2013-11-07T16:32:50-06:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 150524324 DELAWARE VALLEY HOSPITAL INC DELA 6078652197 1 TITUS PLACE WALTON NY 138561457 PAUL SUMMERS 6078652160 2013-11-07 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-03-07 17:11:31Z PAUL SUMMERS 1 TITUS PLACE WALTON NY 138561457 16598413 0 X WWW.UHS.NET/ X 1950 NY TO SERVE OUR PATIENTS IN AN EFFICIENT AND PATIENT-FOCUSED MANNER AND OFFER A RANGE OF ACUTE, OUTPATIENT, DIAGNOSTIC, RAHABILITATIVE, PRIMARY CARE AND WELLNESS SERVICES. 8 5 235 42 0 0 318096 174385 14883364 15941204 36294 30474 71876 452257 15309630 16598320 0 0 0 0 9991256 9754918 0 0 18444 5337612 6625523 15328868 16380441 -19238 217879 15172234 15513860 8932984 9035446 6239250 6478414 X TO SERVE ITS PATIENTS WITH COMPASSION AND IN AN EFFICIENT AND PATIENT FOCUSED MANNER WHILE OFFERING A RANGE OF ACUTE, OUTPATIENT, DIAGNOSTIC, REHABILITATIVE, PRIMARY CARE AND WELLNESS SERVICES. 0 0 4646936 7485471 INPATIENT AND ACUTE SERVICES: DELAWARE VALLEY HOSPITAL FULFILLS IT'S MISSION BY WORKING TOGETHER WITH THE COMMUNITY, PHYSICIANS, AND OTHER HEALTHCARE PROVIDERS TO CONTINUOUSLY IMPROVE THE AVAILABILITY AND QUALITY OF SERVICES. THIS INCLUDES THE ABILITY TO PROVIDE A COMPREHENSIVE RANGE OF SHORT-TERM (96 HRS. OR LESS) INPATIENT ACUTECARE, SWING BED AND ADDICTION TREATMENT SERVICES VIA IT'S 25-BED HOSPITAL LOCATED ON THE MAIN CAMPUS IN WALTON IN DELAWARE COUNTY, NY. PATIENT DISCHARGES IN 2012 WERE COMPRISED OF 457 ACUTE, 108 SWING BED, AND 82 ADDICTION TREATMENT. ACUTE CARE REPRESENTED 1544 PATIENT DAYS, IN ADDITION TO THE 1,132 PATIENT DAYS FOR SWING BED AND 1,369 PATIENT DAYS IN THE ADDICTION TREATMENT PROGRAM. INDICATIVE OF THE COMPREHENSIVE HEALTHCARE PROVIDED TO THESE PATIENTS, A TOTAL OF 7,626 LAB TESTS, 2,082 RESPIRATORY TREATMENTS, 325 X-RAYS, 666 PHYSICAL THERAPY SESSIONS, AND 313 EKG'S WERE ADMINISTERED. OTHER SERVICES INCLUDED OCCUPATIONAL THERAPY, ENDOSCOPIES, ECHO EXAMS, ULTRASOUNDS, CT EXAMS, AND MAMMOGRAPHIES. TO ENSURE OUR RURAL AREA RESIDENTS HAVE ACCESS TO HIGH QUALITY, EFFICIENT CARE IN A COMFORTABLE AND PRIVATE AREA, THE HOSPITALS NEW IMAGING CENTER IS EQUIPPED WITH A 16-SLICE CT SCANNER. MRI SERVICES ARE NOW OFFERED ON SUNDAYS THROUGH AN AGREEMENT WITH A MOBILE VENDOR. UPGRADES AND ADDITIONS IN 2012 INCLUDED ADDITIONAL MODULES UNDER THE CURRENT SOFTWARE VENDOR (HMS) TO MEET PHASE I OF MEANINGFUL USE. THOSE ADDITIONS INCLUDED MEDICAL RECORDS SCANNING. EQUIPMENT PURCHASES IN 2012 CONSISTED OF A NEW ULTRASOUND MACHINE TO IMROVE ECHOCARDIOGRAM IMAGES, REPLACEMENT OF OUTDATED ITRAVENOUS PUMPS AND NEW STRETCHERS TO ENHANCE PATIENT SAFETY IN THE EMERGENCY ROOM AND ENDOSCOPY DEPARTMENTS. 2287552 4732831 CLINICS: DELAWARE VALLEY HOSPITAL PROVIDES A WIDE RANGE OF PRIMARY AND PREVENTIVE CARE SERVICES THROUGH IT'S PRIMARY CARE CENTERS LOCATED IN WALTON, DOWNSVILLE, AND ROSCOE. THESE PRIMARY CARE CENTERS FORM THE FOUNDATION NECESSARY TO SERVE OUR COMMUNITIES WITH A COORDINATED SYSTEM OF CARE WHILE PAYING SPECIAL ATTENTION TO UNDER-SERVED AREAS. IN 2012 OUR CLINICS PROVIDED CARE TO 12,711 PATIENTS IN WALTON, 1,986 IN ROSCOE, AND 1,117 IN DOWNSVILLE. WITH A FOCUS ON CONTINUOUS IMPROVEMENT THE PRIMARY CARE CENTERS OPERATE UNDER A NEW HEALTH INFORMATION MANAGEMENT SYSTEM AND CONTINUE TO BE SMOKE AND TOBACCO FREE. THEY HAVE ALSO BECOME A KEY TO THE IMPROVEMENT OF CHILDHOOD IMMUNIZATION LEVELS IN COORDINATION WITH DELAWARE COUNTY'S PUBLIC HEALTH NURSING SERVICES AND OTHER AREA HEALTHCARE PROVIDERS. 5038572 3722902 OUTPATIENT AND AMBULATORY SERVICES: DELAWARE VALLEY HOSPITAL PROVIDES A COMPREHENSIVE RANGE OF OUTPATIENT DIAGNOSTIC AND TREATMENT SERVICES AT IT'S WALTON CAMPUS. THESE INCLUDE A NEW 7-BED EMERGENCY DEPARTMENT WHICH SERVES THE COMMUNITY 24/7. OTHER TREATMENT SERVICES INCLUDE EMERGENCY CARE, REHABILITATIVE SERVICES, AMBULATORY PROCEDURES, AND ACCESS TO SPECIALTY SERVICES. THE HOSPITAL ALSO CONDUCTS EXTENSIVE WELLNESS PROGRAMMING THAT INCLUDES CARDIOVASCULAR NUTRITION AWARENESS, WEIGHT REDUCTION AND DIABETES EDUCATION/GLUCOSE TESTING. A FREE PRESCRIPTION DELIVERY PROGRAM IS PROVIDED FOR ROSCOE AND DOWNSVILLE PATIENTS AS THESE COMMUNITIES ARE WITHOUT A LOCAL PHARMACY. OCCUPATIONAL HEALTH PROGRAMMING MEETS THE NEEDS OF LOCAL BUSINESSES, FIRE DEPARTMENTS, AND EMERGENCY SQUADS BY PROVIDING PHYSICALS, DRUG TESTING, AND ERGONOMIC EDUCATION. IN 2012 THE EMERGENCY DEPARTMENT TREATED OR ADMITTED 5,446 RESIDENTS VIA ITS NEW 5,000+ SQ. FT. FACILITY, THE LAB PERFORMED 57,618 TESTS, AND 6,707 PHYSICAL/OCCUPATIONAL THERAPY SESSIONS WERE CONDUCTED. THE IMAGING CENTER PERFORMED 6,983 X-RAYS, CT SCANS, MRI'S AND MAMMOGRAPHIES FOR OUTPATIENT SERVICES. 11973060 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 36 0 1 235 1 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 1 0 0 NY X PAUL SUMMERS 6078652197 DELAWARE VALLEY HOSPITAL 1 TITUS WALTON NY 138561457 DAVID POLGE 55.00 X X 94555 0 6937 DR MICHAEL FREEMAN 55.00 X X 165662 0 16672 DR RAJESH DAVE 1.00 54.00 X X 0 573938 33045 HELEN JOHNSTON 1.00 X X 0 0 0 EDWARD SNOW 1.00 X X 0 0 0 SHELLEY KAISER 1.00 X 0 0 0 DRU CAVANAGH 24.00 31.00 X X 66621 88718 31657 REV LARRY LIGHT 1.00 X 0 0 0 BRIDGET DEMOTT 1.00 X 0 0 0 ERIN NEALE 1.00 X 0 0 0 EDWARD SCHOTT 1.00 X X 0 0 0 DOTTIE KRUPPO 55.00 X 77500 0 10772 JOAN GUARNIERI 55.00 X 94254 0 7503 PAUL SUMMERS 55.00 X 109398 0 8033 DEBORAH HITT 55.00 X 80200 0 10871 VICTORIA CONKLING 55.00 X 98290 0 2652 ROBERT REYNOLDS 55.00 X 156552 0 8752 RYAN KIM 55.00 X 197530 0 3703 DOV CAI 55.00 X 175546 0 3703 JASPREET SOOD 55.00 X 176589 0 3703 DR VADIM DAVYDOV 55.00 X 123190 0 8499 DR VALENTINA DAVYDOV 55.00 X 127446 0 0 PAUL DOWNTON 55.00 X 133761 0 14676 LARRY HANRAHAN 55.00 X 148980 0 3430 2026074 662656 174608 10 0 1 0 HEALTHCARE MANAGEMENT SYSTEMS 2739 MOMENTUM PLACE CHICAGO IL 60689 INFORMATION TECHNOLOGY 430657 LABORATORY CORP OF AMERICA PO BOX 121140 BURLINGTON NC 27216 MEDICAL SUPPORT 172944 SIEMENS HEALTHCARE DIAGNOSTICS PO BOX 121102 DALLAS TX 75312 INFORMATION TECHNOLOGY 159998 ALLIANCE HEALTHCARE SYSTEMS PO BOX 96485 CHICAGO IL 60693 MEDICAL SUPPORT 146418 6 129570 44815 174385 NET PATIENT REVENUE 900099 15941204 15941204 15941204 26897 26897 3670 93 3577 3577 3577 MEANINGFUL MEDICARE 900099 321444 321444 VENDING MACHINE 722210 26173 26173 PHYSICIAN OTHER REVENUE 621498 17208 17208 87432 77593 9839 452257 16598320 16357449 0 66486 X 2069362 1649190 420172 6006574 4317765 1688809 189522 119759 69763 929687 586442 343245 559773 408578 151195 2387 2387 4912 4912 93185 93185 3686 3686 3416 3416 1664203 1220265 443938 1705245 1207199 494827 3219 38427 38427 232937 36997 195940 33956 24202 9754 49147 24769 9153 15225 327301 327301 983957 972937 11020 252511 206337 46174 BAD DEBT EXPENSE 1144756 1144756 MISCELLANEOUS 85497 53864 31633 16380441 11973060 4388937 18444 1063572 1520178 337426 342187 1900842 2028397 131118 131996 601048 700958 19686817 12224089 7891878 7462728 848049 869513 2188301 1507903 210000 950000 15172234 15513860 987734 852434 5435261 5075249 874161 784632 982332 789703 653496 1533428 8932984 9035446 X 5858215 6098671 62825 61533 318210 318210 6239250 6478414 15172234 15513860 X 217879 11629 9656 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3686 3686 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DELAWARE VALLEY HOSPITAL HAS LIMITED LOBBYING ACTIVITIES WHICH ARE CONDUCTED ON BEHALF OF THE ORGANIZATION THROUGH MEMBERSHIP IN IROQUOIS HEALTHCARE AND THE HEALTH CARE ASSOCIATION OF NEW YORK STATE (HANYS). THESE ACTIVITIES INCLUDE ADVERTISEMENTS AND CONTACTS WITH THE LEGISLATORS ON VARIOUS HEALTHCARE ISSUES. 381035 -1293 379742 342832 38203 381035 424391 6550 88109 342832 361680 145420 82709 424391 765743 79512 299 483874 361680 0.84000 0.16000 1 0 51202 51202 9522389 4072106 5450283 9903003 8151983 1751020 210223 210223 7462728 WELLS FARGO - PRINCIPAL PMTS. ON BOND 171900 F TEMPORARILY RESTRICTED DONATIONS 69064 F CAPITAL CONSTRUCTION (FUNDED DEPR.) 1266939 F 1507903 OTHER RECEIVABLES - MALPRACTICE INSURANCE 950000 950000 DUE UNITED MED. ASSOC. / CHEN. MEM. 171162 DUE UNITED HEALTH SERVICES HOSPITALS 362266 MALPRACTICE INSURANCE RESERVE 1000000 1533428 X 16598320 0 16598320 0 16598320 16370785 0 16370785 9656 9656 16380441 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PURCHASE OF CAPITAL EQUIPMENT (MEDICAL) AND IMPROVEMENT OF FACILITIES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2012 AND 2011, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTERST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2009 THROUGH 2012. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST RATE SWAP 9,656. 1 1 X 1 X 1 X 1 1 0 1 1 130399 28787 101612 0.00620 3384423 2002820 1381603 0.08430 3514822 2031607 1483215 0.09050 81561 81561 0.00500 279532 279532 0.01710 1275 1275 0.00010 362368 362368 0.02220 3877190 2031607 1845583 0.11270 1 47931 526588 3257689 3419904 -162215 X 1 0 1 1 DELAWARE VALLEY HOSPTITAL

1 TITUS PLACE WALTON NY 13856

X X X DELAWARE VALLEY HOSPITAL 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X 1 X X X 0 X X 1 X 0 0 5 WALTON FAMILY HEALTH CENTER

2 TITUS PLACE WALTON NY 13856

OUTPATIENT PHYSICIAN CLINIC DOWNSVILLE FAMILY HEALTH CENTER

28315 STATE HWY 206 DOWNSVILLE NY 13755

OUTPATIENT PHYSICIAN CLINIC ROSCOE FAMILY HEALTH CENTER

1982 OLD ROUTE 17 ROSCOE NY 12776

OUTPATIENT PHYSICIAN CLINIC PHYSICAL AND OCCUPATIONAL THERAPY

123 STOCKTON AVENUE WALTON NY 13856

REHABILITATION CLINIC SPECIALTY CLINIC

121 STOCKTON AVENUE WALTON NY 13856

OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: DELAWARE VALLEY HOSPITAL IS A CRITICAL ACCESS HOSPITAL (CAH) AS DESIGNATED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. UNLIKE NON-CAH'S THAT ARE REIMBURSED BASED ON A PROSPECTIVE REIMBURSEMENT METHODOLOGY, CAH'S ARE REIMBURSED THEIR ALLOWABLE COSTS FOR MEDICARE PURPOSES. THE MEDICARE COST REPORT (CMS 2552) AND THE MEDICAID INSTITUTIONAL COST REPORT (ICR) WAS UTILIZED FOR PURPOSES OF IDENTIFYING COSTS AND NET REVENUE. A. COSTS:I. FYE COSTS AS INDEPENDENTLY AUDITED. NON-ALLOWABLE COSTS (I.E.-PHYSICIANS, ETC.) ARE USED TO REDUCE COSTS TO ARRIVE AT ALLOWABLE COSTS.II. VARIOUS STATISTICAL BASIS ARE USED TO ALLOCATE GENERAL SERVICE COSTS (I.E.-ADMINISTRATION, PLANT OPERATIONS, HOUSEKEEPING, ETC.), VIA A "STEPDOWN" METHODOLOGY TO REVENUE PRODUCING COST CENTERS SUCH AS ANCILLARY COST CENTERS (I.E. - RADIOLOGY, LAB, PHYSICAL THERAPY, ETC.) ROUTINE COST CENTERS (MEDICAL SURGICAL, ETC.) AND OUTPATIENT COST CENTERS (EMERGENCY, CLINIC, ETC.). III. ROUTINE COSTS PER DAY ARE THEN CALCULATED BY DIVIDING DIRECT AND INDIRECT COSTS (STEPDOWN) BY TOTAL DAYS. THIS PER DAY COST CAN THEN BE MULTIPLIED BY PAYOR SPECIFIC DAYS TO ARRIVE AT ROUTINE PAYOR COSTS.IV. ANCILLARY AND OUTPATIENT COSTS RELATED TO SPECIFIC PAYORS CAN BE DETERMINED BASED ON THE RATIO OF COST TO CHARGES (RCC).1. THE RCC IS CALCULATED BY DIVIDING THE DIRECT AND INDIRECT COSTS (STEPDOWN COSTS)BY GROSS CHARGES. THE RCC CAN THEN BE MULTIPLIED BY PAYOR SPECIFIC GROSS CHARGES TO ARRIVE AT PAYOR SPECIFIC COSTS. B. REVENUE: I. MEDICARE: NET REVENUE IS BASED IN DVH'S ALLOWABLE COSTS (INPATIENT AND OUTPATIENT) ARE REIMBURSED WITH A 1% MARKUP. II. MEDICAID: NET REVENUE IS BASED ON THE FOLLOWING:A. INPATIENT - A BASE YEAR COST PER DAY TRENDED ANNUALLY FOR INFLATION.B. OUTPATIENT - MEDICAID PUBLISHED RATES.III. OTHER PAYORS: REVENUE IS BASED ON NEGOTIATED RATES OF PAYMENT. PART I, L7 COL(F): DELAWARE VALLEY HOSPITAL REPORTED BAD DEBT EXPENSE IN THE AMOUNT OF $1,144,756 IN PART IX, LINE 24A. THE AFOREMENTIONED BAD DEBT EXPENSE WAS NOT USED IN THE CALCULATIONS OF SCHEDULE H, PART 1, LINES 7A THRU 7K. PART II: DELAWARE VALLEY HOSPITAL ACTIVELY PROMOTES THE HEALTH OF THE COMMUNITY IT SERVES BY PROVIDING A COURSE FOCUSING ON INDIVIDULALS' NUTRITION AND DIET NAMED LIFESTEPS. THE HOSPITAL ALSO PROVIDES FREE BLOOD PRESSURE AND GLUCOSE SCREENINGS ANNUALLY AT THE DELAWARE COUNTY FAIR. THE HOSPITALS DIETITIAN SERVES ON THE LOCAL SCHOOL COMMITTEE ON OBESITY TO HELP ADDRESS STUDENT HEALTH. THE HUMAN RESOURCE COORDINATOR PARTICIPATES IN THE LOCAL SCHOOL CAREER DAY, MAKING STUDENTS AWARE OF HEALTHCARE CAREERS. THE HOSPITAL ALSO HOLDS A 2 DAY MASH CAMP FOR STUDENTS IN GRADES 7 - 12 TO OFFER THEM THE OPPORTUNITY TO HAVE HANDS ON EXPERIENCE IN VARIOUS HEALTHCARE CAREERS. NUMEROUS JOB FAIRS ARE ATTENDED. LASTLY, THE HOSPITAL IS ACTIVELY PURSUING THE QUANTIFICATION OF THESE COMMUNITY HEALTH AND WELLNESS ACTIVITIES, AS WELL AS OTHERS, FOR REPORTING ON THE 2013 TAX RETURN. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT SPECIFICALLY REFERENCE OR DESCRIBE BAD DEBT EXPENSE. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS. PART III, LINE 8: BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. THE HOSPITAL HAS A POLICY TO PROVIDE A COMMUNITY BENEFIT TO UNINSURED PATIENTS THAT CONSISTS OF FEE DISCOUNTS. CERTAIN PATIENTS THAT WERE PROVIDED FEE DISCOUNTS WOULD HAVE LIKELY QUALIFIED UNDER THE CHARITY CARE POLICY. PART III, LINE 9B: A SYSTEM-WIDE POLICY CLEARLY STATES "FORWARDING A CLAIM TO A COLLECTION AGENCY WHILE FINANCIAL ASSISTANCE IS BEING DETERMINED IS PROHIBITED." AFTER PATIENTS' REQUESTS FOR FINANCIAL ASSISTANCE ARE APPROVED THE ORGANIZATION WILL PROVIDE THEM WITH THE SAME LEVEL OF FINANCIAL ASSISTANCE FOR 6 MONTHS AT WHICH TIME ANOTHER EVALUATION OF THE PATIENT'S FINANCIAL CONDITION WILL BE MADE. PART VI, LINE 2: DELAWARE VALLEY HOSPITAL (DVH) WORKS CLOSELY WITH OTHER HEALTHCARE ORGANIZATIONS AND SERVICE AGENCIES TO ADDRESS THE NEEDS OF AREA RESIDENTS. THE DELAWARE COUNTY PUBLIC HEALTH DEPARTMENT CONDUCTED IT'S MANDATED NEEDS ASSESSMENT IN 2008. DVH PARTICIPATED IN THE PROCESS. THE HOSPITAL ALSO SERVES AS A MEMBER OF THE DELAWARE COUNTY RURAL HEALTHCARE ALLIANCE; A COALITION OF SERVICE AND HEALTHCARE AGENCIES. THESE RELATIONSHIPS ALLOW THE HOSPITAL TO RECOGNIZE THE NEEDS OF THE COMMUNITY AND ADDRESS THEM AS APPROPRIATE IN CONJUNCTION WITH OTHER STAKEHOLDERS. PATIENT SATISFACTION SURVEYS ARE COMPLETED ON AN ONGOING BASIS. ADMINISTRATIVE REPRESENTATIVES ALSO ATTEND ALL DELAWARE VALLEY HOSPITAL VOLUNTEERS MEETINGS, WHOSE MEMBERS ARE ABLE TO OFFER INSIGHT INTO THE NEEDS OF THE COMMUNITY MEMBERS. IN ADDITION, THE HOSPITAL HAS STAFF WHO SIT ON THE COUNTY'S EMERGENCY PREPAREDNESS COMMITTE, AS WELL ON THE WALTON CENTRAL SCHOOL DISTRICT'S COMMUNITY AND WELLNESS COMMITTEES. PART VI, LINE 3: DELAWARE VALLEY HOSPITAL, INC. IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO ALL PATIENTS IN NEED AND TO COMMUNICATE THE AVAILABILITY OF ITS FINANCIAL ASSISTANCE AND RELATED PROGRAMS TO ALL. A PATIENT FINANCIAL ADVOCATE IS AVAILABLE TO ASSIST PATIENTS AND PROVIDE ASSESSMENTS FOR ELIGIBILITY UNDER ANY STATE, FEDERAL, OR UHS SYSTEM HOSPITALS' FINANCIAL ASSISTANCE PROGRAM. BROCHURES AND SIGNAGE ARE POSTED IF REQUIRED BY NEW YORK STATE REGULATIONS AT EACH REGISTRATION/PATIENT ACCESS AREA. IF NEEDED, TRANSLATION SERVICES ARE AVAILABLE. DELAWARE VALLEY HOSPITAL, INC. ALSO MAINTAINS A FINANCIAL ASSISTANCE HELP LINE THAT IS ADVERTISED ON ALL (INPATIENT & OUTPATIENT) BILLS. PART VI, LINE 4: DELAWARE VALLEY HOSPITAL (DVH) IS A 25-BED CRITICAL ACCESS HOSPITAL (CAH) FACILITY LOCATED IN WALTON IN DELAWARE COUNTY, NY. DVH PROVIDES HIGH QUALITY HEALTH AND MEDICAL CARE SERVICES TO A RURAL POPULATION OF APPROXIMATELY 31,000 PEOPLE LIVING IN SOUTHWESTERN DELAWARE AND NORTHEASTERN SULLIVAN COUNTIES. AS A CAH FACILITY, THE HOSPITAL GENERALLY SERVES PATIENTS WHOSE ACUTE STAY WILL BE 96 HOURS OR LESS; HOWEVER, DVH ALSO PROMOTES LONGER-TERM INPATIENT PHYSICAL REHABILITATIVE AND ADDICTION TREATMENT CARE FOR PATIENTS. A NEW 7-BED EMERGENCY DEPARTMENT WAS CONSTRUCTED IN 2008 AND SERVES THE COMMUNITY 24/7. THE HOSPITAL ALSO OFFERS DIAGNOSTIC AND TREATMENT SERVICES WHICH INCLUDE A FULL SERVICE LABORATORY ON SITE, AMBULATORY SERVICES, ENDOSCOPY, BLOOD TRANSFUSIONS AND PHLEBOTOMY. IT'S NEW IMAGING CENTER IS EQUIPPED WITH CT SCAN, MAMMOGRAPHY, BONE DENSITOMETRY AND ULTRASOUND TO NAME A FEW. CARDIOPULMONARY SERVICES INCLUDE EKG, PFT'S, HOLTER AND EVENT MONITORING AND A CARDIAC REHABILITATION PROGRAM. SPEECH, PHYSICAL AND OCCUPATIONAL THERAPY ARE OFFERED BOTH ON AN INPATIENT AND OUTPATIENT BASIS. PRIMARY AND PREVENTIVE CARE FOR ALL AGES, AND OCCUPATIONAL HEALTH SERVICES ARE PROVIDED THROUGH THE THREE PRIMARY CARE SITES IN WALTON, DOWNSVILLE AND ROSCOE, NY. AREA SPECIALISTS COME TO DELAWARE VALLEY HOSPITAL'S VISITING SPECIALIST CENTER ON A REGULAR BASIS TO SEE PATIENTS. THE SERVICE AREA WAS DETERMINED BY EXAMINING INPATIENT ORIGIN BY ZIP CODE AND BY COUNTY. BECAUSE THE MAJORITY OF THE SERVICE AREA FALLS INTO A SINGLE COUNTY, COLLABORATION TO IDENTIFY PUBLIC HEALTH PRIORITIES TOOK PLACE AT THE COUNTY LEVEL. DVH'S SERVICE AREA IS CENTERED IN DELAWARE COUNTY, WITH 81% OF PATIENTS COMING FROM MIDDLE AND SOUTHWESTERN DELAWARE COUNTY COMMUNITIES, AND ANOTHER 15% FROM NORTHERN SULLIVAN, BROOME, OTSEGO, AND CHENANGO COUNTIES. DVH'S 85% ZIP CODE SERVICE AREA INCLUDES THE COMMUNITIES OF: WALTON, DOWNSVILLE, SIDNEY CENTER, ROSCOE, HANCOCK, HAMDEN, DELHI, EAST BRANCH, DELANCEY, SIDNEY, UNADILLA, BAINBRIDGE, FRANKLIN, AND LONG EDDY. PART VI, LINE 5: DURING 2012 THE DELAWARE VALLEY HOSPITAL PARTICIPATED IN SEVERAL PROGRAMS TO PROMOTE THE HEALTH AND WELL-BEING OF THE LOCAL COMMUNITY WITHIN DELAWARE COUNTY. FOR EXAMPLE, THE HOSPITAL SUPPORTED THE DELAWARE COUNTY FAIR WITH A TOTAL OF 15 EMPLOYEES SPENDING 195 WORKING HOURS AT THE EVENT. THE HOSPITAL STAFF PROVIDED APPROXIMATELY 270 BLOOD PRESSURE TESTS, 120 BLOOD SUGAR SCREENINGS AND OTHER HEALTH RELATED TESTS, FOR A TOTAL OF 400 SERVICES AT NO COST TO THE COMMUNITY. THE HOSPITAL ALSO PROVIDED OTHER EVENTS DURING THE YEAR INCLUDING NUMEROUS NUTRITION AND LIFESTYLE EDUCATION OPPORTUNITIES. OTHER COMMUNITY HEALTH IMPROVEMENT PROGRAMS INCLUDED DRUG SCREENS FOR THE DELAWARE VALLEY AND CHENANGO COUNTY DRUG COURT FOR CONVICTED (NON-VIOLENT) INDIVIDUALS. THIS PROGRAM PROVIDED DRUG TEST, COUNSELING, AND COMMUNITY SERVICE AS AN ALTERNATIVE TO INCARCERATION. THE HOSPITAL'S LIFESTEPS PROGRAM ADVOCATED WEIGHT LOSS AND HEALTHY EATING HABITS AND SOLUTIONS. THE HOSPITAL'S DIRECTOR OF COMMUNITY HEALTH SERVICES SERVES ON THE DELAWARE COUNTY RURAL HEALTH CARE ALLIANCE. THIS PROGRAM IS A COALITION OF HEALTH CARE PROVIDERS FROM DELAWARE COUNTY THAT FOCUSES ON THE NEEDS OF COMMUNITY MEMBERS. ALSO TO NOTE, THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF BOTH STAFF AND MEMBERS OF THE LOCAL COMMUNITY. PART VI, LINE 6: DELAWARE VALLEY HOSPITAL, INC. IS AN IMPORTANT PART OF A LARGER SYSTEM OF INTEGRATED DELIVERY OF CARE, WHICH PROVIDES ADDITIONAL BENEFITS TO THE COMMUNITY. AS A RESULT OF THE FORMATION OF UHS IN 1981 AND THE SUBSEQUENT TRANSFORMATION OF THE COMBINED ORGANIZATION INTO A HEALTH CARE SYSTEM, OUR REGION TODAY OFFERS MORE COMPLETE AND ADVANCED CARE THAN MANY COMMUNITIES FIVE TIMES OUR SIZE. IN 2010, THE UNITED HEALTH SERVICES SYSTEM ENGAGED IN A STRATEGIC PLANNING PROCESS FOR THE YEARS 2010-2014. CONSISTENT WITH THE MISSION AND VISION, THE PLAN FOCUSED ON CONTINUING TO STRENGTHEN THE HEALTH SYSTEM AND ITS SERVICES TO THE REGION. THE STRATEGIC PLAN IS ORGANIZED AROUND FOUR OBJECTIVES: CLINICAL EXCELLENCE, SERVICE EXCELLENCE, MARKET GROWTH AND AND FINANCIAL STRENGTH. SPECIFIC DESTINATION METRICS OR MEASURES OF SUCCESS WERE DEVELOPED FOR EACH STRATEGIC OBJECTIVE. THE SPECIFIC INITIATIVES SUPPORTING ACHIEVEMENT OF THE OBJECTIVES ARE REVIEWED ON A REGULAR BASIS. EACH ENTITY CARRIES OUT INITIATIVES LOCALLY AND REGIONALLY. THE UHS COMMUNITY SERVICE REPORT CAPTURES THE BENEFITS SPECIFIC TO UHS WITH THE OTHER AFFILIATES SUBMITTING SEPARATE REPORTS. CLINICAL EXCELLENCE: UHS IS FOCUSED ON BUILDING UPON PREVIOUS EFFORTS THAT ESTABLISHED A CONSISTENT SYSTEM-WIDE FOCUS FOR EVALUATING AND ASSURING EXCELLENCE IN THE DELIVERY OF CLINICAL CARE.UHS IS FOCUSED ON THE DEVELOPMENT OF A COMPREHENSIVE OUTPATIENT CARE MODEL; IMPLEMENTATION OF SOARIAN CLINICAL SYSTEMS TO SUPPORT SERVICE QUALITY AND EXCELLENCE; IMPLEMENTATION OF A MULTI-YEAR PROVIDER RECRUITMENT AND RETENTION STRATEGY; ORGANIZE UHS PROVIDERS TO ACCOMMODATE FUTURE PAYMENT METHODOLOGIES; ALONG WITH THE DEVELOPMENT OF A TALENT MANAGEMENT INITIATIVE TO REALIZE THE LONG TERM STRATEGY FOR A SUSTAINABLE WORKFORCE.SERVICE EXCELLENCE: UHS HAS ELEVATED THE EMPHASIS ON OUTPATIENT CENTERED SERVICE DELIVERY THAT RESULTS IN A MEANINGFULLY DIFFERENT PATIENT EXPERIENCE. INCLUDED IN THIS CATEGORY WOULD BE THE FOLLOWING: IMPLEMENTING THE PRIMARY CARE MEDICAL HOME; COMPREHENSIVE EVALUATION OF PATIENT NEEDS ACROSS THE CARE CONTINUUM; FULL IMPLANTATION OF THE ELECTRONIC MEDICAL RECORD; DEVELOPMENT AND IMPLEMENTATION OF DISEASE MANAGEMENT PROGRAMS; AND IMPLEMENTATION OF CONSISTENT CUSTOMER SERVICE STANDARDS AND TRAINING TO DELIVER ON THE UHS BRAND PROMISE OF RESPECT AND ACCOUNTABILITY.MARKET GROWTH: UHS OPERATES IN A COMPETITIVE ENVIRONMENT WHERE KEY COMPETITORS FUNCTION AS CLOSED, SELF-CONTAINED NETWORKS. AT THE ROOT OF EACH NETWORK IS PRIMARY CARE, WHICH IS THEREFORE A KEY TO SUSTAINABLE GROWTH. KEY RESOURCES HAVE BEEN DEVOTED TO PRIMARY CARE SUPPLY, EXPANSION LOCATIONS, AND DEVELOPMENT OF CONSISTENT OPERATIONAL STANDARDS THAT ARE PATIENT-CENTERED.FINANCIAL STRENGTH: STANDING IN THE SHADOW OF HEALTHCARE REFORM, THE FINANCIAL LANDSCAPE FOR HEALTHCARE AT BOTH THE FEDERAL AND STATE LEVELS CONTINUES TO BE UNPREDICTABLE IN TERMS OF THE MAGNITUDE OF NEGATIVE IMPACTS. UHS IS FOCUSED ON RAISING THE FINANCIAL AMBITION OF THE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 DR MICHAEL FREEMAN 165662 0 0 0 0 0 0 0 16672 0 182334 0 0 0 DR RAJESH DAVE 0 480788 0 78696 0 14454 0 16750 0 16295 0 606983 0 0 DRU CAVANAGH 66621 88718 0 0 0 0 0 18641 0 13016 66621 120375 0 0 ROBERT REYNOLDS 156552 0 0 0 0 0 0 0 8752 0 165304 0 0 0 RYAN KIM 197530 0 0 0 0 0 0 0 3703 0 201233 0 0 0 DOV CAI 175546 0 0 0 0 0 0 0 3703 0 179249 0 0 0 JASPREET SOOD 176589 0 0 0 0 0 0 0 3703 0 180292 0 0 0 LARRY HANRAHAN 148980 0 0 0 0 0 0 0 3430 0 152410 0 0 0 A COUNTY OF DELAWARE INDUSTRIAL DEVELOPMENT AGENCY 161137407 245867AA4 2007-06-29 5805000 CONSTRUCTION OF NEW ER/IMAGING CENTER; REFINANCE HOSPITAL MORTGAGE 0 0 0 A 5805000 250826 5805000 2008 0 0 1 1 A 0 0 0 0 1 0 1 A 1 1 0 0 0 0 A 0 MICHAEL LAYTON BROTHER-IN-LAW OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 43793 EMPLOYEE WAGES 0 BONNIE CRAIG SISTER OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 28992 EMPLOYEE WAGES 0 NANCY VOLLKOMMER SISTER-IN-LAW OF VICKI CONKLING, V.P. NURSING ADMIN./CNO 26088 EMPLOYEE WAGES 0 DR DENISE FREEMAN SPOUSE OF MICHAEL FREEMAN, MEDICAL STAFF PRESIDENT 44748 EMPLOYEE WAGES 0 MILA KATANIC-TUCKER STEP DAUGHTER OF EDWARD SNOW, BOARD OF DIRECTORS 24366 EMPLOYEE WAGES 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBER OF THE ORGANIZATION IS UNITED HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER OF THE ORGANIZATION IS UNITED HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11 THE DELAWARE VALLEY HOSPITAL CONTROLLER PREPARES THE FORM 990 AND THEN PRESENTS IT TO OUR V.P. FINANCE/CFO FOR REVIEW. IT IS THEN FORWARDED TO OUR EXTERNAL AUDITORS, FUST CHARLES CHAMBERS FOR THEIR REVIEW. ONCE THEY DETERMINE IT TO BE COMPLETE, IT IS THEN PRESENTED TO THE PRESIDENT/CEO FOR APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 15A PERFORMANCE REVIEW OF PRESIDENT/CEO IS COMPLETED BY BOARD CHAIR AND 2ND VICE CHAIR/UHS, INC. LIAISON ANNUALLY. RESULTS PRESENTED TO EXECUTIVE COMPENSATION COMMITTEE, COMPRISED OF CHAIR, LIAISON, AND THREE OTHER BOARD MEMBERS. COMMITTEE USES SULLIVAN-CARTER, A PAID CONSULTING FIRM, TO OBTAIN NATIONAL CEO COMPENSATION DATA BY HOSPITAL TYPE, SIZE, ETC. AS BASIS FOR ESTABLISHING ACCEPTABLE RANGE OF COMPENSATION TO ENSURE COMPLIANCE WITH TREASURY REGULATION 53.4958-1(D)(4)(3). THE COMMITTEE THEN DETERMINES AND APPROVES THE PRESIDENT/CEO COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES FORM 990 AND OTHER INFORMATION REQUIRED UNDER INTERNAL REVENUE SERVICE REGULATIONS TO THE PUBLIC, UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN SERVICES FEES: PROGRAM SERVICE EXPENSES 1,220,265. MANAGEMENT AND GENERAL EXPENSES 443,938. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,664,203. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 9,656. UNITED HEALTH SERVICES HOSPITAL INC 10-42 MITCHELL AVENUE BINGHAMTON NY 13903 161165049 HOSPITAL NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 PROFESSIONAL HOME CARE 4401 VESTAL PARKWAY EAST VESTAL NY 13850 161261977 HOME HEALTH CARE NY 501(C)(3) 9 UNITED HEALTH SERVICES INC 0 IDEAL SENIOR LIVING CENTER 508 HIGH STREET ENDICOTT NY 13760 222902896 SENIOR LIVING CENTER NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 IDEAL SENIOR LIVING CENTER HOUSING 508 HIGH STREET ENDICOTT NY 13760 222902899 SENIOR HOUSING NY 501(C)(3) 9 UNITED HEALTH SERVICES INC 0 CHENANGO MEMORIAL HOSPITAL 179 NORTH BROAD STREET NORWICH NY 13815 150532180 HOSPITAL NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 UNITED MED MANAGEMENT 601 RIVERSIDE DRIVE JOHNSON CITY NY 13790 161396133 PHYSICIAN PRACTICE NY 501(C)(3) 11B UNITED HEALTH SERVICES INC 0 UNITED HEALTH SERVICES HOSPITAL INC 20-40 MITCHELL AVENUE BINGHAMTON NY 13903 PARENT COMPANY NY 501(C)(3) 9 UNITED HEALTH SERVICES INC BOARD OF DIRECTORS 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0