@kinlingrover.com Representing: Community members at large. Alisa Galazzi Chief Executive Officer Housing Assistance Corporation on Cape Cod 460 West Main Street Hyannis, MA 02601 508-771-5400 agalazzi@haconcapecod.org Representing: Regional programs addressing homelessness, housing security, and development of attainable housing. Mary Devlin Public Health and Wellness Division Manager Visiting Nurse Association of Cape Cod 255 Independence Drive, Hyannis, MA 02601 508-957-7619 mdevlin@vnacapecod.org Representing: Regional public health programs with emphasis on chronic disease prevention and healthy aging of the senior population. Michael McGuire Director Cape Cod Cooperative Extension P.O. Box 367, Barnstable, MA 02630 508-375-6701 mmaguire@barnstablecounty.org Representing: Barnstable County initiatives related to nutrition, food safety, tick borne diseases, water quality protection and youth and family programs. Patricia Mitrokostas Director of Prevention Programs, Public Relations & Organizational Advancement Gosnold, Inc. 350 Gifford Street, Suite W-10, Falmouth, MA 02540 508-540-2317 pmitrokostas@gosnold.org Representing: Regional substance use prevention, intervention, and treatment programs for individuals and families. Stacie Peugh Chief Executive Officer YMCA Cape Cod 2245 Iyannough Rd, West Barnstable, MA 02668 508-362-6500 speugh@ymcacapecod.org Representing: Youth development, chronic disease management programs, wellness and prevention. Susan Travers Director Truro Council on Aging 7 Standish Way, North Truro 02652 508-487-2462 Stravers@truro-ma.gov Representing: Councils on Aging Serving Together (COAST), senior populations, and the Lower and Outer region of Barnstable County. Cape Cod Healthcare member: Theresa M. Ahern Senior Vice President, Strategy, Community and Governmental Affairs Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA 02601 774-470-5506 tahern@capecodhealth.org Community Benefits Team Meetings The FY18 Community Health Committee meetings were held on the following dates and times: November 7, 2017 9:00-11:00 am February 27, 2018 4:00-5:30 pm June 13, 2018 4:00-5:30 pm July 17, 2018 4:00-5:00 pm Community Partners AIDS Support Group of Cape Cod Alzheimer's Family Caregiver Support Center Arts Foundation of Cape Cod Barnstable County Cape Cod Cooperative Extension Services Barnstable County Department of Human Services Barnstable County Regional Substance Use Council Barnstable County Sheriff's Office Barnstable Public School District Behavioral Health Innovators Behavioral Health Provider Coalition of Cape Cod & the Islands Big Brothers Big Sisters of Cape Cod & the Islands Boys & Girls Club of Cape Cod Cape & Islands EMS Systems, Inc. Cape & Islands United Way Cape Cod Child Development Cape Cod Community College Cape Cod Foundation Cape Cod Hunger Network Cape Cod Medical Reserve Corps Cape Cod Times Needy Fund Cape Wellness Collaborative Caron Treatment Centers Children's Cove Community Health Network Area 27 Cape Cod & Islands (CHNA 27) Dance in the Rain Peer to Peer Mental Health Center Dream Day Cape Cod Duffy Health Center Falmouth Housing Corporation Family Pantry of Cape Cod Flower Angels USA Glenna Kohl Fund for Hope Good Grief Project Greater Hyannis Civic Association Hyannis Open Streets Project Gosnold, Inc. Harbor Community Health Centers Hyannis Healthy Aging Cape Cod Helping Our Women Housing Assistance Corporation Cape Cod Independence House Massachusetts Department of Public Health Massachusetts Department of Mental Health National Alliance on Mental Illness Cape Cod Outer Cape Health Services Parkinson Support Network of Cape Cod Pause A While Samaritans on Cape Cod and the Islands Shea's Youth Basketball Association Specialty Network for the Uninsured Sustainable CAPE Team Maureen Town of Barnstable Youth Commission Town of Yarmouth Park and Recreations Department United States National Park Service and Cape Cod National Seashore University of Massachusetts Laboratory of Medical Zoology University of Massachusetts Medical School WE CAN WellStrong YMCA Cape Cod Community Health Needs Assessment Date Last Assessment Completed and Current Status The 2017-2019 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report (CHNA Report) and Implementation Plan was released and made widely available to the public on September 30, 2016. Consultants/Other Organizations The following organizations participated in the 2017-2019 Cape Cod Hospital and Falmouth Hospital community health needs assessment project: AIDS Support Group of Cape Cod, Alzheimer's Family Support Center of Cape Cod, Arbor Counseling Services, Barnstable County Department of Health and Environment, Barnstable County Department of Human Services, Barnstable County Public Nursing Division, Barnstable County Regional Substance Use Council, Barnstable Public School System, Barnstable Town Council, Behavioral Health Provider Coalition of Cape Cod & the Islands, Boys & Girls Club of Cape Cod, Cape & Islands Emergency Medical Services System, Cape & Islands Suicide Prevention Coalition, Cape & Islands United Way, Cape Cod Center for Women, Cape Cod Child Development, Cape Cod Community College, Cape Cod Council of Churches, Cape Cod District Attorney's Office, Cape Cod Foundation, Cape Cod Neighborhood Support Coalition, Cape Cod WIC, Caron Treatment Center, CCHC Centers for Behavioral Health, CCHC Emergency Services, Child and Family Services, Children's Cove, Coalition for Children, Community Action Committee of Cape Cod & the Islands, Community Development Partnership, Community Health Center of Cape Cod, Community Health Network Area 27, Duffy Health Center, Elder Services of Cape Cod & the Islands, Emerald Physicians, Falmouth Human Services, Falmouth Public School System, Falmouth Service Center, Falmouth Together We Can Falmouth Volunteers in Public Schools, Glenna Kohl Fund for Hope, Gosnold, Inc., Harbor Community Health Center-Hyannis, Health Imperatives Cape Cod, Healthy Living Cape Cod, Helping Our Women, Homeless Prevention Council, HOPE Dementia & Alzheimer's Services of Cape Cod, Hope Health, Housing Assistance Corporation, Independence House, John Snow, Inc., Justice Resource Institute, Lyme Awareness of Cape Cod, MA Department of Mental Health, MA Department of Public Health, Mashpee Wampanoag Tribe Health Service Unit, Mother and Infant Recovery Network, National Alliance on Mental Illness Cape Cod, Outer Cape Health Services, Outer Cape Women Infants and Children (WIC), Samaritans on Cape Cod and the Islands, Sandpiper Nursery School, Sandwich Public School System, SHINE (Serving Health Information Needs of Everyone), Sight Loss Services, Spaulding Rehabilitation Hospital Cape Cod, Specialty Network for the Uninsured, Substance Use in Pregnancy Task Force, The Family Pantry of Cape Cod, Town of Brewster Health Department, Town of Falmouth Council on Aging, Town of Falmouth Health Department, Town of Mashpee Council on Aging, Town of Mashpee Human Services, Town of Provincetown Council on Aging, Town of Sandwich Council on Aging, Town of Truro Council on Aging, Vinfen, Visiting Nurse Association of Cape Cod, WE CAN, Yarmouth Police Department, and the YMCA Cape Cod. Data Sources CHNA, Community Focus Groups, Consumer Group, Hospital, Interviews, MassCHIP, Other, Public Health Personnel, Surveys, US Census: American Community Survey, Center for Disease Control and Prevention, Behavioral Health Risk Factor Surveillance System, and local and regional reports and studies on demographics, health conditions and community needs. CHNA Document - PDF format CCHC CHNA REPORT_2017-2019.PDF Implementation Strategy (optional) File Upload (optional) Not Specified Community Benefits Programs Annual Strategic Grants Program: Chronic and Infectious Disease and Prevention Program Type: Community Education, Community Participation/Capacity Building Initiative, Grant/Donation/Foundation/Scholarship, health Screening, Outreach to Underserved, Prevention, Support Group. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantaged Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Housing Stability/Homelessness, Mental Illness and Mental Health. DoN Health Priorities (optional): Built Environment, Housing. Target Population: Regions Served: County-Barnstable - Health Indicator: Immunization, Mental Health, Other: Cancer, Other: Elder Care, Other: First Aid/ACLS/CPR, Other: Hepatitis, Other: Homelessness, Other: Lyme Disease, Other: Nutrition, Other: Sexually Transmitted Diseases, Other: Stress Management, Physical Activity, Responsible Sexual Behavior - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Award up to $250,000 to local non-profit organizations operating quality programs with anticipated outcomes aligned with Cape Cod Hospital and Falmouth Hospital implementation strategies related to chronic and infectious diseases and prevention and wellness. Goal Status Eleven organizations received $250,474 in grants ranging from $5,400 to $30,000. The recipients of grant awards included AIDS Support Group of Cape Cod, A Baby Center, Alzheimer's Family Caregiver Support Center, Cape Cod Cooperative Extension, Cape Cod Times Needy Fund, Cape Wellness Collaborative, Housing Assistance Corporation on Cape Cod, National Alliance on Mental Illness Cape Cod, Samaritans on Cape Cod & the Islands, Team Maureen, and the YMCA Cape Cod. Partners - Partner Name, Description and Web Address AIDS Support Group of Cape Cod - www.asgcc.org Alzheimers Family Caregiver Support Center - www.alzheimerscapecod.org A Baby Center - www.ababycenter.org Cape Cod Cooperative Extension - www.capecodextension.org Cape Cod Times Needy Fund - www.needyfund.org Housing Assistance Corporation on Cape Cod - www.haconcapecod.org Cape Wellness Collaborative - www.capewellness.org Team Maureen - www.teammaureen National Alliance on Mental Illness Cape Cod - www.namicapecod Samaritians on Cape Cod & The Islands - www.capesamaritans.org YMCA Cape Cod - www.ymcacapecod.org Contact Information Mary Pumphery 297 North Street Building 3, 3rd Floor Hyannis, MA 02601 Phone: 774-470-5506 Detailed Description The FY18 Annual Strategic Grants Program was a competitive grant initiative with the objective to support community-based chronic and infectious disease and prevention and wellness projects aligned with two of the four health priorities identified in the FY17 - FY19 Cape Cod Hospital and Falmouth Hospital Community Health Needs Assessment Report and Implementation Plan. Grants were awarded to organizations with projects that reached vulnerable populations, maximized partnership collaboration and featured evidence-based programs or promising practices with the objective to improve the health of Barnstable County residents. Recovery Specialist Program in the Emergency Departments at Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services, Grant/Donation/Foundation/Scholarship, Outreach to Underserved. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, reducing Health Disparity. EOHHS Focus Issue(s) (optional): Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional): Social Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Mental Health, Other: Alcohol and Substance Abuse, Other: Hepatitis, Other: Uninsured/Underinsured, substance Abuse - Sex: All - Age Group: Adult, Adult-Elder, Adult-Young, All Adults - Ethnic Group: All - Language: All. Goal Description Engage and consult with at least 250 patients with Substance Use Disorders treated in the Emergency Departments at Cape Cod Hospital and Falmouth Hospital. Goal Status The Recovery Specialists provided consultations to 548 patients in Cape Cod Hospital and Falmouth Hospital Emergency Departments in FY18. Goal Description Motivate and assist 40% of patients who receive a consultation from the Recovery Specialist to accept a transfer to treatment or direct referral to treatment prior to discharge from the Emergency Department. Goal Status Seventy-six percent (76%) of the 548 patients who received Recovery Specialist consultation and engagement accepted direct transfer or direct referrals to inpatient/outpatient treatment upon discharge from the Emergency Departments. Treatment modalities included inpatient detoxification, hospital transfers, intensive outpatient programs, and Medication Assisted Treatment and Office-Based Addiction Programs. Goal Description Offer post-discharge follow-up and assistance to patients with Substance Use Disorders who refused services while in the Emergency Departments. Goal Status Post-discharge follow-up was offered to patients beginning in February of 2018. Two hundred and eighty-four (284) patients received post-discharge follow-up by phone including Specialists extending their assistance by coordinating referrals and treatment program placement. Twenty-six percent (26%) of those receiving post-discharge follow-up support accepted direct referrals to treatment. accepted direct referrals to treatment. Partner Name, Description and Web Address Gosnold, Inc. - www.gosnold.org Barnstable County Regional Substance Use Council - www.bchumanservices.net/initiatives/regional-substance-use-council/ Outer Cape Health Services - www.outercape.org Duffy Health Center - www.duffyhealthcenter.org Community Health Center of Cape Cod - www.chcofcapecod.org Harbor Community Health Center- Hyannis - www.hhsi.us/locations/harbor-community-health-center-hyannis/ Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description - Cape Cod Hospital and Falmouth Hospital partnered with Gosnold, Inc. to provide peer-led Recovery Specialist services in the Emergency Departments at both hospitals. Recovery Specialists have the lived experience of addiction and recovery and engage patients with Substance Use Disorders prior to discharge from the Emergency Departments. Recovery Specialists work as part of the hospital care team with the objective to motivate patients to accept treatment for Substance Use Disorders through a transfer to an inpatient treatment program or direct referrals to outpatient treatment programs. CCHC Cancer Support Services and Survivorship Activities Program Type: Community Education, Direct Services, Grant/Donation/Foundation/Scholarship, Support Group. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Built Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Other: Cancer, Other: Cancer - Breast, Other: Cancer - Cervical, Other: Cancer - Colo-rectal, Other: Cancer - Lung, Other: Cancer - Multiple Myeloma, Other: Cancer - Other, Other: Cancer - Ovarian, Other: Cancer - Prostate, Other: Cancer - Skin, Other: Cardiac Disease, Other: Cultural Competency, Other: Nutrition, Physical Activity - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Oncology Social Workers will provide psycho-social support to over 3,000 patients. Goal Status Oncology Social Workers provided services to more than 3,500 oncology patients. Services included direct counseling, family counseling, referrals to support services, referrals to support groups and financial counseling. Patients were provided direct referrals to the following community-based programs: transportation provided by the American Cancer Society's Road to Recovery Program and Lyft rides to appointments through Boston Cancer Support program, access to free complementary services such as massage, acupuncture and nutritional counseling through the Cape Wellness Collaborative, and physical reconditioning programs through CCHC's Living Fit for You! Cancer Wellness Program and the YMCA's LIVESTRONG program. Goal Description Support groups will be provided to patients and families. Goal Status More than 550 patients and family members attended CCHC support groups in FY18. Support groups included Leukemia and Lymphoma Society Family Support Groups, Support for People with Oral, Health, and Neck Cancers, Breast Cancer Support Groups and Ostomy Clinics. Support groups were facilitated by CCHC staff and hosted at CCHC facilities. Goal Description Host a Cancer Survivorship Day event to celebrate survivors, inspire those recently diagnosed and support families and caregivers. Goal Status The FY18 Survivorship Day event hosted more than 150 attendees and 25 volunteers from the CCHC Cancer Program. Support organizations, including The American Cancer Society, Team Maureen, and the Cape Wellness Collaborative provided information on prevention, support programs and self-care. CCHC employees donated 103 gift bags that were distributed to survivors. Goal Description Host a Cancer Survivorship Day event to celebrate survivors, inspire those recently diagnosed and support families and caregivers. Goal Status The FY18 Survivorship Day event hosted more than 150 attendees and 25 volunteers from the CCHC Cancer Program. Support organizations, including The American Cancer Society, Team Maureen, and the Cape Wellness Collaborative provided information on prevention, support programs and self-care. CCHC employees donated 103 gift bags that were distributed to survivors. Goal Description Through a grant from the American Cancer Society, CCHC will offer an Oncology Nutrition program to improve patients' quality of life and outcomes. Goal Status CCHC launched an Oncology Nutrition program and provided 1:1 counseling for 216 patients and their families with a Registered Dietitian through 300 visits. Services offered by the Oncology Nutrition program include meal planning for various diets and nutritional needs, assistance with initiating a tube feed for patients who are no longer able to consume foods orally, working closely with patient's care team to ensure adequate nutrition at patient's home, and providing local grocery store and local organic market gift cards for patients in need of additional monetary/dietary support. Partner Name, Description and Web Address American Cancer Society www.cancer.org/about-us/local/massachusetts.html YMCA Cape Cod LIVESTRONG www.ymcacapecod.org/programs/health-well-being/livestrong/ Cape Wellness Collaborative Visiting Nurse Association of Cape Cod Team Maureen www.capewellness.org/ www.vnacapecod.org www.teammaureen.org Boston Cancer Support www.bostoncancersupport.org Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description CCHC Cancer Support Services provides oncology patients and their families' psychological and social support during their treatment journey. A team of Oncology Social Workers provide ongoing counseling and support groups and direct referrals to services such as transportation, home care, and community-based wellness services such as reiki, acupuncture and massage. A new Oncology Nutrition program was started in FY18 and cancer survivorship is celebrated, supported and recognized within hospital departments and in the community. Living Fit for you! Cancer Wellness Program at Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Not Specified. Target Population: Regions Served: County-Barnstable - Health Indicator: Mental Health, Other: Cancer, Other: Cancer - Breast, Other: Cancer - Cervical, Other: Cancer - Colo-rectal, Other: Cancer - Lung, Other: Cancer - Multiple Myeloma, Other: Cancer - Other, Other: Cancer - Ovarian, Other: Cancer - Prostate, Other: Cancer - Skin, Other: Chronic Pain, Other: Nutrition, Physical Activity, - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Provide free group exercise program, 1:1 wellness counseling, oncology rehabilitation screenings and access to cancer survivorship programs for adults undergoing or recovering from treatment for cancer. Goal Status In FY18, 82 patients were referred to the program with 262 individualized exercise classes and wellness consults provided to address fatigue, de-conditioning, stress reduction, distress management, nutritional services, diabetes education and sleep issues. Goal Description Referrals will be made to appropriate services to continue rehabilitation and improved health outcomes. Goal Status The program referred nearly 90% of patients to additional rehabilitative services including pulmonary, cardiac, nutrition, speech and occupational therapy. Partner Name, Description and Web Address Cape Cod Healthcare - www.capecodhealth.org/classes-events Cape Wellness Collaborative - www.capewellness.org Contact Information: Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Living Fit for You! is a free, structured, and medically-supervised six-week exercise and education program for cancer survivors before, during or after treatment. Activities focus on improving fatigue, de-conditioning and a loss of physical function. The program was founded at Falmouth Hospital and expanded to include Cape Cod Hospital in August of 2018. Moms Do Care Cape Cod Program Type: Community Participation/Capacity Building Initiative, Direct Services, Grant/Donation/Foundation/Scholarship, Health Screening, Outreach to Underserved, School/Health Center Partnership, Support Group. Outreach to Underserved, School/Health Center Partnership, Support Group. Program Type: Community Participation/Capacity Building Initiative, Direct Services, Grant/Donation/Foundation/Scholarship, Health Screening, Outreach to Underserved, School/Health Center Partnership, Support Group. Outreach to Underserved, School/Health Center Partnership, Support Group Statewide Priority: Address Unmet Health Needs of the Uninsured, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): Housing Stability/Homelessness, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional): Built Environment, Employment, Housing, Social Environment. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Mental Health, Other: Alcohol and Substance Abuse, Other: Family Planning, Other: Homelessness, Other: Language/Literacy, Other: Nutrition, Other: Parenting Skills, Other: Uninsured/Underinsured, Substance Abuse, - Sex: Female- Age Group: All Adults - Ethnic Group: All - Language: English. Goal Description Provide prenatal and postpartum care coordination, access to MAT programs, and addiction recovery services to 75 pregnant women in Barnstable County. Goal Status Moms Do Care enrolled 62 women in the program. Substance use treatment and access to prenatal care services were coordinated by a Certified Addiction Registered Nurse and a Recovery Coach provided peer support services and assistance addressing social determinants of health such as housing and transportation. Goal Description Increase positive health outcomes for the women enrolled in program. Outcomes measured using baseline data included, but was not limited to, overdose rates, use of alcohol and illegal use of drugs and increased utilization of outpatient mental health and Medication-Assisted Treatment. Goal Status Advocates for Human Potential, an organization selected by MA Department of Public Health, served as the evaluator for Moms Do Care Cape Cod and Moms Do Care Worcester projects. From baseline reporting at the time of enrollment through follow-up interviews 6 months after their child was delivered, aggregated data from both sites demonstrated that Moms Do Care participants experienced a reduction in the number of overdoses, a reduction in the use of alcohol or illegal drugs, and increased utilization and adherence to mental health and substance use treatment services. Goal Description Develop a sustainability plan to continue program activities in the community at the project funding conclusion in July 2018. Goal Status CCHC worked closely with collaborators transitioning the program to Duffy Health Center in August of 2018. Duffy Health Center was awarded a MA DPH grant to continue the program starting in October 2018. CCHC provided a bridge grant of $21,000 to support the program during the transition and ensure program activities continued between grant cycles. CCHC remains a committed collaborator on the project and refers to the program from different clinical departments including hospital emergency and maternity departments, behavioral health departments, and obstetrical practices. Partner Name, Description and Web Address The Duffy Health Center - www.duffyhealthcenter.org Gandara Center - www.gandaracenter.org Institute for Health and Recovery - www.healthrecovery.org/projects/moms-do-care/ Massachusetts Department of Public Health: Bureau of Substance Addiction Services - www.mass.gov/orgs/bureau-of-substance-addiction-services Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Hospital received grant funds from the MA Department of Public Health to design and operate a program called Moms Do Care with the objectives of expanding access to substance use treatment, prenatal care and peer-based recovery support services for pregnant women with Opioid Use Disorders living in Barnstable County. Specialty Network for the Uninsured: Harbor Community Health Center Hyannis Program Type Grant/Donation/Foundation/Scholarship, Outreach to Underserved. Statewide Priority Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional) Not Specified. Target Population: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Arthritis, Other: Asthma/Allergies, Other: Cancer, Other: Cancer - Prostate, Other: Cardiac Disease, Other: Chronic Pain, Other: Colitis/Crohn Disease, Other: Cultural Competency, Other: Diabetes, Other: Family Planning, Other: Hearing, Other: Hepatitis, Other: Hypertension, Other: Language/Literacy, Other: Lyme Disease, Other: Osteoporosis/Menopause, Other: Parkinson's Disease, Other: Pregnancy, Other: Pulmonary Disease/Tuberculosis, Other: Stroke, Other: Uninsured/Underinsured, Other: Vision,- Sex: All - Age Group: All - Ethnic Group: All - Language: All, Portuguese, Spanish. Goal Description Increase access to specialty care for low-income, uninsured and under-insured individuals. Goal Status In FY18, SNU coordinated 518 appointments with local medical specialists for low-income, uninsured or under-insured individuals. The FY18 program experienced an increase of 5% over the number of visits provided in FY17. Goal Description Provide access to specialists for uninsured or under-insured residents who face language barriers to care. Goal Status The number of SNU participants requesting a medical interpreter during a specialty appointment nearly doubled from FY17 (10%) to FY18 (19%). In FY18, 81% of individuals requesting a medical interpreter requested Portuguese translation and 19% requested Spanish translation. Goal Description Analyze program utilization data to identify the specialty services most needed by SNU program participants. Goal Status In FY18, the five most frequently utilized specialty services included urology, ophthalmology, ear, nose and throat (ENT), cardiology and general surgery. Partner Name, Description and Web Address Cape Cod Healthcare - www.capecodhealth.org Community Health Center of Cape Cod - www.chcofcapecod.org Duffy Health Center - www.duffyhealthcenter.org Harbor Community Health Center Hyannis - www.hhsi.us Island Health Care - www.ihimv.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare Community Benefits provides annual grant support to Harbor Community Health Center-Hyannis to coordinate the Specialty Network for the Uninsured (SNU). The SNU program increases access to specialty care for uninsured and under-insured residents of Barnstable County through managing a network of medical specialists who provide office visits, procedures and continued care of uninsured and under-insured individuals. Barnstable County Tick Disease Testing and Education Project Program Type: Grant/Donation/Foundation/Scholarship. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Not Specified. DoN Health Priorities (optional): Not Specified. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Lyme Disease - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Provide up to 1,500 subsidized tick tests for Barnstable County residents. Testing to include: identification of tick species and life stage, high resolution micrographs of tick, assessment of feeding status, and secure private delivery of pathogen testing results. Goal Status As of September 30, 2018, just over 1,110 tick tests were completed and the results provided data and information to aid in personal risk assessment. Goal Description Provide county-wide surveillance data for use by medical providers and public health officials. The detection of one or more pathogens in ticks will be reported. Goal Status Approximately, 32% of the 1,112 tested positive with one or more pathogens. Data and information is shared with the Cape Cod Cooperative Extension. It was also noted that Barnstable residents submitted a relatively low-rate of non-tick samples compared to other regions in MA, signaling that residents assisted by this grant appear more likely to properly detect and identify ticks as opposed to other arthropods or foreign substances. Goal Description The Cape Cod Extension will develop, produce and release an online series of tick disease education and prevention videos for the public featuring a local epidemiologist. The online videos will be promoted across the county via public locations including schools, libraries, councils on aging and other civic gathering locations. aging and other civic gathering locations. gathering locations. Goal Status A series of ten tick education videos titled "Tickology" were released to the public on September 25, 2018. Promotion of the videos has been targeted towards libraries, garden centers, businesses, museums, land use organizations, and public health officials. Videos can be accessed on the Cape Cod Extension's website, www.capecodextension.org/ticks/ and YouTube. Partner Name, Description and Web Address Cape Cod Cooperative Extension: www.capecodextension.org UMASS Laboratory of Medical Zoology: www.tickdiseases.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC Community Benefits provided grant funding to subsidize a tick-borne pathogen testing program and expanded tick borne disease prevention education for residents of Barnstable County. Tick-testing and reporting was conducted by the UMASS Laboratory of Medical Zoology. The Cape Cod Cooperative Extension developed, produced and released to the public a 10-part online video series titled "Tickology" providing easily-accessible community education on tick disease prevention by local epidemiologists. Community-Based Interpreter Services Program Type: Outreach to Underserved. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes,Stability/Homelessness, Substance Use Disorders. DoN Health Priorities (optional): Social Environment. Target Population Regions Served: Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Arthritis, Other: Asthma/Allergies, Other: Cancer, Other: Cardiac Disease, Other: Chronic Pain, Other: Colitis/Crohn Disease, Other: Cultural Competency, Other: Diabetes, Other: Family Planning, Other: Hepatitis, Other: HIV/AIDS, Other: Hypertension, Other: Lyme Disease, Other: Nutrition, Other: Osteoporosis/Menopause, Other: Parkinson's Disease, Other: Pregnancy, Other: Pulmonary Disease/Tuberculosis, Other: Sexually Transmitted Diseases, Other: Sickle Cell Disease, Other: Smoking/Tobacco, Other: Stroke, Other: Uninsured/Underinsured, Overweight and Obesity, Physical Activity, Substance Abuse, Tobacco Use - Sex: All - Age Group: All Adults - Ethnic Group: All, Portuguese, Spanish - Language: All, Portuguese, Spanish. Goal Description Assist more than 800 individuals with free medical interpreters in community-based primary care and specialty care settings. Goal Status The Community Based Interpreters program served 883 individuals with medical interpretation in community-based health care settings. Goal Description Analyze program utilization data to assess regional medical interpretation needs for program evaluation. Goal Status Over 80% of people served requested Portuguese translation and 19% requested Spanish translation. Overall the number of individuals served was similar to FY17; however the regions of Cape Cod where those served by the program reside shifted slightly. The Mid-Cape region experienced an increase of 5% of the total population served and the Upper Cape region experienced a decrease in people served. In FY17 and FY18, only 1% of individuals served by the program resided in the Outer and Lower regions of Cape Cod. Partner Name, Description and Web Address Community Based Medical Offices on Cape Cod - Various Harbor Community Health Center Hyannis - www.hhsi.us/cape-cod/harbor-community-health-center-hyannis Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description CCHC provides free medical language interpreters to community-based physician offices to assist limited and non-English speaking patients and their families. The availability of proficient and professional interpreter services ensures the delivery of safe, quality health care and positive clinical outcomes. EMS Interpreter's Services Program: A collaboration between Cape Cod Healthcare and the Cape and Islands Emergency Medical Services System Program Type: Direct Services, Grant/Donation/Foundation/Scholarship, Health Professional/Staff Training. Statewide Priority: Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional): N/A. DoN Health Priorities (optional): Social Environment. Brief Description or Objective: CCHC Community Benefits provides support to the regional SHINE program to expand information, counseling and assistance with Medicare and health insurance needs at various outposts across Barnstable County. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Cultural Competency, Other: Language/Literacy - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Pilot the program with Hyannis Fire Department and Yarmouth Fire Department; two of the three largest fire and rescue departments in Barnstable County, to assess need, develop training resources and track service utilization. Goal Status According to survey data, over 90% of fire department staff from both towns identified that they had encountered language barriers making it difficult to accurately assess and document health information from a patient who speaks a language other than English prior to arrival at the hospital. In response, CCHC trained firefighters and emergency responders to use phone-based interpreter services and provided a toll free number to access interpreter services from their cell phones. In addition, a language identification poster and a medical visual translator document were provided to each ambulance in the town. In the pilot phase of the program, EMT's utilized the service for 32% of patients who required translation services upon arrival at the hospital. The average translation call was 3.8 minutes and cost less than $4 per call. Goal Description Expand the program beyond two pilot sites to other municipal fire and rescue departments in Barnstable County. Goal Status CCHC Community Benefits provided program funds for ongoing costs of interpreter services and materials for the program, expanding to 13 out of the 15 towns in Barnstable County. Staff from the interpreter services departments at Cape Cod Hospital and Falmouth Hospital provided training to the town departments on use of interpreter services and visual language identifiers. Data collection is ongoing. Partner Name, Description and Web Address Cape and Islands Emergency Medical Services System - www.capeandislandsems.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare (CCHC) and the Cape and Islands Emergency Medical Services System partnered to create a unique program that provides phone-based medical interpreter services offered via the cell phones of paramedics and first responders on ambulances to improve communication with limited-English speaking patients during an emergency and to increase accuracy of information relayed by patients during transport to a hospital. Program Type: Community Participation/Capacity Building Initiative,Grant/Donation/Foundation/Scholarship, Health Screening, Prevention. Statewide Priority: Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes,DoN Health Priorities (optional) Built Environment, Social Environment. Target Population Regions Served: County-Barnstable - Health Indicator: Other: Hypertension, Other: Stroke, Overweight and Obesity, Physical Activity- Sex: All - Age Group: All Ethnic Group: All - Language: All. Goal Description Increase the number of residents participating in the Health Parks, Healthy People seasonal walking program and 5K Run/Walk aimed at improving health knowledge and awareness of free and open spaces for physical activity. Goal Status In FY18, over 285 individuals participated in the summer walking program and 5K Run/Walk at the Cape Cod National Seashore representing a 30% increase in the number of participants over FY17. Partner Name, Description and Web Address Cape Cod National Seashore - www.nps.gov/caco/index.htm National Park Service - www.nps.gov/.../healthy-parks-healthy-people Cape Cod Healthcare - www.capecodhealth.org/wellness-wise/healthy-parks-healthy-people/ www.capecodhealth.org/wellness-wise/healthy-parks-healthy-people/ National Alliance on Mental Illness (NAMI) Cape Cod www.namicapecod.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description Cape Cod Healthcare collaborated with the Cape Cod National Seashore and the National Park Services to promote community open space for wellness, exercise and physical activity to improve the health of Cape Cod residents and visitors. Prescription Assistance Program for Vulnerable Populations:Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Reducing Health Disparity. Disparity. Disparity. Disparity. Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC Community Benefits provided grant funding to subsidize a tick-borne pathogen testing program and expanded tick borne disease prevention education for residents of Barnstable County. Tick-testing and reporting was conducted by the UMASS Laboratory of Medical Zoology. The Cape Cod Cooperative Extension developed, produced and released to the public a 10-part online video series titled "Tickology" providing easily-accessible community education on tick disease prevention by local epidemiologists. Detailed Description Cape Cod Healthcare collaborated with the Cape Cod National Seashore and the National Park Services to promote community open space for wellness, exercise and physical activity to improve the health of Cape Cod residents and visitors. Prescription Assistance Program for Vulnerable Populations: Cape Cod Hospital and Falmouth Hospital Program Type: Direct Services. Statewide Priority: Address Unmet Health Needs of the Uninsured, Chronic Disease Management in Disadvantage Populations, Reducing Health Disparity. Disparity. Disparity. Disparity. EOHHS Focus Issue(s) (optional): Chronic Disease with focus on Cancer, Heart Disease, and Diabetes. DoN Health Priorities (optional): Not Specified. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Uninsured/Underinsured- Sex: All Age Group: All Ethnic Group: All Language: All. Goal Description Assist residents who are unable to afford medications to ensure compliance with hospital discharge planning. Goal Status In FY18, Cape Cod Hospital and Falmouth Hospital emergency and behavioral health departments provided prescription vouchers and prescription assistance totaling more than $18,300 for uninsured, under-insured or financially disadvantaged populations. Total spending on the prescription assistance program dropped by approximately 22% from FY17. This reduction is attributed to the hospital pharmacies now providing subsidized prescriptions rather than the previous approach of providing vouchers for patients to purchase prescriptions from large, national retail pharmacies. Partner Name, Description and Web Address Cape Cod Hospital - www.capecodhealth.org Falmouth Hospital - www.capecodhealth.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description The Prescription Assistance Program is an initiative of Cape Cod Hospital and Falmouth Hospital emergency, behavioral health and pharmacy departments as a community benefit assisting uninsured, under-insured and financially disadvantaged patients with no other viable means to pay for medications upon discharge from hospital facilities. Transportation Assistance Program for Vulnerable Populations: Cape Cod Hospital and Falmouth Hospital Program Type Direct Services. Statewide Priority Reducing Health Disparity. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional) Built Environment. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Other: Safety, Other: Uninsured/Underinsured - Sex: All - Age Group: All - Ethnic Group: All - Language: All. Goal Description Assist residents who are unable to afford or access transportation to ensure compliance with their discharge plan. Goal Status Cape Cod Hospital and Falmouth Hospital emergency and behavioral health departments provided transportation vouchers totaling more than $62,500 for financially disadvantaged patients upon discharge. FY18 hospital transportation assistance increased more than 50% over FY17. Partner Name, Description and Web Address Local Taxi Companies - N/A Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description In an effort to assist low-income and vulnerable populations, Cape Cod Hospital and Falmouth Hospital provided access to transportation upon discharge from emergency and behavioral health departments, to those patients without resources for transportation. Health Education and Support Services for Wellness at Cape Cod Hospital and Falmouth Hospital Program Type Community Education, Direct Services, Health Screening, Outreach to Underserved, Prevention, School/Health Center Partnership, Support Group. Statewide Priority Chronic Disease Management in Disadvantage Populations, Promoting Wellness of Vulnerable Populations, Reducing Health Disparity. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health, Substance Use Disorders. DoN Health Priorities (optional) Built Environment, Education. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care, Immunization, Mental Health, Other: Alcohol and Substance Abuse, Other: Alzheimer Disease, Other: Arthritis, Other: Asthma/Allergies, Other: Bereavement, Other: Cancer, Other: Cardiac Disease, Other: Cultural Competency, Other: Diabetes, Other: HIV/AIDS, Other: Hypertension, Other: Nutrition, Other: Parenting Skills, Other: Pregnancy, Other: Stroke, Overweight and Obesity, Physical Activity,- Sex: All - Age Group: All - Ethnic Group: All - Language: English, Portuguese, Spanish. Goal Description Provide health education and support activities for the community on a continuum of issues including, but not limited to, chronic disease prevention, screening and self-management for conditions such as cancer, heart disease, and diabetes, breastfeeding and parenting, behavioral health, and cultural competency in care. Goal Status In FY18, over 14,500 staff hours were dedicated to ensuring health education and support services. Classes and support groups were offered and facilitated for individuals, families and the community. Partner Name, Description and Web Address American Cancer Society - www.cancer.org Visiting Nurses Association of Cape Cod - www.vnacapecod.org YMCA Cape Cod - www.ymcacapecod.org Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 Detailed Description At Cape Cod Hospital and Falmouth Hospital, health education and outreach activities, classes, support groups and services to increase wellness are offered to the community across a number of different health areas. From maternity department tours and new parenting classes, to community-based diabetes and stroke education, fall prevention classes, bereavement support groups and advance care planning presentations, the hospitals dedicate clinical staff and resources to support the wellness of Barnstable County residents. Workforce and Career Development Initiatives: Cape Cod Healthcare Program Type Community Participation/Capacity Building Initiative, Health Professional/Staff Training, Mentorship/Career Training/Internship, Outreach to Underserved, School/Health Center Partnership. Statewide Priority Reducing Health Disparity, Supporting Healthcare Reform. EOHHS Focus Issue(s) (optional) Chronic Disease with focus on Cancer, Heart Disease, and Diabetes, Mental Illness and Mental Health. DoN Health Priorities (optional) Education, Employment. Target Population Regions Served: County-Barnstable - Health Indicator: Access to Health Care - Sex: All - Age Group: Adult, Adult-Young - Ethnic Group: All - Language: All. Goal Description CCHC staff in various departments will provide clinical oversight and supervision to students engaged in allied health programs and various job training initiatives in the region. CCHC staff in various departments will provide clinical oversight and supervision to students engaged in allied health programs and various job training initiatives in the region. Goal Status In FY18, over 26,000 staff hours were devoted to workforce and career development partnership efforts including supervision of student training, job shadowing and clinical oversight. Staff hours allocated to workforce development initiatives increased by more than 30% over FY17. This increase is reflective of growth in strategic partnerships aimed at increasing educational and employment opportunities in our region. increasing educational and employment opportunities in our region. Partner Name, Description and Web Address Barnstable High School - www.barnstable.k12.ma.us Cape Cod Community College - www.capecod.edu/ Cape Cod Regional Technical High School - www.capetech.us MA College of Pharmacy and Health Sciences - www.mcphs.edu The Riverview School - www.riverviewschool.org University of Massachusetts - www.massachusetts.edu/ Upper Cape Regional Technical School - www.uppercapetech.com/ Contact Information Mary Pumphery Cape Cod Healthcare 297 North Street, Building 3, 3rd Floor Hyannis, MA, 02601 Phone: 774-470-5506 DETAILED DESCRIPTION CCHC invests in partnerships with local high schools, vocational schools, community colleges, and allied health programs for job training and shadowing and internships with health care providers in various hospital departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. CCHC invests in partnerships with local high schools, vocational schools, community colleges, and allied health programs for job training and shadowing and internships with health care providers in various hospital departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. departments including, but not limited to, phlebotomy, radiology, behavioral health, and materials management. Our efforts contributed to regional economic development efforts to increase opportunity for educational attainment and provide experience for individuals to obtain stable, quality, and well-compensated jobs in our region. well-compensated jobs in our region. FUNCTIONAL EXPENSE NOTE FORM 990, PART I AND PART IX FUNDRAISING IS CONDUCTED ON BEHALF OF CAPE COD HEALTHCARE, INC. BY CAPE COD HEALTHCARE FOUNDATION, INC. CERTAIN OFFICERS ARE COMPENSATED BY CAPE COD HEATHCARE, INC. FUNDS RAISED ARE REPORTED AT CAPE COD HEALTHCARE, INC. AND AFFILIATES. FORM 990, PART I, LINE 6 CAPE COD HEALTHCARE, INC.'S VOLUNTEERS INCLUDE ITS TRUSTEES. FORM 990, PART VI, LINE 2 TRUSTEES AND OFFICERS SIT ON THE BOARDS OF THE FOLLOWING: EMERALD PHYSICIANS MEMBER TRUST: PHILIP MCLOUGHLIN JOEL CROWELL CAPE HEALTH INSURANCE COMPANY: MICHAEL K LAUF MICHAEL L CONNORS MICHAEL G JONES BRUCE JOHNSTON PHILIP MCLOUGHLIN THE MEMBERS OF CAPE COD HEALTHCARE, INC.'S BOARD ALSO SIT ON THE BOARD OF CAPE COD MEDICAL OFFICE BUILDING AND EMERALD PHYSICIAN SERVICES, LLC, FOR-PROFIT RELATED ORGANIZATIONS. FORM 990, PART VI, LINE 4 The organization's bylaws were amended to include the following items: deletion of the development and philanthropy committee as a standing board committee as the function has been absorbed by Cape Cod Healthcare Foundation; deletion of a minimum number of members; prior automatic removal as a member for failing to attend three consecutive annual meetings have been removed; trustees may serve a maximum of three consecutive 3-year terms instead of four; physician trustees may serve three consecutive 2-year terms instead of four, establishment of a requirement for the Compliance Officer to make an annual compliance report to the Board of Trustees, and proxy votes may be submitted by facsimile transmission. FORM 990, PART VI, LINES 6&7(A) THE ORGANIZATION HAS MEMBERS/INCORPORATORS WHO ELECT THE ORGANIZATION'S TRUSTEES. FORM 990, PART VI, LINE 7(B) THE DECISIONS OF THE GOVERNING BODY THAT NEED APPROVAL BY ITS MEMBERS/INCORPORATORS INCLUDE APPROVAL OF CHANGES MADE TO THE CORPORATION'S BYLAWS AND APPROVAL WHEN THERE IS A DIVESTING OF ONE OF THE MAJOR AFFILIATES OF THE ORGANIZATION. FORM 990, PART VI, LINE 11 THE ORGANIZATION'S FORM 990 IS REVIEWED AT SEVERAL LEVELS. THE ORGANIZATION ENGAGES A PUBLIC ACCOUNTING FIRM TO ASSIST IN THE PREPARATION AND REVIEW OF ITS FORM 990 AND WHO SIGNS AS PAID PREPARER. SENIOR MANAGEMENT OF THE ORGANIZATION IS RESPONSIBLE FOR THE TIMELY PREPARATION OF FORM 990. THE COMPLETED FORM 990, WITH THE EXCEPTION OF AN ANONYMOUS DONOR, IS PROVIDED TO THE FINANCE COMMITTEE AND THE ENTIRE BOARD IN ADVANCE OF THE FILING DEADLINE. FORM 990, PART VI, LINE 12 THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY AND REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THIS POLICY. ON AN ANNUAL BASIS, EACH TRUSTEE, OFFICER AND EMPLOYEE AT THE SENIOR MANAGEMENT LEVEL COMPLETES A CONFLICT OF INTEREST DISCLOSURE FORM. THE FORMS ARE REVIEWED BY CAPE COD HEALTHCARE, INC.'S ("CCHC") DIRECTOR OF CLINICAL AND RESEARCH COMPLIANCE WHO PREPARES A SUMMARY FOR CCHC'S COMPLIANCE OFFICER. ANY MATERIAL INTERESTS SO DISCLOSED ARE PRESENTED TO THE CORPORATION'S GOVERNANCE COMMITTEE FOR REVIEW AND RESOLUTION. ALL DISCLOSURE STATEMENTS SUBMITTED BY EMPLOYEES WILL BE REVIEWED BY HUMAN RESOURCES AND/OR CCHC'S DIRECTOR OF CLINICAL AND RESEARCH COMPLIANCE. FOR ANY DISCLOSURE THAT IS CONSIDERED SUBSTANTIVE THE EMPLOYEE'S AREA MANAGER WILL BE CONSULTED TO DETERMINE IF THE SITUATION IS GENERALLY ACCEPTABLE, REQUIRES FURTHER EXAMINATION AND POSSIBLE ACTION OR IS GENERALLY NOT ACCEPTABLE. ANY ACTION PLAN CREATED TO MANAGE A CONFLICT OF INTEREST WILL BE MONITORED BY THE EMPLOYEE'S AREA MANAGER OR SUPERVISOR. FORM 990, PART VI, LINE 15 THE ANNUAL PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, OFFICERS, EXECUTIVES AND KEY EMPLOYEES INCLUDE THE FOLLOWING: CEO - COMPENSATION WILL BE DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, AND WILL INCLUDE CONSIDERATION OF RELEVANT MARKET DATA FURNISHED BY A DISINTERESTED COMPENSATION CONSULTANT, AND A REVIEW OF JOB PERFORMANCE. OFFICERS, EXECUTIVES AND KEY EMPLOYEES - OFFICER, EXECUTIVE AND KEY EMPLOYEE COMPENSATION WILL BE DETERMINED BY THE CEO AND WILL INCLUDE CONSIDERATION OF RECENT RELEVANT MARKET DATA FURNISHED BY A DISINTERESTED COMPENSATION CONSULTANT, AND A REVIEW OF JOB PERFORMANCE. THE CEO'S DETERMINATION OF SUCH COMPENSATION WILL BE SUBJECT TO THE APPROVAL OF THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE PROCESS AND CONCLUSIONS ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS BYLAWS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE ANNUALLY FILED FORM PC, A PUBLICLY DISCLOSED TAX-EXEMPT ORGANIZATION FILING FOR THE STATE OF MASSACHUSETTS. FORM 990, PART VII, COLUMN (B) THE INDIVIDUALS REPORTED AS RECEIVING COMPENSATION FROM A RELATED ORGANIZATION IN COLUMNS (E) AND (F) IN PART VII ARE EMPLOYEES AT CAPE COD HEALTHCARE, INC., A TAX-EXEMPT RELATED ORGANIZATION. FORM 990, PART VII, SECTION A TITLE FOR JOEL CROWELL: TRUSTEE, SERVED AS TREASURER/CLERK/TRUSTEE UNTIL 5/18 TITLE FOR MICHAEL G. JONES, ESQ: SR. VP & CHIEF LEGAL OFFICER / CLERK FROM 5/18 FORM 990, PART VII, SECTION B WITH THE EXCEPTION OF REPORTING FOR VISITING NURSE ASSOCIATION OF CAPE COD, INC, CAPE COD HEALTHCARE, INC. PAYS INDEPENDENT CONTRACTORS ON BEHALF OF ITS AFFILIATES WHO FILE AS PART OF A GROUP FORM 990 AS CAPE COD HEALTHCARE, INC. AND AFFILIATES. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES ($3,069,833) NET ASSETS RELEASED FROM RESTRICTION (563,057) TRANSFER TO/FROM AFFILIATES 575,802 CHANGE IN VALUE SPLIT INTEREST AGREEMENT 492,634 CHANGE IN VALUE BENEFICIAL INTEREST (174,493) TRANSFER OF NET ASSETS 2,736,781 CONTRIBUTIONS ELIMINATIONS (53,989) INCLUSION OF CCRI TO GROUP EXEMPTION ------------- ($56,155) OTHER CHANGES IN NET ASSETS OR FUND BALANCES CAPE COD HEALTHCARE INC 297 NORTH STREET BLDG 3 HYANNIS MA 02601 222600704 PARENT CORP MA 501(c) (3) 10 NA true CAPE AND ISLAND ENDOSCOPY CENTER 700 ATTUCKS LANE HYANNIS MA 02601 ENDOSCOPY CENTER MA NA CAPE HEALTH INSURANCE COMPANY PO BOX 1051GT GRAND CAYMAN CJ 981230418 INSURANCE CJ CAPE COD HLTHCR C CORP 0 0 true CAPE COD MEDICAL OFFICE BUILDING INC 27 PARK STREET HYANNIS MA 02601 042423073 RENTAL SRVCE MA NA C CORP 0 15000 1.00000 true POOLED INCOME FUNDS (2) SUPPORT MA NA true EMERALD PHYSICIAN SERVICES LLC 25 COMMUNICATION WAY HYANNIS MA 02601 043369730 PRIMARY CARE MA EMERALD TRUST S CORP 26802932 13385182 1.00000 true EMERALD PHYSICIANS MEMBER TRUST 297 NORTH STREET BLDG 3 HYANNIS MA 02601 467220648 EMRLD SHAREHO MA MACC TRUST 0 0 1.00000 true CHARITABLE REMAINDER TRUSTS (20) SUPPORT MA NA true false false false false false false false false true true false false true true true false true true CAPE HEALTH INSURANCE COMPANY R 2957963 FMV CAPE COD HOSPITAL 297 NORTH ST BLDG 3 HYANNIS MA 02601 042103600 CAPE VISITING NURSE ASSN OF CAPE COD INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 042104159 CAPE FALMOUTH HOSPITAL ASSOCIATION INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 042220716 CAPE CAPE COD HUMAN SERVICES INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 042323506 CAPE MEDICAL AFFILIATES OF CAPE COD INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 043187299 CAPE CAPE COD HEALTHCARE FOUNDATION INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 043475950 CAPE CAPE & ISLANDS HEALTH SERVICES II 297 NORTH ST BLDG 3 HYANNIS MA 02601 043572408 CAPE FALMOUTH ASSISTED LIVING INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 223379395 CAPE JML CARE CENTER INC 297 NORTH ST BLDG 3 HYANNIS MA 02601 042995795 CAPE