TY 2015 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
CARDINAL HEALTH DRUGS 7000 CARDINAL PLACE DUBLIN,OH43017	PHARMACEUTICAL	571,506
SECO PHYSICALOCCUPATIONAL THERAPY 26 CONKY AVE NORWICH,NY13815	PHYSICAL/OCC. THERAPY	354,626
MEDHOST OF TENNESSEE 2739 MOMENTUM PLACE CHICAGO,IL60689	INFORMATION TECHNOLOGY	276,444
LOCUMTENENS PO BOX 405547 ATLANTA,GA30384	STAFFING SERVICE	240,663
ALLIANCE HEALTHCARE SYSTEMS PO BOX 96485 CHICAGO,IL60693	MEDICAL SUPPORT	207,306
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 5

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

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

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization DELAWARE VALLEY HOSPITAL INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization DELAWARE VALLEY HOSPITAL INC		Employer identification number 15-0524324

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization DELAWARE VALLEY HOSPITAL INC			Employer identification number 15-0524324
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

6,849

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

6,849

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	AMOUNTS DISCLOSED ARE THE LOBBYING PORTIONS OF DUES PAID TO HEALTHCARE ASSOCIATION OF NY AND IROQUOIS HEALTHCARE.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	361,539	348,578	379,742	381,035	342,832
b	Contributions ...	5,286	12,961	1,700	-1,293	38,203
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	42,156		32,864
f	Administrative expenses ....
g	End of year balance ......	324,669	361,539	348,578	379,742	381,035

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

98.010 %

Temporarily restricted endowment SchDMd Bullet

1.990 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

Yes

(ii) related organizations .................

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	51,202		51,202
b	Buildings	9,982,137	5,028,958	4,953,179
c	Leasehold improvements
d	Equipment ...	10,907,798	9,338,672	1,569,126
e	Other ...	429,324		429,324
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				7,002,831

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)WELLS FARGO - PRIN. PMTS. ON BOND	150,109	F
(2)TEMP.RESTRICTED DONATIONS	14,147	F
(3)CAPITAL CONST(FUNDED DEPR)	1,791,665	F
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	1,955,921

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
DUE UNITED MED. ASSOC. / CHEN. MEM.	252,281
DUE UHS HOSPITALS	157,579
MALPRACTICE INSURANCE RESERVE	65,000
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	474,860
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1	21,626,305
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e	0
3	Subtract line 2e from line 1..................		3	21,626,305
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5	21,626,305

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1	20,640,344
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e	0
3	Subtract line 2e from line 1...................		3	20,640,344
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	20,640,344

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

PURCHASE OF CAPITAL EQUIPMENT (MEDICAL) AND IMPROVEMENT OF FACILITIES.

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, 2015 AND 2014, 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 2012 THROUGH 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .
b	Medicaid (from Worksheet 3, column a) . . . . .
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	135,971	82,929	53,042	0.270 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	135,971	82,929	53,042	0.270 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	154,738		154,738	0.780 %
f	Health professions education (from Worksheet 5) . . .	43,270		43,270	0.220 %
g	Subsidized health services (from Worksheet 6) . . . .	10,234,139	7,866,435	2,367,704	11.980 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	517		517	0 %
j	Total. Other Benefits . .	10,432,664	7,866,435	2,566,229	12.980 %
k	Total. Add lines 7d and 7j .	10,568,635	7,949,364	2,619,271	13.250 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

325,022

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

95,839

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

4,742,710

Enter Medicare allowable costs of care relating to payments on line 5.....

4,691,734

Subtract line 6 from line 5. This is the surplus (or shortfall)........

50,976

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	DELAWARE VALLEY HOSPTITAL 1 TITUS PLACE WALTON,NY13856	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.UHS.NET

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.UHS.NET

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTP://WWW.UHS.NET

The FAP application form was widely available on a website (list url):

HTTP://WWW.UHS.NET

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.UHS.NET

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 5: DELAWARE VALLEY HOSPITAL HAS MEMBERSHIP IN THE DELAWARE COUNTY HEALTHCARE ALLIANCE, A COALITION OF HEALTHCARE AND COMMUNITY ORGANIZATIONS THROUGHOUT THE COUNTY, AS WELL AS ON ITS WELLNESS COMMITTEE. A STAFF MEMBER ALSO SERVES ON THE COMMUNITY COMMITTEE OF THE LOCAL SCHOOL. THE HOSPITAL ALSO HAS REPRESENTATION ON THE COUNTY'S EMERGENCY PREPAREDNESS COMMITTEE (BNICER). THE HOSPITAL'S COMMUNITY RELATIONS DIRECTOR PARTICIPATES IN ALL DVH VOLUNTEER MEETINGS AND ACTIVELY SEEKS THEIR INPUT AND FEEDBACK ABOUT THE HOSPITAL'S SERVICES. THE HOSPITAL'S BOARD OF DIRECTORS PROVIDES INPUT AS TO WHAT THEY HEAR FROM COMMUNITY MEMBERS. PATIENT SATISFACTION SURVEYS ARE ALSO USED IN GAINING INPUT FROM OUR PATIENTS.
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 6A: UNITED HEALTH SERVICE HOSPITALS, INC.CHENANGO MEMORIAL HOSPITAL
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 6B: DELAWARE COUNTY GOVERNMENT AGENCIES:DELAWARE COUNTY PUBLIC HEALTH, MENTAL HEALTH, OFFICE FOR THE AGING, DEPT OF SOCIAL SERVICES, SHERIFF'S DEPT, ALCOHOL AND DRUG ABUSE COUNCIL, PLANNING DEPT, EMERGENCY SERVICES, DRUG TREATMENT COURT, WATERSHED AFFAIRSHOSPITAL AND HEALTH SERVICES:UHS DELAWARE VALLEY HOSPITAL, BASSETT HEALTHCARE-O'CONNOR HOSPITAL AND TRI-TOWN, MARGARETVILLE HOSPITAL, CATSKILL AREA HOSPICEEDUCATION:ROXBURY CENTRAL SCHOOLNURSING HOMES:ROBINSON TERRACEALLIANCES:RURAL HEALTH NETWORK OF SOUTH CENTRAL NYOTHER HUMAN SERVICE AGENCIES:CORNELL COOPERATIVE EXTENSION, RURAL 3 FOR TOBACCO FREE COMMUNITIES, CANCER SERVICE PROGRAM OF DELAWARE, OTSEGO AND SCHOHARIE COUNTIES, DELAWARE OPPORTUNITIES, NY CONNECTS, FAMILY RESOURCE NETWORK, CATHOLIC CHARITIES
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 11: THREE YEAR PLAN OF ACTIONPROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSESUPPORT COLLABORATION AMONG LEADERS, PROFESSIONALS AND COMMUNITY MEMBERS WORKING IN MEB HEALTH PROMOTION, SUBSTANCE ABUSE AND OTHER MEB DISORDERS AND CHRONIC DISEASE PREVENTION, TREATMENT AND RECOVERY.OBJECTIVES:IDENTIFY AND STRENGTHEN OPPORTUNITIES FOR SHARING DATA ON ACCESS TO CARE, IDENTIFY SERVICE GAPS, STUDY COST EFFECTIVENESS STRATEGIES FOR INTEGRATION AND COORDINATION AND IMPACT OF INTERVENTIONS.SUPPORT EFFORTS TO INTEGRATE MEB DISORDER SCREENING AND TREATMENT INTO PRIMARY CARE.UHS DELAWARE VALLEY HOSPITAL ANTICIPATES IT WILL HAVE OTHER OBJECTIVES IT WILL WANT TO FOCUS ON WITHIN THIS PRIORITY BASED ON THE FINDINGS AND WORK OF THE COALITION.2015 SERVICE REPORT UPDATE IN OUR REGULAR CONTACT WITH OUR COUNTY MENTAL HEALTH DEPARTMENT, ESPECIALLY DURING TRAVEL TO DSRIP MEETINGS, WE CAME TO REALIZE THE SEVERE SHORTAGE OF MENTAL HEALTH PROFESSIONALS IN OUR AREA; AND THE EXTREME DIFFICULTY IN RECRUITING OTHERS WOULD ONLY BE SOLVED THROUGH THE ADVANCEMENT OF TELEPSYCH SERVICES. USING VAP GRANT FUNDING, DVH WAS ABLE TO HIRE A TELEMEDICINE CONSULTANT AND THE DECISION WAS MADE TO FOCUS FIRST ON TELEPSYCH SERVICES. UHS HAS AGREED TO SUPPLY THE PROFESSIONALS FOR THIS PROGRAM. THE GOAL IS TO OFFER A SPECIALTY CLINIC TO PATIENTS WHO ARE REFERRED FROM THEIR PRIMARY CARE PHYSICIANS FOR EVALUATION. BY OFFERING THIS SERVICE, THE COUNTY DEPARTMENT WILL HAVE MORE TIME TO CARE FOR THOSE WHO HAVE MORE SERIOUS CONDITIONS. TELEMEDICINE IS SCHEDULED TO BEGIN IN 2016, ONCE THE TELECOMMUNICATION VENDOR IS SELECTED. THE DVH VOLUNTEERS AGREED TO PURCHASE A MONITOR AND CAMERA WHICH WILL MAKE PATIENTS FEEL MORE COMFORTABLE THAN THEY MIGHT BE LOOKING AT AN IPAD OR COMPUTER SCREEN. THAT WILL BE COMPLETED IN THE 1ST QUARTER OF 2016. IN ADDITION, DVH IS ALSO CONSIDERING HAVING ONE OF ITS PRIMARY CARE PHYSICIANS ACCEPT PATIENTS FROM THE COUNTY MENTAL HEALTH DEPARTMENT WHO DO NOT HAVE A PRIMARY CARE PROVIDER AND WISH TO COME TO DVH. AGAIN THIS WILL ALLOW THE COUNTY DEPARTMENT MORE TIME FOR MORE SERIOUS CASES, AS THE PROVIDER WILL BE ABLE TO PRESCRIBE THE MEDICATIONS, THESE STABLE PATIENTS REQUIRE.PREVENT CHRONIC DISEASESREDUCE OBESITY IN CHILDREN AND ADULTS OBJECTIVES:BY 12/31/17, REDUCE THE % OF CHILDREN WHO ARE OBESE BY 5% IN PUBLIC SCHOOL CHILDREN.BY 12/31/15 10% OF ELEMENTARY SCHOOL CHILDREN IN GRADES 2-4 IN THE WALTON, ROSCOE, DOWNSVILLE AND LIVINGSTON MANOR SCHOOL DISTRICTS WILL PARTICIPATE IN THE UHS STAY HEALTHY! "TAKING SMALL STEPS TOGETHER" PROGRAM, WHICH ENCOURAGES CHILDREN TO EAT 5 SERVINGS OF FRUITS AND VEGETABLES PER DAY, HAVE 2 HOURS OR LESS OF SCREEN TIME AND 1 HOUR OR MORE OF PHYSICAL ACTIVITY.WORKING WITH THE SCHOOL NURSES AT ROSCOE, DOWNSVILLE AND LIVINGSTON MANOR SCHOOLS, CHILDREN WILL BE ENROLLED IN THE PROGRAM DURING 2015.WORKING WITH THE TOWNSEND SCHOOL PTA WALTON ELEMENTARY SCHOOL CHILDREN WILL BE ENROLLED IN THE PROGRAM DURING 2015.WORKING WITH EACH SCHOOL, CHILDREN WILL BE ENCOURAGED TO COMPLETE AT LEAST 2 ROUNDS OF THE 5 WEEK PROGRAM. CHILDREN COMPLETING EACH ROUND WILL RECEIVE A "CHARM" TO PUT ON A BRACELET.THE PROGRAM WILL BE REPEATED EACH YEAR OF THE COMMUNITY SERVICE PLAN.BY 12/31/15 AT LEAST 100 CHILDREN IN WALTON, ROSCOE, DOWNSVILLE AND LIVINGSTON MANOR SCHOOLS WILL PARTICIPATE IN AN AFTER SCHOOL COOKING CLASS LEARNING HOW TO MAKE AND CHOOSE HEALTHY SNACKS.IN 2015, UHS DELAWARE VALLEY HOSPITAL WILL WORK WITH THE 21ST CENTURY RISE PROGRAM TO OFFER AFTER SCHOOL COOKING CLASSES TO ROSCOE, DOWNSVILLE AND LIVINGSTON MANOR STUDENTS SO THEY CAN IDENTIFY AND MAKE HEALTHY SNACKS. STUDENTS WILL PREPARE SNACKS; RECEIVE RECIPE CARDS TO TAKE HOME AND HEALTHY SNACK TIP SHEETS FOR PARENTS.IN 2015, UHS DELAWARE VALLEY HOSPITAL WILL WORK WITH THE WALTON CENTRAL SCHOOL WELLNESS COMMITTEE TO OFFER AFTER SCHOOL COOKING CLASSES TO STUDENTS AS ABOVE.BY 12/31/17, REDUCE THE % OF ADULTS 18 AND OVER WHO ARE OBESE.DUE TO REQUESTS FROM COMMUNITY MEMBERS, BY 12/31/15 AT LEAST 20 ADULTS WILL PARTICIPATE IN HEALTHY COOKING CLASSES. EACH PARTICIPANT WILL RECEIVE RECIPE CARDS TO TAKE HOME AND THE CLASSES WILL FEATURE A MEAT, POULTRY, FISH AND VEGETABLE DISHES.2015 SERVICE REPORT UPDATE HEALTHY COOKING CLASSES ALTHOUGH THIS WAS AN INITIAL PLAN OF DVH, WE FOUND THAT WITH LIMITED RESOURCES THIS IS JUST NOT GOING TO BE A FEASIBLE PROJECT FOR US, OR THAT THE PLANNED EFFORTS WOULD REALLY MOVE THE NEEDLE IN TERMS OF MAKING A DIFFERENCE. ALTHOUGH WELL RECEIVED, OUR COOKING CLASSES CAN ONLY REACH A FEW PEOPLE AT A TIME. INSTEAD, WE HAVE TEAMED UP WITH THE UHS BARIATRIC SURGERY PROGRAM AND OUR DIETITIAN IS NOW COUNSELING MANY OF OUR AREA PATIENTS WHO ARE CONSIDERING THIS OPTION. SHE ALSO CONTINUES TO OFFER THE LIFESTEPS PROGRAM AT LEAST ONCE EACH YEAR AND GENERALLY REACHES APPROXIMATELY 10 PEOPLE.BY 12/31/17, INCREASE THE NUMBER OF TOWNS AND VILLAGES THAT HAVE PASSED COMPLETE STREETS POLICIES FROM 23-46. COMPLETE STREETS ARE DESIGNED TO ALLOW EASY AND SAFE TRAVEL BY WALKING, RIDING AND BIKING. (TRI-STATES TRANSPORTATION CAMPAIGN)OBJECTIVES:BY 12/31/17 50% OF DELAWARE COUNTY TOWNS WILL HAVE ONE TRAIL MAPPED AND/OR MARKED.BY 12/31/17 25% OF PRIMARY CARE PRACTICES WILL UTILIZE THE PRESCRIPTION TRAIL PROGRAM IN THEIR PRACTICES TO ENCOURAGE PATIENTS TO BE PHYSICALLY ACTIVE.WORKING WITH DELAWARE COUNTY PUBLIC HEALTH, O'CONNOR HOSPITAL, MARGARETVILLE HOSPITAL, THE CATSKILL MOUNTAIN CLUB, AND DELAWARE COUNTY CHAMBER OF COMMERCE EXISTING TRAILS WILL BE IDENTIFIED, THEIR DIFFICULTY LEVEL ASSESSED. POSSIBILITIES OF CREATING NEW TRAILS WILL BE EXPLORED.A WEBSITE WILL BE DEVELOPED TO ENCOURAGE USE OF THE TRAILS, AND MAKE MORE PEOPLE AWARE OF THEIR EXISTENCE AND ANY ACTIVITIES THAT MAY BE HELD ON THE TRAILS.PRIMARY CARE PROVIDERS WILL BE EDUCATED ABOUT THE PRESCRIPTION TRAILS PROGRAM AND THE EXISTING TRAILS.2015 SERVICE REPORT UPDATE IN ADDITION DVH SPOKE WITH WALTON VILLAGE BOARD MEMBERS, IN CONJUNCTION WITH DELAWARE COUNTY PUBLIC HEALTH ABOUT THE COMPLETE STREETS PROGRAM. SINCE SUBMITTING OUR COMMUNITY SERVICE PLAN, WE WERE TOLD THE VILLAGE OF WALTON DID PASS A COMPLETE STREETS POLICY IN DECEMBER, 2015. WE ALSO SPOKE WITH THE TOWN OF COLCHESTER BOARD MEMBERS. THEY TOO PASSED A COMPLETE STREETS POLICY LAST YEAR.IN 2015, WE EXPANDED THE PROFESSIONALS USING THE PRESCRIPTION TRAIL PROGRAM TO INCLUDE THE DIETITIAN, PHYSICAL THERAPY DEPARTMENT AND THE CARDIAC/PULMONARY REHAB DEPARTMENT.PROMOTE USE OF EVIDENCE-BASED CARE TO MANAGE CHRONIC DISEASES. OBJECTIVES:BY DECEMBER 31, 2017, INCREASE THE PERCENTAGE OF PATIENTS, AGES 18-85 YEARS WHO HAVE CONTROLLED THEIR BLOOD PRESSURE (BELOW 140/90)BY DECEMBER 31, 2017 INCREASE THE PERCENTAGE OF PATIENTS WITH DIABETES WHOSE BLOOD GLUCOSE IS IN GOOD CONTROL (HEMOGLOBIN A1C LESS THAN 9%).UHS IS CURRENTLY WORKING TO PROVIDE UHS DELAWARE VALLEY HOSPITAL WITH BASELINE DATA SO THAT TARGETS CAN BE ESTABLISHED FOR THESE 2 OBJECTIVES. THIS IS A SYSTEM FOCUS THAT IS TIED TO PATIENT CENTERED MEDICAL HOME STATUS.2015 SERVICE REPORT UPDATEFALL PREVENTION WITHIN THIS PRIORITY WE FOCUSED ON FALL PREVENTION. WE HAVE HAD 2 DELAWARE VALLEY HOSPITAL (DVH) STAFF TRAINED TO CONDUCT MATTER OF BALANCE CLASSES THROUGH THE DELAWARE COUNTY OFFICE OF THE AGING (OFA). ONE CLASS, WITH A DVH STAFF MEMBER AND A PUBLIC HEALTH STAFF MEMBER WAS HELD. 10 ENROLLED AND 8 COMPLETED ALL OF THE SESSIONS. THE OFA OFFERS THE CLASSES FOR FREE WITH A DONATIONS WELCOME MODEL. WHEN DVH SPONSORS THE CLASS, WE SUPPLY ALL OF THE MATERIALS, SNACKS AND VENUE FREE OF CHARGE TO THE OFA SO THAT ANY DONATIONS THEY RECEIVE CAN BE UTILIZED FOR OTHER CLASSES ELSEWHERE. DVH NEEDS TO IDENTIFY ADDITIONAL STAFF MEMBERS TO BE TRAINED IN THIS PROGRAM AS ONE OF THE TRAINERS HAS LEFT DVH'S EMPLOY. DVH ALSO LEARNED OF THE OPPORTUNITY TO HAVE VOLUNTEERS FROM DELAWARE COUNTY BECOME TAI CHI LEADERS, THROUGH A PROGRAM IN BROOME COUNTY. DVH BROUGHT THIS TO THE ATTENTION OF OFA AND THEY SENT 3 PEOPLE TO THE TRAINING. ALTHOUGH SENDING A STAFF MEMBER TO THE TRAINING AND HAVING THEM CONDUCT CLASSES IS JUST TOO TIME INTENSIVE FOR OUR LIMITED STAFF RESOURCES, DVH AGREED TO SPONSOR A TAI CHI PROGRAM IN WALTON DURING 2016. EVIDENCE-BASED PROGRAMMING CHRONIC DISEASE SELF MANAGEMENT PROGRAM IN OUR WORK ON CHRONIC DISEASE AND OUR PARTNERSHIPS WITHIN OUR PPS OF THE DSRIP INITIATIVE, WE ALLOTTED MONEY WITHIN OUR VAP GRANT FUNDING TO BE UTILIZED TO OFFER STANFORD UNIVERSITY'S EVIDENCE BASED CHRONIC DISEASE SELF MANAGEMENT PROGRAM'S MASTER TRAINER PROGRAM LOCALLY. WHILE WE HAD PLANNED TO HOLD THE CLASS IN 2015, IT WILL BE HELD IN JUNE OF 2016 SO THAT MORE ORGANIZATIONS WITHIN THE 9 COUNTY PPS CAN PREPARE TO PARTICIPATE. DVH WILL BE SENDING AT LEAST 2 STAFF MEMBERS TO THE CLASS, AS WELL AS 2 MEMBERS OF THE UHS STAY HEALTHY! STAFF. O'CONNOR HOSPITAL PLANS TO SEND PARTICIPANTS ALSO. IN ADDITION, DVH INTENDS TO UTILIZE TELECOMMUNICATION TO HELP PATIENTS HAVE ACCESS TO MORE WELLNESS PROGRAMMING. IT HAS SUBMITTED A GRANT APPLICATION TO THE
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 13H: FEDERAL POVERTY GUIDELINES (FPG) IS USED TO DETERMINE THE FAMILY INCOME LIMIT FOR FREE CARE ELIGIBILITY OF 200%. THE FPG IS NOT USED TO DETERMINE DISCOUNTED CARE ELIGIBILITY. HOWEVER THE FPG IS USED TO DETERMINE THE PERCENTAGE OF DISCOUNTED CARE A PATIENT WILL RECEIVE.
DELAWARE VALLEY HOSPTITAL	PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY MAXIMUM CHARGE AMOUNT FOR FAP-ELIGIBLE INDIVIDUALS DID NOT EXCEED 65% OF THE HIGHEST VOLUME PAYOR GROSS CHARGE RATE. DURING 2015, THE HIGHEST VOLUME PAYOR WAS EXCELLUS BLUE CROSS & BLUE SHIELD.

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	1 - WALTON FAMILY HEALTH CENTER 2 TITUS PLACE WALTON,NY13856	OUTPATIENT PHYSICIAN CLINIC
2	2 - DOWNSVILLE FAMILY HEALTH CENTER 28315 STATE HWY 206 DOWNSVILLE,NY13755	OUTPATIENT PHYSICIAN CLINIC
3	3 - ROSCOE FAMILY HEALTH CENTER 1982 OLD ROUTE 17 ROSCOE,NY12776	OUTPATIENT PHYSICIAN CLINIC
4	4 - PHYSICAL AND OCCUPATIONAL THERAPY 123 STOCKTON AVENUE WALTON,NY13856	REHABILITATION CLINIC
5	5 - SPECIALTY CLINIC 121 STOCKTON AVENUE WALTON,NY13856	OUTPATIENT PHYSICIAN CLINIC
6
7
8
9
10

Schedule H (Form 990) 2015

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
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 ON DVH'S ALLOWABLE COSTS (INPATIENT AND OUTPATIENT) AND 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, LN 7 COL(F):	DELAWARE VALLEY HOSPITAL REPORTED BAD DEBT EXPENSE IN THE AMOUNT OF $870,984 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, COMMUNITY BUILDING ACTIVITIES:	DELAWARE VALLEY HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH ITS MEMBERSHIP AND PARTICIPATION IN THE DELAWARE COUNTY HEALTHCARE ALLIANCE, A COALITION OF HEALTHCARE AND COMMUNITY ORGANIZATIONS THROUGHOUT THE COUNTY. STAFF MEMBERS ALSO SERVE ON THE COMMUNITY COMMITTEE OF THE LOCAL SCHOOL. THE HOSPITAL ALSO HAS REPRESENTATION ON THE COUNTY'S EMERGENCY PREPAREDNESS COMMITTEE (BNICER). WEEKLY NARCOTICS ANONYMOUS MEETINGS ARE HELD AT THE HOSPITAL AND HOSPITAL STAFF PERFORMS DRUG TESTING COLLECTION FOR THE COUNTY'S DRUG COURT FREE OF CHARGE. THE WALTON PRIDE COMMITTEE HAS BEEN WORKING TO REVITALIZE THE COMMUNITY AFTER ITS DEVASTATING FLOOD IN 2006. THE HOSPITAL MADE A DONATION TO HELP THEM BRIGHTEN AND CLEAN A CORNER OF ITS MAIN STREET. IT ALSO SUPPORTED THE COMMUNITY HOLIDAY DINNER, THE TOWN'S LITTLE LEAGUE ORGANIZATION, AND THE WALTON VETS CLUB AUXILIARY BY COLLECTING ITEMS TO BE SENT TO OUR TROOPS. THE HOSPITAL ALSO WORKED WITH THE WALTON CENTRAL SCHOOL STUDENT COUNCIL AS THEY CREATED A HIGHLY IMPACTFUL SET OF VIDEOS DRAMATIZING A CHAIN OF EVENTS LEADING UP TO A DEADLY DWI ACCIDENT. DELAWARE VALLEY ALLOWED STUDENTS TO VIDEOTAPE IN ITS ED AND MANY DVH STAFF PARTICIPATED. THE FINAL VIDEO WAS SHOWN IN AN ASSEMBLY JUST BEFORE PROM NIGHT. DVH HOSTED SEVERAL PUBLIC EDUCATIONAL SESSIONS PRESENTED BY THE ALZHEIMER'S ASSOCIATION. THE HOSPITAL GROUNDS ARE ALSO HOST TO A FARMER'S MARKET FROM JULY THROUGH OCTOBER. THE PRESIDENT/CEO OF DELAWARE VALLEY IS AN ACTIVE MEMBER OF THE WALTON LIONS CLUB.IN 2015, THE WALTON MINISTERIAL ASSOCIATION BEGAN A HUNGER WALK TO RAISE MONEY FOR THE LOCAL FOOD BANK AND CHILDREN'S NUTRITION PROGRAMS. DELAWARE VALLEY WAS A LEADING SPONSOR OF THE EVENT AND STAFF SERVED ON THE PLANNING COMMITTEE. HOWEVER, THE SINGLE LARGEST COMMUNITY BUILDING ACTIVITY DVH ACCOMPLISHED WAS THE CREATION OF OFFICE SPACE FOR THE RURAL HEALTH NETWORK OF SOUTH CENTRAL NY'S OUTREACH STAFF. THE NETWORK'S MAIN OFFICE IS IN WHITNEY POINT, NY, OVER AN HOUR AWAY FROM DELAWARE COUNTY , ONE OF THEIR TARGET AREAS. BY PROVIDING THEM WITH FREE OFFICE SPACE, THEY WILL HAVE A HOME BASE MORE CENTRALLY LOCATED TO THOSE THEY ARE TRYING TO SERVE. THE ORGANIZATION OFFERS MANY NAVIGATION-TYPE PROGRAMS, MOST ESPECIALLY ACCESS TO TRANSPORTATION SERVICES.
PART III, LINE 4:	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:	UHS HOSPITALS POLICY CLEARLY STATES THAT THE FORCED SALE OR FORECLOSURE OF A PATIENT'S PRIMARY RESIDENCE, LIQUIDATION OF RETIREMENT ASSETS OR COLLEGE SAVINGS, AND THE SALE OF A CAR USED REGULARLY ARE NOT PERMITTED. THE POLICY ALSO PROHIBITS COLLECTION FROM PATIENTS WHO ARE DETERMINED TO BE ELIGIBLE FOR MEDICAID AT THE TIME OF SERVICE.UHSH REFRAINS FROM SENDING AN ACCOUNT TO COLLECTION AGENCIES IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION AND THE REQUIRED DOCUMENTATION ARE PROVIDED. UHSH PROVIDES WRITTEN NOTICE NO LESS THAN 30 DAYS PRIOR TO REFERRING DEBTS TO COLLECTION AGENCIES AND WILL REFRAIN FROM INITIATING ANY EXTRAORDINARY COLLECTION ACTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST DISCHARGE BILLING STATEMENT. UHSH ALSO REQUIRES THAT COLLECTION AGENCIES FOLLOW THE FINANCIAL ASSISTANCE POLICY GUIDELINES AND MUST RECEIVE WRITTEN CONSENT FROM UHSH BEFORE COMMENDING LEGAL ACTION.
PART VI, LINE 2:	RECRUITMENT OF HEALTHCARE PROFESSIONALS IS ALWAYS A CHALLENGE, ESPECIALLY IN OUR RURAL AREA. DELAWARE VALLEY HOSPITAL (DVH) AND ITS 3 PRIMARY CARE CENTERS MAINTAIN THEIR STANDING AS APPROVED SITES FOR PROFESSIONALS SEEKING ASSISTANCE THROUGH THE NATIONAL HEALTH SERVICE CORPS. THE HOSPITAL ALSO HOSTS BOTH RN AND CNA STUDENTS, FROM OUR LOCAL COLLEGE, (SUNY DELHI) AND BOARD OF COOPERATIVE EDUCATIONAL SERVICES (BOCES). A VERY SUCCESSFUL MASH CAMP IS HELD DURING THE YEAR TO PROVIDE AN OPPORTUNITY FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT HEALTHCARE CAREERS AND ENCOURAGE THEM TO PRACTICE IN OUR RURAL COMMUNITY. IN 2015 STUDENTS ATTENDED OVER A TWO DAY PERIOD. DURING 2015, THE HOSPITAL CONTINUED TO WORK HAND IN HAND WITH THE DELAWARE COUNTY PUBLIC HEALTH DEPARTMENT AND A MULTITUDE OF COMMUNITY ORGANIZATIONS AND HEALTHCARE PROVIDERS TO ADDRESS NEEDS IDENTIFIED IN THE COMMUNITY HEALTH ASSESSMENT. CONTINUING ON OUR PREVIOUS EFFORTS, BOTH THE VILLAGE OF WALTON AND TOWN OF COLCHESTER ADOPTED COMPLETE STREETS POLICIES. MENTAL HEALTH AND SUBSTANCE ABUSE HAVE BEEN IDENTIFIED IN THE NEEDS ASSESSMENT AS A PRIORITY. IN 2015, MEETINGS CONTINUED WITH ORGANIZATIONS AND ENTITIES THAT ADDRESS MENTAL, EMOTIONAL, AND BEHAVIORAL HEALTH, AS WELL AS SUBSTANCE ABUSE. THE DIRECTOR OF COMMUNITY RELATIONS SITS ON THE MENTAL HEALTH COMMITTEE OF DELAWARE COUNTY. THE MOST CHALLENGING BARRIER TO ACCESS TO CARE IS THE LACK OF PROVIDERS TO CARE FOR THESE PATIENTS. DELAWARE VALLEY HIRED THE TELEMEDICINE CONSULTANT AND THROUGH HIS ASSISTANCE, AND THE FORMATION OF AN INTER-DISCIPLINARY TEAM , THE HOSPITAL NOW HAS ITS POLICIES AND PROCEDURES IN PLACE; IDENTIFIED LOCATIONS FOR EQUIPMENT; ASSESSED VARIOUS VENDORS TO PROVIDE SERVICES AND WILL BE RECEIVING EQUIPMENT, AS A LOAN, FROM BINGHAMTON UNIVERSITY, THROUGH ONE OF THEIR PROGRAMS. THE HOSPITAL IS CURRENTLY WORKING WITH ITS UHS COUNTERPARTS TO IDENTIFY PROFESSIONALS TO PROVIDE CARE. THE HOSPITAL ALSO PARTICIPATED IN THE UHS PPS FOR THE DSRIP PROGRAM, NOW CALLED CARE COMPASS NETWORK. THE COMMUNITY RELATIONS DIRECTOR SAT ON THE EXECUTIVE COMMITTEE AND WAS ACTIVELY INVOLVED IN THE ORGANIZATION'S EASTERN REGIONAL PERFORMANCE GROUP MEETINGS. CHRONIC DISEASE MANAGEMENT IS ANOTHER IDENTIFIED NEED AND THE DIRECTOR ALSO SAT ON THE TWO PROJECT COMMITTEES TO ADDRESS CARDIOVASCULAR HEALTH AND COPD. THE HOSPITAL IS PLANNING TO SPONSOR A STANFORD UNIVERSITY BASED, CHRONIC DISEASE SELF MANAGEMENT MASTER TRAINER TRAINING IN 2016.
PART VI, LINE 3:	DELAWARE VALLEY HOSPITAL IS COMMITTED TO PROVIDING OUR PATIENTS' THE KNOWLEDGE THAT WE OFFER FINANCIAL ASSISTANCE. EACH PATIENT CARE REGISTRATION AREA HAS SIGNS TELLING THE PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO THEM. THERE ARE ALSO BROCHURES REGARDING THE PROGRAM THROUGHOUT THE HOSPITAL'S FACILITIES AND THE INFORMATION IS ALSO POSTED ON THE WEBSITE. IF NEEDED, TRANSLATION SERVICES ARE AVAILABLE. A FINANCIAL ASSISTANCE HELP LINE IS ALSO AVAILABLE AND ADVERTISED ON ALL BILLINGS. IN 2015, THE HOSPITALS FINANCIAL ASSISTANCE POLICY CHANGED TO PROVIDE ALL SELF-PAY PATIENTS AN AUTOMATIC 30% DISCOUNT AT THE TIME OF SERVICE. IF FURTHER ASSISTANCE IS NEEDED, THE PATIENT APPLIES THROUGH THE FINANCIAL ASSISTANCE PROGRAM. DELAWARE VALLEY ALSO OFFERS PATIENTS EASY ACCESS TO A FIDELIS REPRESENTATIVE, BY PROVIDING A SITE FOR THEM TO INTERVIEW AND ENROLL RESIDENTS IN THEIR MEDICAID MANAGED CARE PRODUCT. FIDELIS IS THE ONLY PROVIDER OF THESE SERVICES FOR DELAWARE COUNTY.
PART VI, LINE 4:	DELAWARE VALLEY HOSPITAL'S SERVICE AREA IS CENTERED IN DELAWARE COUNTY, WITH 79% OF THE PATIENTS COMING FROM THE WESTERN HALF OF DELAWARE COUNTY, AND ANOTHER 15% FROM NORTHERN SULLIVAN, BROOME, OTSEGO, AND CHENANGO COUNTIES. DVH'S 85% ZIP CODE SERVICE AREA INCLUDES THE COMMUNITIES OF WALTON, DOWNSVILLE, ONEONTA, ROSCOE, HANCOCK, DELHI, EAST BRANCH, SIDNEY, SIDNEY CENTER, BINGHAMTON, UNADILLA, LONG EDDY, AND HAMDEN. DELAWARE COUNTY IS LOCATED ON THE WESTERN EDGE OF THE CATSKILL MOUNTAINS IN RURAL, UPSTATE NEW YORK. ENCOMPASSING 1446.37 SQUARE MILES, ITS SIZE APPROXIMATES THAT OF RHODE ISLAND AND IS THE FOURTH LARGEST OF NEW YORK STATE'S 62 COUNTIES. IN FACT, ITS SIZE IS SO GREAT THAT, SEVEN COUNTIES AND THE STATE OF PENNSYLVANIA BORDER DELAWARE COUNTY. IT ALSO RANKS AS THE SIXTH MOST RURAL COUNTY IN THE STATE WITH JUST 33 PERSONS PER SQUARE MILE. ITS TOPOGRAPHY IS CHARACTERIZED BY WINDING, AND TWISTING, TWO-LANE ROADS THAT TRANSVERSE A MOUNTAINOUS TERRAIN, MAKING TRAVEL CHALLENGING, ESPECIALLY DURING THE WINTER MONTHS. TRANSPORTATION IS AN EXTREMELY CHALLENGING BARRIER TO CARE. THE AREA DOES NOT HAVE PUBLIC TRANSPORTATION AND WHILE RECENTLY A COUPLE OF PRIVATE TRANSPORTATION SERVICES HAVE BEGUN, THEY ARE TOO COST PROHIBITIVE FOR MANY TO ACCESS. THE COUNTY IS HOME TO TWO OF THE STATE'S LARGEST RESERVOIRS IN THE NEW YORK CITY WATERSHED, WHICH HAS THE LARGEST UNFILTERED DRINKING WATER SUPPLY IN THE UNITED STATES. APPROXIMATELY 55% OF DELAWARE COUNTY'S POPULATION LIES WITHIN THE WATERSHED. NEW YORK CITY HAS WORKED TO PRESERVE AND SAFEGUARD THE WATERSHED FROM ENVIRONMENTAL DEGRADATION BY MEANS OF RESTRICTIONS AND REGULATIONS ON LAND USE WITHIN AND SURROUNDING THE WATERSHED. THE INITIAL IMPACT OF THE WATERSHED ON DELAWARE COUNTY HAS BEEN TO LIMIT ECONOMIC DEVELOPMENT WHICH PREVENTS EXPANSION OF THE TAX BASE. BECAUSE OF THE ENVIRONMENTAL ECOSYSTEM OF THE WATERSHED, THERE HAVE BEEN STRICT REGULATIONS PERTAINING TO AGRICULTURAL POLLUTION AND BUILDING CONSTRUCTION. LIMITING INFRASTRUCTURE GROWTH RESULTS IN DECREASED EMPLOYMENT OPPORTUNITIES. THESE UNIQUE CIRCUMSTANCES RESULT IN HEALTH CARE RELATED CHALLENGES FOR THE COUNTY RESIDENTS. THESE LIMITATIONS ALSO IMPACT THE LOCAL HEALTH AND SOCIAL SERVICE AGENCIES AND ORGANIZATIONS AND THE DELIVERY OF CARE AND SERVICES.THESE LIMITATIONS HAVE CAUSED RESIDENTS TO SEEK ALTERNATIVES TO STIMULATE ECONOMIC GROWTH. DELAWARE COUNTY FARMERS HAVE STARTED SPECIALTY INDUSTRIES. THIS IS REFLECTED IN THE INCREASED NUMBER OF SPECIALTY FARMS. OTHER ECONOMIC DEVELOPMENTS ARE TAKING THE FORM OF TOURISM (E.G. BED AND BREAKFAST), RECREATIONAL FACILITIES COMPATIBLE WITH THE ENVIRONMENT (E.G. GOLF, SKIING, HIKING, HUNTING AND FISHING), LOW POLLUTION FARMING, AND PROFESSIONAL/BUSINESS SERVICES COMPANIES.THE MEDIAN AGE IN DELAWARE COUNTY IS 45.4 YEARS, WHILE 35% ARE AGE 55 AND OVER, AND 20% OF THOSE ARE 65 YEARS AND OVER. 95.6% OF THE POPULATIONS ARE WHITE, SO THERE IS LITTLE ETHNIC DISPARITY. THE MEDIAN FAMILY INCOME IS $ 44,470 AND APPROXIMATELY 14% OF THE POPULATION LIVES IN POVERTY. ACCORDING TO THE 2009-2011 AMERICAN COMMUNITY SURVEY BY THE U.S. CENSUS BUREAU THE PERCENTAGE OF RELATED CHILDREN LIVING BELOW THE POVERTY LEVEL WITH A FEMALE HEAD OF HOUSEHOLD, NO HUSBAND PRESENT HAS RISEN TO 66.7% FOR CHILDREN UNDER 5 YEARS OF AGE IN DELAWARE COUNTY. THIS IS WELL ABOVE NEW YORK AND UNITED STATES COMPARISONS OF 42.8% AND 47% RESPECTIVELY.
PART VI, LINE 5:	DELAWARE VALLEY HOSPITAL, A CRITICAL ACCESS HOSPITAL, PROMOTES COMMUNITY HEALTH THROUGH ITS ONGOING EFFORTS TO PROVIDE THOSE SERVICES MOST OFTEN UTILIZED BY THOSE IT SERVES. ITS INPATIENT SERVICES INCLUDE ACUTE CARE FOR THOSE PATIENTS REQUIRING 96 HOURS OR LESS OF HOSPITALIZATION; LONGER TERM REHABILITATIVE CARE FOR THOSE NEEDING TIME TO GAIN STRENGTH OR STAMINA AFTER A DEBILITATING ILLNESS OR INJURY OR A SURGICAL PROCEDURE; AND INPATIENT ADDICTION TREATMENT. THE HOSPITAL ALSO PROVIDES 24 HOUR EMERGENCY CARE. DIAGNOSTIC AND TREATMENT SERVICES INCLUDE LABORATORY, CARDIOPULMONARY AND IMAGING SERVICES. THE HOSPITAL HAS THE CAPABILITY OF PERFORMING PULMONARY FUNCTION TESTING, EKGS, CARDIAC STRESS TESTING, AND PLACING HOLTER AND EVENT MONITORS, AS WELL AS HOME SLEEP STUDY EQUIPMENT. IN THE IMAGING CENTER X-RAY, FLUOROSCOPY, MAMMOGRAPHY, BONE DENSITOMETRY, ULTRASOUND, ECHOCARDIOGRAMS AND CT SCANS ARE PERFORMED. A MOBILE MRI SERVICE IS AVAILABLE TWICE WEEKLY. ITS OUTPATIENT REHABILITATION DEPARTMENT OFFERS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, AND A CARDIOPULMONARY REHABILITATION PROGRAM IS ALSO IN PLACE. THROUGH ITS THREE PRIMARY CARE OFFICES LOCATED IN WALTON, DOWNSVILLE AND ROSCOE, NY PATIENTS OF ALL AGES CAN RECEIVE ACUTE AND PREVENTIVE CARE. OCCUPATIONAL HEALTH SERVICES INCLUDE PRE-EMPLOYMENT AND DOT PHYSICALS, IMMUNIZATIONS, DRUG TESTING AND ANNUAL PHYSICALS FOR FIRE DEPARTMENT MEMBERS. VISITING SPECIALISTS INCLUDE A GENERAL SURGEON, CARDIOLOGIST AND PODIATRIST.DURING 2015, THE COMMUNITY RELATIONS DIRECTOR MET WITH THE STAFF OF THE UHS STAY HEALTHY AND NURSE DIRECT DEPARTMENTS, AS WELL AS THE NEW UHS CARDIAC NAVIGATOR TO PROVIDE THEM WITH INFORMATION ABOUT SERVICES AVAILABLE TO PATIENTS IN OUR AREA. OUT OF THIS MEETING THE BARIATRICS COUNSELOR DECIDED TO PRESENT A SEMINAR FOR DVH AREA RESIDENTS IN WALTON. DELAWARE VALLEY HOSPITAL'S CERTIFIED DIETICIAN/NUTRITIONIST HELD A LIFESTEPS CLASS WHICH FOCUSES ON PARTICIPANTS' LIFESTYLES AS IT RELATES TO DIET AND EXERCISE. 7 PEOPLE PARTICIPATED. THE HOSPITAL CONTINUED ITS ANNUAL PRESENCE AT THE WEEK-LONG DELAWARE COUNTY FAIR. DURING THE WEEK, THE HOSPITAL STAFF PROVIDED LOTS OF HEALTH AND NUTRITION INFORMATION TO FAIRGOERS, PERFORMING AT LEAST 384 BLOOD PRESSURE CHECKS; 155 PULSE OX (HEART RATE AND OXYGEN LEVEL TESTS); AND 17 BALANCE SCREENINGS. IN ADDITION, PROPER HANDWASHING WAS A FEATURE OF THE HOSPITAL'S BOOTH. 31 EMPLOYEES SPENT A TOTAL OF 189 HOURS AT THE 6 DAY LONG EVENT. IN AN EFFORT TO ASSIST THE LOCAL COOPERATIVE EXTENSION WITH THE PROMOTION OF HEALTHY EATING AND EATING FRESH, LOCAL FARM PRODUCTS THE HOSPITAL AGREED TO CONTINUE TO HOST A FARMER'S MARKET ON 8 WEDNESDAYS DURING THE SUMMER. THIS IS DOUBLE THE TIME THAT THEY WERE HELD LAST YEAR; REFLECTING THEIR POPULARITY. FALL PREVENTION IS A CONCERN FOR EVERYONE AS THE POPULATION AGES. DELAWARE VALLEY HOSPITAL HELD ITS SECOND, EIGHT WEEK MATTER OF BALANCE PROGRAM, WITH 14 PARTICIPANTS BEGINNING THE CLASS AND 11 RECEIVING COMPLETION CERTIFICATES. WHEN DVH STAFF HEARD OF A TAI CHI TRAINING BEING PRESENTED IN OUR AREA, STAFF RECRUITED OTHERS FROM OTHER ORGANIZATIONS TO TAKE THE TRAINING. SEVERAL DID AND BEGINNING IN 2016, CLASSES WILL BE HELD.BECAUSE TWO LOCAL COMMUNITIES HAD NO PHARMACY AND TRAVEL CAN BE DIFFICULT, THE HOSPITAL CONTINUED TO OFFER ITS FREE PRESCRIPTION DELIVERY PROGRAM TO RESIDENTS IN THE DOWNSVILLE AND ROSCOE AREA. IN 2015, 17 PATIENTS WERE SERVED, RECEIVING 143 PRESCRIPTIONS THROUGH THE SERVICE. THE ROSCOE COMMUNITY DID GET THEIR OWN PHARMACY DURING THE YEAR, REDUCING THE NEED TO CONTINUE THE SERVICE FOR THOSE COMMUNITY MEMBERS. IN ORDER TO ADDRESS A LONG-STANDING REQUEST BY MEMBERS OF THE COMMUNITY, THE HOSPITAL OPENED ITS RETAIL COMMUNITY PHARMACY IN OCTOBER. THE HOSPITAL OFFERS A FREE MAIL SERVICE FOR THOSE WHO ARE UNABLE TO COME TO THE PHARMACY TO PICK UP THEIR PRESCRIPTIONS.STAFF PARTICIPATED IN THE AMERICAN HEART ASSOCIATION'S GO RED FOR WOMEN EVENT AND HEART WALK; A LOCAL TOY DRIVE FOR CHILDREN; COMMUNITY FIT DAYS IN DELHI; AND THE DELAWARE COUNTY SENIOR PICNIC, WHERE MEDICATION SAFETY WAS A HIGHLIGHT.
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 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.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DR MICHAEL FREEMANMEDICAL STAFF PRESIDENT	(i) (ii)	248,091 ------------- 0	0 ------------- 0	0 ------------- 0	14,141 ------------- 0	22,425 ------------- 0	284,657 ------------- 0	0 ------------- 0
2JOHN CARRIGG2ND VICE CHAIR	(i) (ii)	0 ------------- 451,780	0 ------------- 72,630	0 ------------- 0	0 ------------- 16,165	0 ------------- 17,264	0 ------------- 557,839	0 ------------- 0
3PAUL SUMMERSDIRECTOR/CEO	(i) (ii)	174,968 ------------- 0	17,815 ------------- 0	0 ------------- 0	7,658 ------------- 0	8,974 ------------- 0	209,415 ------------- 0	0 ------------- 0
4DR RAJESH DAVEFORMER 2ND VICE CHAIR	(i) (ii)	0 ------------- 506,732	0 ------------- 81,489	0 ------------- 10,750	0 ------------- 16,165	0 ------------- 17,419	0 ------------- 632,555	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
FORM 990, PART VII, SECTION A, LINE 5, UNRELATED PARTY DETAIL:	INDIVIDUAL: MICHAEL FREEMAN, MEDICAL STAFF PRESIDENT COMPENSATION RECEIVED FROM UNRELATED ORGANIZATION: UNITED MEDICAL ASSOCIATES (UMA) COMPENSATION: WAGES 248,091

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
DELAWARE VALLEY HOSPITAL INC

Employer identification number
15-0524324

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	COUNTY OF DELAWARE INDUSTRIAL DEVELOPMENT AGENCY	16-1137407	245867AA4	06-29-2007	5,805,000	CONSTRUCTION OF NEW ER/IMAGING CENTER; REFINANCE HOSPITAL MORTGAGE		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	5,805,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	250,826
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	5,805,000
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...	X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...	X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......
b Exception to rebate? ........
c No rebate due? .........
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MICHAEL LAYTON	BROTHER-IN-LAW OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES	53,331	EMPLOYEE WAGES		No
(2) BONNIE CRAIG	SISTER OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES	36,446	EMPLOYEE WAGES		No
(3) NANCY VOLLKOMMER	SISTER-IN-LAW OF VICKI CONKLING, V.P. NURSING ADMIN./CNO	29,311	EMPLOYEE WAGES		No
(4) MILA KATANIC-TUCKER	STEP DAUGHTER OF EDWARD SNOW, BOARD OF DIRECTORS	24,168	EMPLOYEE WAGES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Return Reference	Explanation
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 990 PREPARATION AND FILING IS THE RESPONSIBILITY OF THE DELAWARE VALLEY HOSPITAL, INC. (DVH) BOARD OF DIRECTORS WHO DELEGATES THE TIMELY AND ACCURATE COMPLETION OF FORM 990 TO MANAGEMENT. THE UHS FINANCE DEPARTMENT PREPARES THE 990 WHICH IS THEN REVIEWED BY THE CORPORATE CFO,INDEPENDENT AUDITORS, AND THE DVH BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	DIRECTORS, OFFICERS AND KEY EMPLOYEES SUBMIT ANNUAL CONFLICT OF INTEREST STATEMENTS WHICH ARE REVIEWED BY THE CEO, BOARD CHAIRMAN AND THE ORGANIZATION'S AUDIT COMMMITTEE.
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. THE COMMITTEE USES SULLIVAN-COTTER, 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.
FORM 990, PART IX, LINE 11G	PHYSICIAN SERVICES FEES: PROGRAM SERVICE EXPENSES 4,531,153. MANAGEMENT AND GENERAL EXPENSES 538,722. FUNDRAISING EXPENSES 87,620. TOTAL EXPENSES 5,157,495.
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 22,307.
FORM 990, PART XII, LINE 2C	NO CHANGE FROM PRIOR YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DELAWARE VALLEY HOSPITAL INC

Employer identification number

15-0524324

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)UNITED HEALTH SERVICES HOSPITALS INC 10-42 MITCHELL AVENUE BINGHAMTON,NY13903 16-1165049	HOSPITAL	NY	501(C)(3)	3	UNITED HEALTH SERVICES INC		No
(2)PROFESSIONAL HOME CARE 601 RIVERSIDE DRIVE JOHNSON CITY,NY13790 16-1261977	HOME HEALTH CARE	NY	501(C)(3)	9	UNITED HEALTH SERVICES INC		No
(3)IDEAL SENIOR LIVING CENTER 508 HIGH STREET ENDICOTT,NY13760 22-2902896	SENIOR LIVING CENTER	NY	501(C)(3)	3	UNITED HEALTH SERVICES INC		No
(4)IDEAL SENIOR LIVING CENTER HOUSING 508 HIGH STREET ENDICOTT,NY13760 22-2902899	SENIOR HOUSING	NY	501(C)(3)	9	UNITED HEALTH SERVICES INC		No
(5)CHENANGO MEMORIAL HOSPITAL 179 NORTH BROAD STREET NORWICH,NY13815 15-0532180	HOSPITAL	NY	501(C)(3)	3	UNITED HEALTH SERVICES INC		No
(6)UNITED HEALTH SERVICES INC 20-40 MITCHELL AVENUE BINGHAMTON,NY13903 22-2682421	PARENT COMPANY	NY	501(C)(3)	9	UNITED HEALTH SERVICES INC BOARD OF DIRECTORS		No
(7)TWIN TIER HOME HEALTH INC 601 RIVERSIDE DRIVE JOHNSON CITY,NY13790 22-2438211	HOME HEALTH CARE	NY	501(C)(3)	7	UNITED HEALTH SERVICES INC		No
(8)PROJECT HEAR INC 601 RIVERSIDE DRIVE JOHNSON CITY,NY13790 16-1462675	HOME EMERGENCY ALARM SYSTEM	NY	501(C)(3)	9	TWIN TIER HOME HEALTH INC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

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

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

Yes

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

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

Yes

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: 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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	221
6	Total number of volunteers (estimate if necessary) .............	6	23
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	496,656	491,375
9	Program service revenue (Part VIII, line 2g) .........	17,299,407	20,803,358
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	47,308	43,318
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	935,656	288,254
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	18,779,027	21,626,305
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	8,453,297	8,465,037
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 113,196
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	9,703,340	12,175,307
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	18,156,637	20,640,344
19	Revenue less expenses. Subtract line 18 from line 12.......	622,390	985,961
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	16,390,107	17,094,367
21	Total liabilities (Part X, line 26).............	7,729,410	7,451,663
22	Net assets or fund balances. Subtract line 21 from line 20.....	8,660,697	9,642,704

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 4,209,687 including grants of $ ) (Revenue $ 9,560,720 )
	INPATIENT AND ACUTE SERVICES: DELAWARE VALLEY HOSPITAL FULFILLS ITS 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 2015 WERE COMPRISED OF 316 ACUTE, 187 SWING BED, AND 79 ADDICTION TREATMENT. ACUTE CARE REPRESENTED 943 PATIENT DAYS, IN ADDITION TO THE 1,801 PATIENT DAYS FOR SWING BED AND 1,222 PATIENT DAYS IN THE ADDICTION TREATMENT PROGRAM. INDICATIVE OF THE COMPREHENSIVE HEALTHCARE PROVIDED TO THESE PATIENTS, A TOTAL OF 6,348 LAB TESTS, 15,846 RESPIRATORY TREATMENTS, 336 X-RAYS, 842 PHYSICAL THERAPY SESSIONS, AND 181 EKG'S WERE ADMINISTERED. OTHER SERVICES INCLUDED OCCUPATIONAL AND SPEECH THERAPY, ENDOSCOPY, ECHO EXAMS, ULTRASOUNDS, CT EXAMS AND MAMMOGRAPHY. TO ENSURE OUR RURAL AREA RESIDENTS HAVE ACCESS TO HIGH QUALITY, EFFICIENT CARE IN A COMFORTABLE AND PRIVATE AREA, THE HOSPITAL'S IMAGING CENTER IS EQUIPPED WITH A 16-SLICE CT SUITE. MRI SERVICES ARE OFFERED ON SUNDAYS THROUGH AN AGREEMENT WITH A MOBILE VENDOR.

4b	(Code: ) (Expenses $ 3,208,310 including grants of $ ) (Revenue $ 4,421,606 )
	CLINICS: DELAWARE VALLEY HOSPITAL PROVIDES A WIDE RANGE OF PRIMARY AND PREVENTIVE CARE SERVICES THROUGH ITS 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 2015 OUR CLINICS PROVIDED CARE TO 14,518 PATIENTS IN WALTON, 1,211 IN ROSCOE, AND 1,341 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.

4c	(Code: ) (Expenses $ 8,640,657 including grants of $ ) (Revenue $ 6,821,032 )
	OUTPATIENT AND AMBULATORY SERVICES: DELAWARE VALLEY HOSPITAL PROVIDES A COMPREHENSIVE RANGE OF OUTPATIENT DIAGNOSTIC CARDIOPULMONARY, IMAGING LAB AND TREATMENT SERVICES AT ITS WALTON CAMPUS. THESE INCLUDE A 7-BED EMERGENCY DEPARTMENT WHICH SERVES THE COMMUNITY 24/7. OTHER TREATMENT SERVICES INCLUDE PHYSICAL REHABILITATIVE SERVICES, AMBULATORY PROCEDURES, AND ACCESS TO SPECIALTY SERVICES. THE HOSPITAL ALSO CONDUCTS EXTENSIVE WELLNESS PROGRAMMING THAT INCLUDES NUTRITION AWARENESS AND DIABETES EDUCATION. A FREE PRESCRIPTION DELIVERY PROGRAM IS PROVIDED FOR ROSCOE AND DOWNSVILLE PATIENTS. DOWNSVILLE IS WITHOUT A LOCAL PHARMACY AND ROSCOE JUST RECENTLY HAD A NEW PHARMACY OPEN IN THE COMMUNITY. OCCUPATIONAL HEALTH PROGRAMMING MEETS THE NEEDS OF LOCAL BUSINESSES, FIRE DEPARTMENTS, AND EMERGENCY SQUADS BY PROVIDING PHYSICALS, DRUG TESTING, AND ERGONOMIC EDUCATION. IN 2015 THE EMERGENCY DEPARTMENT TREATED OR ADMITTED 5,606 RESIDENTS VIA ITS 5,000+ SQ. FT. FACILITY, THE LAB PERFORMED 68,939 TESTS, AND 6,410 PHYSICAL/OCCUPATIONAL THERAPY SESSIONS WERE CONDUCTED. THE IMAGING CENTER PERFORMED 7,888 X-RAYS, CT SCANS, MRI'S AND MAMMOGRAPHIES FOR OUTPATIENT SERVICES. OUTPATIENT SERVICES WERE ALSO PERFORMED IN 2015 FOR 137 AMBULATORY PROCEDURES, 1,200 OPIATED ADDICTION SESSIONS, AND 875 SERVICES ASSOCIATED WITH CARDIOPULMONARY REHABILITATION.

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ 283,547 )
	OTHER PROGRAM SERVICES REVENUE IS PRIMARILY MADE UP OF MEANINGFUL USE MEDICARE FUNDING OF $283,547.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ 283,547 )
4e	Total program service expenses16,058,654

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) HELEN JOHNSTON...................................................................... BOARD CHAIR	1.00 .................	X	X		0	0	0
(2) DR MICHAEL FREEMAN...................................................................... MEDICAL STAFF PRESIDENT	56.00 .................	X	X		248,091	0	36,566
(3) JOHN CARRIGG...................................................................... 2ND VICE CHAIR	1.00 ................. 55.00	X	X		0	524,410	33,429
(4) LARRY LIGHT...................................................................... TREASURER	1.00 .................	X	X		0	0	0
(5) EDWARD SNOW...................................................................... SECRETARY	1.00 .................	X	X		0	0	0
(6) ERIN NEALE...................................................................... DIRECTOR	1.00 .................	X			0	0	0
(7) AMANDA HALL...................................................................... DIRECTOR	1.00 .................	X			0	0	0
(8) PAUL SUMMERS...................................................................... DIRECTOR/CEO	55.00 .................	X	X		192,783	0	16,632
(9) JOAN GUARNIERI...................................................................... V.P. COMM HEALTH SVCS	55.00 .................		X		100,201	0	13,514
(10) DOTTIE KRUPPO...................................................................... V.P. ANCILLARY SVCS	55.00 .................		X		80,279	0	16,952
(11) DEBORAH HITT...................................................................... V.P. QUALITY/SUPPORT SVCS	55.00 .................		X		87,495	0	17,725
(12) VICTORIA CONKLING...................................................................... V.P. NURSING/CNO	55.00 .................		X		104,564	0	6,228
(13) DR RAJESH DAVE...................................................................... FORMER 2ND VICE CHAIR	1.00 ................. 55.00			X	0	598,971	33,584

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	813,413	1,123,381	174,630

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	477,115

f	All other contributions, gifts, grants, and similar amounts not included above		1f	14,260

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		491,375

			Business Code
2a	NET PATIENT REVENUE	900099	20,803,358	20,803,358
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			20,803,358

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			43,318			43,318
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MEANINGFUL USE MEDICARE		900099	216,810	216,810
b	PHYSICIAN OTHER REVENUE		621498	48,763	48,763
c	VENDING MACHINE		722210	4,707			4,707
d	All other revenue ....			17,974	17,974
e	Total. Add lines 11a–11d ......			288,254
12	Total revenue. See Instructions......			21,626,305	21,086,905	0	48,025

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	636,374	460,098	176,276
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	6,214,699	4,298,260	1,916,439
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	189,066	122,893	66,173
9	Other employee benefits .......	924,998	587,373	337,625
10	Payroll taxes ...........	499,900	329,934	169,966
11	Fees for services (non-employees):
a	Management ......	2,818		2,818
b	Legal .........	7,405		7,405
c	Accounting ...........	81,406		81,406
d	Lobbying ...........	6,849		6,849
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	4,557		4,557
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	5,157,495	4,531,153	538,722	87,620
12	Advertising and promotion ....	310			310
13	Office expenses .......	4,444,148	3,821,320	616,273	6,555
14	Information technology ......	43,589		43,589
15	Royalties ..
16	Occupancy ...........	226,400	46,418	179,982
17	Travel ............	37,785	25,091	10,168	2,526
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	25,118	5,688	3,245	16,185
20	Interest ...........	247,968		247,968
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	823,539	812,519	11,020
23	Insurance ...	98,984	86,185	12,799
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	BAD DEBT EXPENSE	870,984	870,984
b	MISCELLANEOUS	95,952	60,738	35,214
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	20,640,344	16,058,654	4,468,494	113,196
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,380,818	1	2,554,440
2	Savings and temporary cash investments .........			1,352,899	2	1,357,318
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			1,889,306	4	2,153,339
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			440,094	8	523,224
9	Prepaid expenses and deferred charges ......			321,124	9	464,907
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	21,370,461
b	Less: accumulated depreciation	10b	14,367,630	7,026,058	10c	7,002,831
11	Investments—publicly traded securities .			1,025,200	11	1,017,387
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			1,909,608	13	1,955,921
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			45,000	15	65,000
16	Total assets. Add lines 1 through 15 (must equal line 34)...			16,390,107	16	17,094,367

17	Accounts payable and accrued expenses .....	887,125	17	971,189
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	4,116,920	20	3,814,257
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	612,001	23	527,784
24	Unsecured notes and loans payable to unrelated third parties ..	1,645,482	24	1,663,573
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	467,882	25	474,860
26	Total liabilities. Add lines 17 through 25..	7,729,410	26	7,451,663

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	8,299,158	27	9,318,035
28	Temporarily restricted net assets ...........	43,329	28	6,460
29	Permanently restricted net assets	318,210	29	318,209
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	8,660,697	33	9,642,704
34	Total liabilities and net assets/fund balances ........	16,390,107	34	17,094,367