Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
CAPE REGIONAL MEDICAL CENTER INC
 
Employer identification number
21-0662542
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015
Page 2

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
non-cash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
SCHEDULE I, PART I; QUESTION 2 Ancillary Healthcare ScholarshipS ARE AWARDED TO INDIVIDUALS BASED ON A REVIEW AND APPROVAL PROCESS FOR VARIOUS APPLICANTS IN ACCORDANCE WITH THE ORGANIZATION'S CHARITABLE PURPOSES, PROGRAMS AND SERVICES. GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.
SCHEDULE I, PART II PLEASE NOTE THAT ALL GIFTS, GRANTS AND CONTRIBUTIONS TO OTHER ORGANIZATIONS WERE LESS THAN OR EQUAL TO $5,000 EACH. THEREFORE, THERE ARE NO ORGANIZATIONS LISTED IN SCHEDULE I, PART II. THE TOTAL AMOUNTS PAID FOR CONTRIBUTIONS AND EVENT SPONSORSHIPS CAN BE FOUND ON CORE FORM, PART IX, LINE 1.
SCHEDULE I, PART III PLEASE NOTE THAT TOTAL ANCILLARY HEALTHCARE SCHOLARSHIPS AWARDED WERE LESS THAN $5,000. THEREFORE, THEY ARE NOT SHOWN IN SCHEDULE I, PART III. THE TOTAL AMOUNTS PAID FOR GRANTS AND OTHER ASSISTANCE PAID TO DOMESTIC INDIVIDUAL CAN BE FOUND ON CORE FORM, PART IX, LINE 2.
Schedule I (Form 990) 2015



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