2012-10-25T12:37:39-05:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 150524324 DELAWARE VALLEY HOSPITAL INC DELA 6078652197 1 TITUS PLACE WALTON NY 138561457 PAUL SUMMERS 6078652160 2012-10-11 1 P00589741 3154463600 2011 2016-02-24 21:20:13Z PAUL SUMMERS 1 TITUS PLACE WALTON NY 138561457 15309630 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. 9 5 243 49 0 0 443654 318096 15178353 14883364 26635 36294 78825 71876 15727467 15309630 0 0 0 0 9878570 9991256 0 0 14115 5537932 5337612 15416502 15328868 310965 -19238 15422294 15172234 8830758 8932984 6591536 6239250 X TO PROVIDE HIGH QUALITY HEALTH AND MEDICAL CARE SERVICES TO THE RESIDENTS OF IT'S RURAL SERVICE AREA. THE PRINCIPAL GEOGPRAPHIC AREAS SERVED INCLUDES THE MIDDLE AND SOUTHWESTERN PORTIONS OF DELAWARE COUNTY. IN ADDITION, A SIGNIFICANT NUMBER OF RESIDENTS LIVING IN NORTHERN SULLIVAN COUNTY UTILIZE THESE SERVICES. THE MAIN HOSPITAL CAMPUS IS LOCATED IN WALTON, WITH HEALTH CENTERS OPERATED IN DOWNSVILLE AND ROSCOE. 0 0 4231228 8322388 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 ACUTE, 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 2011 WERE COMPRISED OF 607 ACUTE, 137 SWING BED, AND 72 ADDICTION TREATMENT. ACUTE CARE REPRESENTED 1,768 PATIENT DAYS, IN ADDITION TO THE 1,202 PATIENT DAYS FOR SWING BED AND 1,440 PATIENT DAYS IN THE ADDICTION TREATMENT PROGRAM. INDICATIVE OF THE COMPREHENSIVE HEALTHCARE PROVIDED TO THESE PATIENTS, A TOTAL OF 8,335 LAB TESTS, 3,086 RESPIRATORY TREATMENTS, 421 X-RAYS, 647 PHYSICAL THERAPY SESSIONS, AND 423 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. 1805236 1536798 CLINICS: DELAWARE VALLEY HOSPITAL PROVIDES A WIDE RANGE OF PRIMARY AND PREVENTIVE CARE SERVICES THROUGH IT'S FAMILY HEALTH CENTERS LOCATED IN WALTON, DOWNSVILLE, AND ROSCOE. THESE HEALTH CENTERS FORM THE FOUNDATION NECESSARY TO SERVE OUR COMMUNITIES WITH A COORDINATED SYSTEM OF CARE WHILE PAYING SPECIAL ATTENTION TO UNDER-SERVED AREAS. IN 2011 OUR CLINICS PROVIDED CARE TO 9,809 PATIENTS IN WALTON, 2,438 IN ROSCOE, AND 1,147 IN DOWNSVILLE. WITH A FOCUS ON CONTINUOUS IMPROVEMENT, THE FAMILY HEALTH 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. 4947607 5024178 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 AND SURGERY. THE HOSPITAL ALSO CONDUCTS EXTENSIVE WELLNESS PROGRAMMING THAT INCLUDES CARDIOVASCULAR AWARENESS/CHOLESTEROL SCREENING, WEIGHT REDUCTION, CANCER EDUCATION AND SCREENING, AND DIABETES EDUCATION/GLUCOSE TESTING. THE PHYSCIAL THERAPY DEPARTMENT PROVIDES HOME VISITS IN COOPERATION WITH THE DELAWARE COUNTY PUBLIC HEALTH NURSING DEPARTMENT. A FREE PRESCRIPTION DELIVERY PROGRAM IS PROVIDED FOR ROSCOE AND DOWNSVILLE PATIENTS AS THESE COMMUNITIES LACK A PHARMACY. OCCUPATIONAL HEALTH PROGRAMMING MEETS THE NEEDS OF LOCAL BUSINESSES, FIRE DEPARTMENTS, AND EMERGENCY SQUADS BY PROVIDING PHYSICALS, DRUG TESTING, AND ERGONOMIC EDUCATION. IN 2011 THE EMERGENCY DEPARTMENT TREATED OR ADMITTED 5,506 RESIDENTS VIA ITS NEW 5,000+ SQ. FT. FACILITY, THE LAB PERFORMED 52,227 TESTS, AND 7,407 PHYSICAL/OCCUPATIONAL THERAPY SESSIONS WERE CONDUCTED. THE IMAGING CENTER PERFORMED 6,523 X-RAYS, CT SCANS, MRI'S AND MAMMOGRAPHIES FOR OUTPATIENT SERVICES. UPGRADES AND ADDITIONS IN 2011 INCLUDED THE STARTUP AND DEVELOPMENT OF AN ELECTRONIC PATIENT TRACKING SYSTEM (NEXTGEN) WITHIN OUR PRIMARY CARE CENTERS. ALSO, IN 2011 THE ROOFING SYSTEM AT THE WALTON PRIMARY CARE CENTER WAS REPLACED. IN 2011 ADDITIONAL SERVICES WERE PROVIDED WITHIN OUR ROSCOE PRIMARY CARE CENTER WITH THE BUILDING IMPROVEMENT AND EQUIPMENT PURCHASES FOR RADIOLOGY SERVICES. 42898 REBATE REVENUE ($24,683)AND OTHER REVENUE - PHYSICIAN ($18,215). 42898 10984071 1 1 0 1 0 0 0 0 0 1 1 0 1 0 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 0 1 35 0 1 243 1 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 1 0 0 NY X PAUL SUMMERS 6078652198 DELAWARE VALLEY HOSPITAL 1 TITUS WALTON NY 138561457 DAVID POLGE 40.00 X X 199727 0 7019 DR MICHAEL FREEMAN 40.00 X X 227914 0 14978 DR RAJESH DAVE 1.00 X X 0 582165 33335 HELEN JOHNSTON 1.00 X X 0 0 0 EDWARD SNOW 1.00 X X 0 0 0 EDWARD SCHOTT 1.00 X X 0 0 0 PAUL CARLSTROM 1.00 X X 0 0 0 REV LARRY LIGHT 1.00 X 0 0 0 BRIDGET DEMOTT 1.00 X 0 0 0 DOTTIE KRUPPO 40.00 X 76807 0 6525 JOAN GUARNIERI 40.00 X 92936 0 6898 PAUL SUMMERS 40.00 X 106655 0 7260 DEBORAH HITT 40.00 X 78771 0 9967 VICTORIA CONKLING 40.00 X 95983 0 1970 DR VADIM DAVYDOV 40.00 X 168913 0 10345 DR VALENTINA DAVYDOV 40.00 X 170600 0 0 SCOTT FLASHNER 35.00 X 153075 0 7212 ROBERT REYNOLD 40.00 X 157291 0 7414 SUMAN CHOUDHURY 63.00 X 126039 0 7212 PAUL DOWNTON 40.00 X 135101 0 13910 1789812 582165 134045 7 0 1 0 EXCELLUS BLUECROSS BLUESHIELD PO BOX 5266 BINGHAMTON NY 13902 HEALTH CARE 962373 HEALTHCARE MANAGEMENT SYSTEMS 2739 MOMENTUM PLACE CHICAGO IL 60689 INFORMATION TECHNOLOGY 179640 NEXTGEN HEALTHCARE INFORMATION 795 HORSHAM RD HORSHAM PA 19044 HEALTH CARE 147173 SIEMENS HEALTHCARE DIAGNOSTICS PO BOX 121102 DALLAS TX 75312 INFORMATION TECHNOLOGY 140375 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 MEDICAL SUPPORT 126738 7 200255 117841 318096 NET PATIENT REVENUE 900099 14883364 14883364 14883364 36294 36294 VENDING MACHINE 722210 25476 25476 REBATES 900099 24683 24683 PHYSICIAN OTHER REVENU 621498 18215 18215 3502 3502 71876 15309630 14926262 0 65272 1283268 774035 509233 6903591 5085649 1817942 229126 148717 80409 1005485 636196 369289 569786 406875 162911 4192 4192 13246 13246 76023 76023 4687 4687 3517 3517 964220 862863 101357 1467704 1087590 378298 1816 186449 186449 233864 54838 179026 28660 24220 4440 42027 27636 2092 12299 344662 344662 937528 926508 11020 220599 174276 46323 BAD DEBT EXPENSE 714110 714110 MISCELLANEOUS 96124 60558 35566 15328868 10984071 4330682 14115 1867280 1063572 654900 337426 2721 0 1825175 1900842 134131 131118 426743 601048 19214404 11322526 8074653 7891878 531930 848049 1904761 2188301 210000 15422294 15172234 824833 987734 5427574 5435261 963096 874161 1134093 982332 481162 653496 8830758 8932984 X 6248704 5858215 24622 62825 318210 318210 6591536 6239250 15422294 15172234 X -19238 -333048 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4687 4687 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. 342832 38203 381035 424391 6550 88109 342832 361680 145420 82709 424391 765743 79512 299 483874 361680 0.84000 0.16000 1 0 51202 51202 9317719 3759164 5558555 9342529 7563362 1779167 502954 502954 7891878 WELLS FARGO - PRINCIPAL PMTS. ON BOND 175539 F TEMPORARILY RESTRICTED DONATIONS 70167 F CAPITAL CONSTRUCTION (FUNDED DEPR.) 1942595 F 2188301 DUE UNITED MED. ASSOC. NET CHEN. MEM. 5074 DUE UNITED HEALTH SERVICES HOSPITALS 419147 DUE UNITED HEALTH SERVICES, INC. 19275 MALPRACTICE INSURANCE RESERVE 210000 653496 15309630 15328868 -19238 -10005 -323043 -333048 -352286 15309630 0 15309630 0 15309630 15328868 0 15328868 0 15328868 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: 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -323,043. 1 1 X 1 X 1 X 1 1 0 1 1 170579 34539 136040 0.00890 4911041 3721724 1639318 0.10690 5081620 3756263 1775358 0.11580 69632 69632 0.00450 94559 94559 0.00620 1275 1275 0.00010 165466 165466 0.01080 5247086 3756263 1940824 0.12660 1 357055 73521 3550393 3737128 -186735 X 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 1 X 0 0 5 ROSCOE FAMILY HEALTH CENTER

1982 OLD ROUTE 17 ROSCOE NY 12776

OUTPATIENT PHYSICIAN CLINIC DOWNSVILLE FAMILY HEALTH CENTER

15212 MAIN ST DOWNSVILLE NY 13755

OUTPATIENT PHYSICIAN CLINIC WALTON FAMILY HEALTH CENTER

2 TITUS PLACE WALTON NY 13856

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 MEDICARE AND MEDICAID. 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 $714,110 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: ...THE CEO SERVES ON THE COUNTY RURAL HEALTH ALLIANCE WHICH BRINGS HEALTHCARE AND SERVICE AGENCIES TOGETHER TO RECOGNIZE AND ADDRESS HEALTHCARE NEEDS OF RESIDENTS. THE HOSPITALS DIETITIAN SERVES ON THE LOCAL SCHOOL COMMITTEE ON OBESITY TO HELP ADDRESS STUDENTS 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. FINALLY, THE CEO SERVES AS A BOARD MEMBER OF THE CATSKILL-HUDSON AREA HEALTH EDUCATION CENTER WHICH FOCUSES ON WORKFORCE DEVELOPMENT. COMMUNITY SUPPORT ACTIVITIES INCLUDE SERVICE ON A COMMITTEE TO ATTRACT AND RETAIN PROFESSIONALS TO OUR AREA IN THE FIELDS OF HEALTHCARE. 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 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. THE CEO OF THE HOSPITAL SERVES ON THE CATSKILL-HUDSON AREA HEALTH EDUCATION CENTER. 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. 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 IN MULTIPLE LANGUAGES 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 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 SURGERY, ENDOSCOPY AND BLOOD TRANSFUSIONS AND PHLEBOTOMY. IT'S NEW IMAGING CENTER IS EQUIPPED WITH CT SCAN, MAMMOGRAPHY, AND BONE DENSITOMETRY TO NAME A FEW. CARDIOPULMONARY SERVICES INCLUDE EKG, PFT'S, 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 FAMILY HEALTH CENTER 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 2011 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 21 EMPLOYEES SPENDING 205 WORKING HOURS AT THE EVENT. THE HOSPITAL STAFF PROVIDED 269 BLOOD PRESSURE TESTS, 123 BLOOD SUGAR SCREENINGS AND OTHER HEALTH RELATED TESTS, FOR A TOTAL OF 406 SERVICES AT NO COST TO THE COMMUNITY. THE HOSPITAL ALSO PROVIDED OTHER EVENTS DURING THE YEAR INCLUDING A TEDDY BEAR CLINIC WHICH SERVED 92 CHILDREN IN THE LOCAL COMMUNITY AND PROVIDED THEM WITH AN INTRODUCTION AND BETTER UNDERSTANDING OF THE HOSPITAL'S EMERGENCY ROOM. THIS ALSO PROVIDED A CHANCE TO MEET THE STAFF THAT IS THERE TO TREAT THEM. 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 VICE-PRESIDENT 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 STRESSES THE NEEDS OF VARIOUS ORGANIZATION IN THE COMMUNITY. 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 2007, THE UNITED HEALTH SERVICES SYSTEM ENGAGED IN A STRATEGIC PLANNING PROCESS FOR THE YEARS 2008-2011. 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 UHSH COMMUNITY SERVICE REPORT CAPTURES THE BENEFITS SPECIFIC TO UHSH, 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 DAVID POLGE 193727 0 0 0 6000 0 4761 0 2258 0 206746 0 0 0 DR MICHAEL FREEMAN 222914 0 0 0 5000 0 4633 0 10345 0 242892 0 0 0 DR RAJESH DAVE 0 434898 0 115267 0 32000 0 15680 0 17655 0 615500 0 0 DR VADIM DAVYDOV 168913 0 0 0 0 0 0 0 10345 0 179258 0 0 0 DR VALENTINA DAVYDOV 170600 0 0 0 0 0 0 0 0 0 170600 0 0 0 SCOTT FLASHNER 153075 0 0 0 0 0 0 0 7212 0 160287 0 0 0 ROBERT REYNOLD 157291 0 0 0 0 0 3919 0 3495 0 164705 0 0 0 COUNTY OF DELAWARE INDUSTRIAL DEVELOPMENT AGENCY 161137407 245867AA4 2007-06-29 5805000 CONSTRUCTION OF NEW ER/IMAGING CENTER; REFINANCE HOSPITAL MORTGAGE 0 0 0 5805000 250826 5805000 2008 0 0 1 1 0 0 0 0 1 1 1 0 0 0 0 MARIANNE SCHOTT SPOUSE OF EDWARD SCHOTT, BOARD CHAIR 16546 EMPLOYEE WAGES 0 MICHAEL LAYTON BROTHER-IN-LAW OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 42289 EMPLOYEE WAGES 0 BONNIE CRAIG SISTER OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 28874 EMPLOYEE WAGES 0 NANCY VOLLKOMMER SISTER-IN-LAW OF VICKI CONKLING, V.P. NURSING ADMIN./CNO 26175 EMPLOYEE WAGES 0 DR DENISE FREEMAN SPOUSE OF MICHAEL FREEMAN, MEDICAL STAFF PRESIDENT 64061 EMPLOYEE WAGES 0 MILA KATANIC-TUCKER STEP DAUGHTER OF EDWARD SNOW, BOARD OF DIRECTORS 11303 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -10,005. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -323,043. TOTAL TO FORM 990, PART XI, LINE 5: -333,048. 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 1 0 1 1 1 0 0