Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
DELAWARE VALLEY HOSPITAL INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1 TITUS PLACE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WALTON, NY138561457
D Employer identification number

15-0524324
E Telephone number

G Gross receipts $ 26,048,256
F Name and address of principal officer:
PAUL SUMMERS
1 TITUS PLACE
WALTON,NY138561457
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.NYUHS.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1950
M State of legal domicile: NY
Part I
Summary
Activities & Governance 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, REHABILITATIVE,PRIMARY CARE AND WELLNESS SERVICES.
2 Check this box MediumBullet
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 2018 (Part V, line 2a) ...... 5 223
6 Total number of volunteers (estimate if necessary) ............. 6 32
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
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,147,511 833,039
9 Program service revenue (Part VIII, line 2g) ......... 23,465,102 24,576,052
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 45,055 95,847
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 438,930 543,318
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 25,096,598 26,048,256
Expenses; 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) 9,613,954 9,859,414
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet196,706    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 13,593,957 14,231,953
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 23,207,911 24,091,367
19 Revenue less expenses. Subtract line 18 from line 12....... 1,888,687 1,956,889
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 20,043,709 21,521,375
21 Total liabilities (Part X, line 26)............. 6,556,278 6,071,776
22 Net assets or fund balances. Subtract line 21 from line 20..... 13,487,431 15,449,599
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: A CRITICAL ACCESS HOSPITAL AND MEMBER OF THE UHS HEALTHCARE SYSTEM, UHS DELAWARE VALLEY HOSPITAL'S MISSION IS TO PROVIDE THE COMMUNITY WITH THE HIGH QUALITY, PATIENT-CENTERED SERVICES THAT ARE MOST OFTEN NEEDED; THEREBY IMPROVING ACCESS TO CARE AND REDUCING THE NEED TO TRAVEL LONG DISTANCES. WE DO THIS BY OFFERING EMERGENCY CARE, INPATIENT SHORT-TERM ACUTE CARE, PHYSICAL REHABILITATIVE CARE AND ADDICTION TREATMENT. IN ADDITION, WE PROVIDE HIGH QUALITY PRIMARY CARE; A WIDE RANGE OF DIAGNOSTIC AND TREATMENT SERVICES; ACCESS TO TOP LOCAL SPECIALTY CARE AND AN OUTPATIENT PHARMACY. UHS DELAWARE VALLEY HOSPITAL ALSO SERVES AS THE GATEWAY FOR PATIENTS TO ACCESS THE STATE-OF-THE-ART TECHNOLOGY AND HIGHLY QUALIFIED SPECIALISTS OF THE UHS SYSTEM, WHEN MORE SPECIALIZED CARE IS NEEDED.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 4,868,304 including grants of $   ) (Revenue $ 4,595,916 )
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 ACUTE CARE, SWING BED AND ADDICTION TREATMENT SERVICES VIA ITS 25-BED HOSPITAL LOCATED ON THE MAIN CAMPUS IN WALTON IN DELAWARE COUNTY, NY. PATIENT DISCHARGES IN 2018 WERE COMPRISED OF 183 ACUTE, 132 SWING BED, AND 126 ADDICTION TREATMENT. ACUTE CARE REPRESENTED 564 PATIENT DAYS, IN ADDITION TO THE 1,715 PATIENT DAYS FOR SWING BED AND 1,669 PATIENT DAYS IN THE ADDICTION TREATMENT PROGRAM. INDICATIVE OF THE COMPREHENSIVE HEALTHCARE PROVIDED TO THESE PATIENTS, A TOTAL OF 5,408 LAB TESTS, 11,467 RESPIRATORY TREATMENTS, 200 X-RAYS, 45 ULTRASOUNDS, 106 CT AND 6 MRI EXAMS, 849 PHYSICAL THERAPY AND 152 OCCUPATIONAL THERAPY SESSIONS, AND 130 EKG'S WERE ADMINISTERED. OTHER SERVICES INCLUDED ECHO EXAMS, AND 654 DIETARY CONSULTS 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 3D MAMMOGRAPHY, ULTRASOUND, BONE DENSITY, X-RAY AND A 128-SLICE CT SUITE. MRI SERVICES ARE OFFERED ON SUNDAYS AND WEDNESDAYS THROUGH AN AGREEMENT WITH A MOBILE VENDOR.
4b (Code:   ) (Expenses $ 3,428,533 including grants of $   ) (Revenue $ 1,867,862 )
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. 2018 INCLUDED 11,806 VISITS IN WALTON, 1,063 IN ROSCOE, AND 2,019 IN DOWNSVILLE.
4c (Code:   ) (Expenses $ 11,463,441 including grants of $   ) (Revenue $ 18,112,274 )
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 AND OCCUPATIONAL REHABILITATIVE SERVICES, AMBULATORY PROCEDURES, CARDIAC AND PULMONARY REHABILITATION AND ACCESS TO SPECIALTY SERVICES. THE HOSPITAL ALSO CONDUCTS EXTENSIVE WELLNESS PROGRAMMING THAT INCLUDES NUTRITION AWARENESS, DIABETES EDUCATION AND CHRONIC DISEASE SELF MANAGEMENT WORKSHOPS. OCCUPATIONAL HEALTH PROGRAMMING MEETS THE NEEDS OF LOCAL BUSINESSES, FIRE DEPARTMENTS, AND EMERGENCY SQUADS BY PROVIDING PHYSICALS, DRUG TESTING, AND ERGONOMIC EDUCATION. IN 2018 THE EMERGENCY DEPARTMENT TREATED OR ADMITTED 5,388 RESIDENTS VIA ITS 5,000+ SQ. FT. FACILITY, THE LAB PERFORMED 65,504 TESTS, AND 6,452 PHYSICAL/OCCUPATIONAL THERAPY SESSIONS WERE CONDUCTED. THE IMAGING CENTER PERFORMED 9,807 X-RAYS, CT SCANS, MRI'S, ULTRASOUNDS, BONE DENSITY TESTS AND MAMMOGRAPHY FOR OUTPATIENT SERVICES. OUTPATIENT SERVICES WERE ALSO PERFORMED IN 2018 FOR 117 AMBULATORY PROCEDURES, 147 ENDOSCOPIES, 2,207 OPIATE ADDICTION TREATMENT SESSIONS, AND 1,073 SERVICES ASSOCIATED WITH CARDIAC AND PULMONARY REHABILITATION. 1,976 CARDIAC RELATED TESTS WERE PERFORMED: EKGS, ECHOCARDIOGRAMS CARDIAC HOLTER AND EVENT MONITORS.
(Code:   ) (Expenses $   including grants of $   ) (Revenue $ 37,564 )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $ 37,564 )
4e Total program service expensesMediumBullet19,760,278
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part IIIClick to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
25
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
223
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
8
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
5
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletPAUL SUMMERSDELAWARE VALLEY HOSPITAL 1 TITUS   WALTON,NY138561457 (607) 865-2197
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) HELEN JOHNSTON......................................................................
BOARD CHAIR
 2.00
.................
  		X   X       0 0 0
(2) JOHN CARRIGG......................................................................
2ND VICE CHAIR
 2.00
.................
55.00 		X   X       0 839,640 38,625
(3) LARRY LIGHT......................................................................
TREASURER
 2.00
.................
  		X   X       0 0 0
(4) EDWARD SNOW......................................................................
SECRETARY
 2.00
.................
  		X   X       0 0 0
(5) ERIN NEALE......................................................................
TRUSTEE
 2.00
.................
  		X           0 0 0
(6) AMANDA HALL......................................................................
TRUSTEE
 2.00
.................
  		X           0 0 0
(7) DR MICHAEL FREEMAN......................................................................
MEDICAL STAFF PRESIDENT
 57.00
.................
  		X   X       236,675 0 38,048
(8) PAUL SUMMERS......................................................................
PRESIDENT/CEO
 57.00
.................
  		X   X       250,895 0 20,699
(9) DR JOHN GIANNONE......................................................................
CHIEF MEDICAL OFFICER
 5.00
.................
  		    X       25,000 0 0
(10) JOAN GUARNIERI......................................................................
V.P. ANCILLARY SVCS
 55.00
.................
  		    X       114,327 0 15,044
(11) DOTTIE KRUPPO......................................................................
V.P. COMMUNITY RELATIONS
 55.00
.................
  		    X       90,685 0 19,526
(12) DEBORAH HITT......................................................................
V.P. QUALITY/SUPPORT SVCS
 55.00
.................
  		    X       101,464 0 20,738
(13) VICTORIA CONKLING......................................................................
V.P. PATIENT CARE SERVICES
 55.00
.................
  		    X       126,070 0 6,987
(14) LUCINDA RIDER......................................................................
CONTROLLER
 55.00
.................
  		    X       80,093 0 19,486
(15) KATHLEEN ULMSCHNEIDER......................................................................
STAFF NURSE
 55.00
.................
  		        X   116,678 0 19,685




Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 1,141,887 839,640 198,838
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet5
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
Yes
 
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SECO PHYSICALOCCUPATIONAL THERAPY

26 CONKY AVE
NORWICH,NY13815 		PHYSICAL/OCC. THERAPY 457,169
MEDHOST OF TENNESSEE

2739 MOMENTUM PLACE
CHICAGO,IL60689 		INFORMATION TECHNOLOGY 425,753
EVANS MECHANICAL INC

314 MAPLE STREET
ENDICOTT,NY13760 		CONTRACTING 317,882
RICHARD WAKEMAN INC

PO BOX 66
SIDNEY,NY13838 		CONSTRUCTION 227,429
ALLIANCE HEALTHCARE SERVICES

PO BOX 96485
CHICAGO,IL606936485 		IMAGING SERVICE 224,019
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet15
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e 743,718
f All other contributions, gifts, grants, and similar amounts not included above1f 89,321
g Noncash contributions included in lines 1a - 1f:$  
h Total. Add lines 1a-1f.......MediumBullet 833,039
Program Service RevenueAmt Business Code
2a OUTPATIENT SERVICES 621400 18,112,274 18,112,274    
b INPATIENT AND ACUTE SERVICES 621990 4,595,916 4,595,916    
c CLINICS 621110 1,867,862 1,867,862    
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f ....MediumBullet 24,576,052
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 94,314     94,314
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 1,533  
b Less: cost or other basis and sales expenses 0  
c Gain or (loss) 1,533  
d Net gain or (loss).....MediumBullet 1,533     1,533
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..MediumBullet      
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..MediumBullet        
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..MediumBullet        
Business Code Miscellaneous Revenue
11a PROCEEDS FROM DEMUTUALIZATION OF 900099 301,084     301,084
b DSRIP PROJECT REVENUE 900099 204,670     204,670
c            
d All other revenue .... 37,564 37,564    
e Total. Add lines 11a–11d ...... MediumBullet 543,318
12 Total revenue. See Instructions......MediumBullet 26,048,256 24,613,616 0 601,601
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21    
2 Grants and other assistance to domestic individuals. See Part IV, line 22    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,302,099 855,482 336,406 110,211
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 6,757,985 5,256,123 1,484,594 17,268
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 198,766 159,013 39,753  
9 Other employee benefits ....... 1,046,144 815,992 209,229 20,923
10 Payroll taxes ........... 554,420 426,384 118,608 9,428
11 Fees for services (non-employees):        
a Management ...... 46,384   46,384  
b Legal ......... 24,429   24,429  
c Accounting ........... 115,204   115,204  
d Lobbying ........... 3,172   3,172  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 8,413   8,413  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 5,778,330 5,017,885 760,445  
12 Advertising and promotion ....        
13 Office expenses ....... 1,384,999 757,353 617,942 9,704
14 Information technology ...... 56,118   56,118  
15 Royalties ..        
16 Occupancy ........... 218,201 54,011 164,190  
17 Travel ............ 47,797 33,531 12,021 2,245
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 38,371 9,011 2,433 26,927
20 Interest ........... 222,795 121,960 100,835  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 990,833 990,833    
23 Insurance ... 184,255 150,048 34,207  
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 DRUGS 3,826,440 3,826,440    
b BAD DEBT EXPENSE 613,846 613,846    
c MEDICAL SUPPLIES 484,311 484,311    
d EQUIPMENT 108,286 108,286    
e All other expenses 79,769 79,769    
25 Total functional expenses. Add lines 1 through 24e 24,091,367 19,760,278 4,134,383 196,706
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 2,843,526 1 4,145,812
2 Savings and temporary cash investments ......... 511,386 2 0
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 2,176,080 4 2,411,558
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 ........ 601,432 8 607,888
9 Prepaid expenses and deferred charges ...... 1,223,449 9 657,839
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 24,845,949
b Less: accumulated depreciation 10b 15,387,266 8,573,855 10c 9,458,683
11 Investments—publicly traded securities . 3,285,408 11 3,791,505
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 763,573 13 448,090
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 65,000 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 20,043,709 16 21,521,375
Liabilities 17 Accounts payable and accrued expenses ..... 1,217,887 17 1,312,145
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 2,840,455 20 2,436,420
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 .. 351,803 23 277,362
24 Unsecured notes and loans payable to unrelated third parties .. 1,597,112 24 1,565,235
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 549,021 25 480,614
26 Total liabilities. Add lines 17 through 25.. 6,556,278 26 6,071,776
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 13,158,986 27 15,119,182
28 Temporarily restricted net assets ........... 10,235 28 12,207
29 Permanently restricted net assets 318,210 29 318,210
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 13,487,431 33 15,449,599
34 Total liabilities and net assets/fund balances ........ 20,043,709 34 21,521,375
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
26,048,256
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
24,091,367
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
1,956,889
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
13,487,431
5
Net unrealized gains (losses) on investments ...............
5
-79,420
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
84,699
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
15,449,599
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 12, check only one box.)
1
2
3
4
5
6
7
8
9

10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
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) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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  
7
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
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 2018 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-2018 		(iii)
Distributable
Amount for 2018
1 Distributable amount for 2018 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2018:
a From 2013.......  
b From 2014.......  
c From 2015.......  
d From 2016.......  
e From 2017.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2018 distributable amount  
i Carryover from 2013 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2018 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2018 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2018, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2018. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2019. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2014......  
b Excess from 2015.....  
c Excess from 2016.....  
d Excess from 2017.....  
e Excess from 2018.....  
Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018
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) 2018


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2
Name of organization
DELAWARE VALLEY HOSPITAL INC
  		Employer identification number
15-0524324
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
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) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2018)

Additional Data


Software ID:  
Software Version:  
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
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.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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) 2018

Schedule C (Form 990 or 990-EZ) 2018
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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) 2015 (b) 2016 (c) 2017 (d) 2018 (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) 2018


Schedule C (Form 990 or 990-EZ) 2018
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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
3,172
j
Total. Add lines 1c through 1i ....................................................................................................
3,172
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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) 2018


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
SchDMd Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2018

Schedule D (Form 990) 2018
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 .... 328,445 330,360 324,669 361,539 348,578
b Contributions ... 1,971 9,996 5,691 5,286 12,961
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		  11,911   42,156  
f Administrative expenses ....          
g End of year balance ...... 330,416 328,445 330,360 324,669 361,539
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet96.000 %
c
Temporarily restricted endowment SchDMd Bullet4.000 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
Yes
 
(ii) related organizations .................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 ....   12,512,694 5,870,440 6,642,254
c Leasehold improvements        
d Equipment ....   11,527,461 9,516,826 2,010,635
e Other .....   754,592   754,592
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 9,458,683
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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.)...........Small Bullet  
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. 248,197
DUE UHS HOSPITALS 215,591
DUE TO UHS, INC. 16,826
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 480,614
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) 2018

Schedule D (Form 990) 2018
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 25,439,689
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -79,420
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 84,699
e Add lines 2a through 2d ..................... 2e 5,279
3 Subtract line 2e from line 1.................. 3 25,434,410
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 613,846
c Add lines 4a and 4b.................... 4c 613,846
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 26,048,256
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 23,477,522
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 23,477,522
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 613,846
c Add lines 4a and 4b..................... 4c 613,846
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 24,091,368
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, 2018 AND 2017, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2015 TO 2018. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.
PART XI, LINE 2D - OTHER ADJUSTMENTS: INTEREST RATE SWAP 84,699.
PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 613,846.
PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 613,846.
Schedule D (Form 990) 2018


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
 
No
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . . 		    164,544   164,544 0.700 %
b Medicaid (from Worksheet 3, column a) . . . . .     5,563,750 4,747,905 815,845 3.480 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     55,634 36,384 19,250 0.080 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     5,783,928 4,784,289 999,639 4.260 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     232,604   232,604 0.990 %
f Health professions education (from Worksheet 5) . . .     48,191   48,191 0.210 %
g Subsidized health services (from Worksheet 6) . . . .     6,317,127 5,443,575 873,552 3.720 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     6,597,922 5,443,575 1,154,347 4.920 %
k Total. Add lines 7d and 7j .     12,381,850 10,227,864 2,153,986 9.180 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
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     4,498   4,498 0.020 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building     12,294   12,294 0.050 %
7 Community health improvement advocacy     1,361   1,361 0.010 %
8 Workforce development            
9 Other            
10 Total     18,153   18,153 0.080 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
613,846
3
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. ......
3
306,923
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
4,714,656
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
4,685,064
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
29,592
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2018
Schedule H (Form 990) 2018
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?1Name, 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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 DELAWARE VALLEY HOSPTITAL
1 TITUS PLACE
WALTON,NY13856 		X       X   X      
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTP://WWW.NYUHS.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2018
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTP://WWW.NYUHS.ORG
b
HTTP://WWW.NYUHS.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 nonpayment?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
DELAWARE VALLEY HOSPTITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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: O'CONNOR HOSPITAL, DELHI, NYTRI-TOWN REGIONAL HOSPITAL, SIDNEY, NYMARGARETVILLE COMMUNITY HOSPITAL, MARGARETVILLE, NY
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: 2016-2018 ACTION PLANPREVENTION STRATEGY: PREVENT CHRONIC DISEASE FOCUS AREA: REDUCE ILLNESS, DISABILITY, AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSUREGOAL: PROMOTE TOBACCO USE CESSATION, ESPECIALLY AMONG LOW SES POPULATIONS AND THOSE WITH POOR MENTAL HEALTH. OBJECTIVE: PROVIDE DELAWARE COUNTY RESIDENTS WITH ACCESS TO TOBACCO CESSATION CLASSES THROUGH VIDEO-CONFERENCING, ELIMINATING THE NEED TO TRAVEL LONG DISTANCES. STRATEGY: DVH WILL OFFER SMOKING CESSATION CLASSES TO BE IMPLEMENTED WITH UHS STAY HEALTHY STAFF THROUGH THE USE OF VIDEO CONFERENCING. THIS TECHNOLOGY IS CURRENTLY IN THE DEVELOPMENT STAGE AND IS SLATED TO BE COMPLETED BY MID-2017. THERE ARE NO SMOKING CESSATION CLASSES IN DELAWARE COUNTY AT THIS TIME. DVH WILL ADVERTISE TOBACCO CESSATION PROGRAMMING TO AREA RESIDENTS IN COLLABORATION WITH OTHER HOSPITALS, THE COUNTY HEALTH DEPARTMENT, AND HEALTH CARE PROVIDERS. CLASSES WILL BEGIN TO BE OFFERED IN FALL OF 2017. THE CLASS WILL BE OFFERED AT LEAST ONCE PER YEAR. MEASURE: THROUGH THIS PARTNERSHIP, WHICH INCLUDES NOT ONLY THE DELAWARE COUNTY-BASED PROVIDERS BUT ALSO THE LARGER UHS HOSPITAL SYSTEM, THE NUMBER OF PARTICIPANTS PARTICIPATING IN AND COMPLETING TOBACCO CESSATION CLASSES WILL BE MEASURED.2017 COMMUNITY SERVICE PLAN UPDATE: DVH HAS CHANGED ITS STRATEGY FOR OFFERING TOBACCO CESSATION CLASSES. TWO STAFF MEMBERS WERE TRAINED AS FACILITATORS OF THE AMERICAN CANCER SOCIETY'S FRESH START PROGRAM. PROGRAMS ARE HELD LOCALLY EVERY FEW MONTHS. TWO TOBACCO CESSATION PROGRAMS OF FOUR SESSIONS EACH WERE HELD IN 2017.IN 2018, ONLY ONE PROGRAM WAS HELD, WITH 2 REGISTERING. HOWEVER, ONLY ONE ATTENDED ONE SESSION AND THE OTHER ATTENDED TWO SESSIONS. IN 2019 DVH WILL BE LOOKING AT WAYS TO INCENTIVIZE PEOPLE TO PARTICIPATE AND WILL TRY AND USE NEW SYNCHRONOUS VIDEOCONFERENCING CAPABILITY TO OFFER THE SESSIONS THAT ARE TAKING PLACE AT UHS. FOCUS AREA: INCREASE ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN BOTH CLINICAL AND COMMUNITY SETTINGS GOAL: PROMOTE CULTURALLY RELEVANT CHRONIC DISEASE SELF-MANAGEMENT EDUCATION.OBJECTIVE: PATIENTS AND CAREGIVERS WILL LEARN DISEASE-MANAGEMENT STRATEGIES. STRATEGY 1. PROMOTE THE USE OF EVIDENCE-BASED INTERVENTIONS TO PREVENT OR MANAGE CHRONIC DISEASES THROUGH PATIENT MEETINGS WITH DVH'S RN PATIENT CARE COORDINATOR AND/OR CERTIFIED DIETICIAN/NUTRITIONIST. MEASURE: NUMBER OF CHRONIC DISEASE PATIENT VISITS WITH DVH PATIENT CARE COORDINATOR AND/OR DIETICIAN/NUTRITIONIST FOR EDUCATION AND/OR HELP IN ELIMINATING BARRIERS TO CARE. 2017 COMMUNITY SERVICE PLAN UPDATE: DVH'S CERTIFIED DIETITIAN/NUTRITIONIST WORKED WITH 397 PATIENTS PROVIDING DIET COUNSELING. THE RN CARE COORDINATOR WORKED WITH 48 PATIENTS, AT HIGH RISK FOR EITHER ER VISITS OR ADMISSION TO THE HOSPITAL, TO HELP EDUCATE AND PROVIDE SUPPORT AND REDUCE BARRIERS TO CARE.2018 COMMUNITY SERVICE PLAN UPDATE: DVH'S CERTIFIED DIETITIAN/NUTRITIONIST HAD 320 DIET COUNSELING SESSIONS. THE RN CARE COORDINATOR WORKED WITH 70 PATIENTS, AT HIGH RISK FOR EITHER ER VISITS OR ADMISSION TO THE HOSPITAL, TO HELP EDUCATE AND PROVIDE SUPPORT AND REDUCE BARRIERS TO CARE.IN 2018, THE DIETITIAN ALSO WORKED WITH 20 ADDITIONAL PEOPLE ON THE PRESCRIPTION FRUIT AND VEGETABLE PROGRAM THROUGH THE RURAL HEALTH NETWORK OF SOUTH CENTRAL NY. EACH WAS SEEN A MINIMUM OF 3 TIMES BY OUR DIETITIAN. AT THE END OF THE PROGRAM, A HEALTHY DINNER WAS HELD FEATURING RECIPES FOR FRESH VEGETABLES. STRATEGY 2: DVH AND O'CONNOR HOSPITAL WILL UTILIZE RESOURCES AT THEIR DISPOSAL THROUGH THEIR RESPECTIVE HOSPITAL SYSTEMS TO IMPLEMENT THE STANFORD UNIVERSITY'S EVIDENCE-BASED CHRONIC DISEASE SELF-MANAGEMENT PROGRAM (CDSMP). BETWEEN DVH AND O'CONNOR, THERE ARE CURRENTLY FOUR TRAINED PEER LEADERS FOR CDSMP. THE APPROACH TO THIS GOAL WILL BE TO CO-LEAD PROGRAMS WITHIN THE SERVICE AREAS OF EITHER ENTITY, AND TO UTILIZE THE RESOURCES OF THE CARE COMPASS NETWORK PPS (WHICH ALSO HAS AN ADDITIONAL TRAINED PEER LEADER), AS NEEDED. EACH ENTITY WILL PROMOTE THE USE OF THIS EVIDENCE-BASED STRATEGY TO PREVENT OR MANAGE CHRONIC DISEASES, AND THE PROGRAM WILL BE OFFERED TWICE EACH YEAR. THIS BEGAN IN THE SPRING OF 2017. MEASURE: THE NUMBER OF CDSMP PROGRAMS OFFERED AND THE NUMBER OF INDIVIDUALS PARTICIPATING IN AND COMPLETING THE PROGRAM. 2017 COMMUNITY SERVICE PLAN UPDATE: THREE 6 WEEK HAPPY, HEALTHY, AND WISE WORKSHOP SERIES WERE HELD THAT FOCUSED ON CHRONIC DISEASE SELF-MANAGEMENT. 22 PARTICIPANTS BEGAN THE WORKSHOPS AND 17 COMPLETED THEM. REVIEWS WERE VERY ENTHUSIASTIC AND POSITIVE.2018 COMMUNITY SERVICE PLAN UPDATE: THREE 6 WEEK HAPPY, HEALTHY AND WISE WORKSHOP SERIES WERE HELD THAT FOCUS ON CHRONIC DISEASE SELF MANAGEMENT. 23 PARTICIPANTS BEGAN THE WORKSHOPS AND 17 COMPLETED THEM. REVIEWS CONTINUE TO BE VERY ENTHUSIASTIC AND POSITIVE.STRATEGY 3: ONCE EACH OF THE HOSPITALS' PEER LEADERS HOLD TWO PUBLIC CDSMP PROGRAMS, THEY WILL EARN THEIR MASTER TRAINING CERTIFICATION AND WILL BE ABLE TO TRAIN OTHERS TO BECOME PEER LEADERS, WHICH WOULD INCREASE THE AVAILABILITY OF THIS PROGRAM THROUGHOUT THE SERVICE AREA, AS WELL AS THE CARE COMPASS NETWORK AREA. DVH WILL HOLD AT LEAST ONE CDSMP PEER LEADER TRAINING PER YEAR. MEASURE: NUMBER OF PROGRAMS AND NUMBER OF PEER LEADERS SUCCESSFULLY TRAINED. 2017 COMMUNITY SERVICE PLAN UPDATE: THE CLASS TO TRAIN ADDITIONAL PEER LEADERS WAS NOT HELD DUE TO A LACK OF PARTICIPANTS.2018 COMMUNITY SERVICE PLAN UPDATE: THIS IS NO LONGER A STRATEGY, AS DVH DID NOT HAVE ENOUGH PARTICIPANTS TO OFFER THE PROGRAM WITHIN THE WINDOW OF TIME ALLOWABLE UNDER STANFORD GUIDELINES. THEREFORE, NONE OF DVH STAFF WERE ABLE TO BECOME MASTER TRAINERS. THEY ARE PEER LEADERS HOWEVER.STRATEGY 4: IN ADDITION, DVH AND O'CONNOR HOSPITALS PLAN TO HAVE UP TO FOUR PEOPLE TRAINED IN THE STANFORD UNIVERSITY DIABETES SELF-MANAGEMENT PROGRAM (DSMP). DVH INTENDS TO PAY FOR THE TRAINING FROM A VAP GRANT IT HAD SECURED. ONCE COMPLETED, AREA RESIDENTS WILL HAVE THE OPPORTUNITY TO TAKE PART IN THE DSMP.MEASURE: NUMBER OF PEER TRAINERS IN DSMP.2017 COMMUNITY SERVICE PLAN UPDATE: THIS WAS NOT COMPLETED. DVH FELT THAT THE DIABETICS ATTENDING THE SERIES OF WORKSHOPS GAINED SIGNIFICANTLY FROM THE COURSE. THE RN CARE COORDINATOR AND THE CERTIFIED DIETITIAN/NUTRITIONIST ROUTINELY WORK CLOSELY AND 1 ON 1 WITH DIABETIC PATIENTS. 2018 UPDATE: THIS WAS NOT AND WILL NOT BE COMPLETED. DVH FEELS THAT THE DIABETICS ATTENDING THE CHRONIC DISEASE SELF MANAGEMENT WORKSHOPS GAINED SIGNIFICANTLY FROM THE COURSE. THE RN CARE COORDINATOR AND THE CERTIFIED DIETITIAN/NUTRITIONIST ROUTINELY WORK CLOSELY AND 1 ON 1 WITH DIABETIC PATIENTS. THERE IS NOT ENOUGH OF A POPULATION THAT WOULD ALLOW US TO OFFER TWO SIMILAR PROGRAMS AND HAVE A VIABLE NUMBER OF PARTICIPANTS IN EACH. WORKING WITH THE UHS SYSTEM, A NURSE PRACTITIONER FROM THE ENDOCRINOLOGY OFFICE NOW SEES DIABETIC PATIENTS AT THE WALTON PRIMARY CARE SITE. HER CLINIC IS BLENDED, IN THAT SHE SEES SOME PATIENTS IN PERSON AND OTHERS THROUGH TELEHEALTH TECHNOLOGY. THE DIETITIAN AND CARE COORDINATOR HELD A DIABETES AWARENESS PROGRAM CENTERED ON CONTINUOUS GLUCOSE MONITORING. THEY INVITED 30 OF THEIR PATIENTS, AND NOTICES WERE SENT TO ALL FORMS OF MEDIA, YET ONLY 3 SHOWED UP.STRATEGY 5: DVH WILL OFFER THE DSMP PROGRAM TO AREA RESIDENTS AT LEAST ONCE PER YEAR, BEGINNING IN THE SPRING OF 2018. MEASURE: NUMBER OF CLASSES OFFERED AND NUMBER OF PARTICIPANTS BEGINNING AND SUCCESSFULLY COMPLETING THE PROGRAM.STRATEGY 6: RESIDENTS WILL BE OFFERED OPPORTUNITY TO PARTICIPATE IN THE EVIDENCE-BASED LIFESTEPS PROGRAM. THIS PROGRAM WILL BE OFFERED TWICE EACH YEAR INTEREST PERMITTING. MEASURE: THE NUMBER OF PARTICIPANTS BEGINNING AND COMPLETING THE COURSE AND THE TOTAL WEIGHT LOSS FOR THE GROUP WILL BE REPORTED.2017 COMMUNITY SERVICE PLAN UPDATE: THE LIFESTEPS PROGRAM WILL CONTINUE TO BE OFFERED. THE PROGRAM WAS DEVELOPED BY THE NATIONAL DAIRY COUNCIL. IT ADDRESSES WEIGHT MANAGEMENT THROUGH LIFESTYLE CHANGES. PARTICIPANTS WEIGH IN WEEKLY. TOPICS INCLUDE PHYSICAL ACTIVITY, SERVING SIZE, FOOD CHOICES, EATING STYLES, LAPSES, STAYING ACTIVE AND IN-STEP. THE PROGRAM WAS PRESENTED TWICE IN 2017. A TOTAL OF 16 PEOPLE BEGAN THE PROGRAM WITH 11 CONTINUING TO COMPLETION. A TOTAL OF 92.4 POUNDS WAS LOST BETWEEN THE PARTICIPANTS COMPLETING THE PROGRAM.2018 UPDATE: THE PROGRAM WAS OFFERED IN JANUARY, 2019 BUT NO ONE SIGNED UP. A SECOND PROGRAM WAS NOT OFFERED AS THE CHRONIC DISEASE SELF MANAGEMENT PROGRAM WAS BEING DONE BY THE DIETITIAN ALREADY.
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.
PART V, SECTION B, LINE 11: 2016-2018 ACTION PLAN (CONTINUED) PREVENTION STRATEGY: PROMOTE A HEALTHY AND SAFE ENVIRONMENT FOCUS AREA: INJURIES, VIOLENCE, AND OCCUPATIONAL HEALTH GOAL: REDUCE RISK OF FALLS, PARTICULARLY AMONG THE ELDERLY. OBJECTIVE: EVIDENCE BASED FALL PREVENTION PROGRAMMING WILL BE AVAILABLE TO AREA RESIDENTS.STRATEGY 1. PROMOTE COMMUNITY-BASED PROGRAMS FOR FALLS PREVENTION UTILIZING THE EVIDENCE-BASED MATTER OF BALANCE PROGRAM. DVH WILL PROVIDE OPPORTUNITIES THROUGHOUT THE COMMUNITY, IN PARTNERSHIP WITH THE DELAWARE COUNTY PUBLIC HEALTH DEPARTMENT AND THE DELAWARE COUNTY OFFICE FOR THE AGING (OFA), TO PARTICIPATE IN AN EVIDENCE-BASED FALLS PREVENTION PROGRAM: MATTER OF BALANCE. DVH HAS ONE CERTIFIED MATTER OF BALANCE LEADER. THEY WILL WORK WITH BOTH OFA AND THE COUNTY HEALTH DEPARTMENT TO PARTNER AND OFFER ONE PROGRAM EACH YEAR AT ITS WELLNESS CENTER. ONE OF THEIR PHYSICAL REHABILITATION STAFF MEMBERS WILL CONDUCT THE SESSION FOCUSING ON PHYSICAL AIDS AND HOW TO GET UP AFTER A FALL. OFA WILL ASSIST WITH IDENTIFYING AND RECRUITING THE TARGET POPULATION, SENIOR CITIZENS, AND ALSO HOLDS THE MASTER TRAINER LICENSE. WITH THIS LICENSE, OFA HAS THE OPPORTUNITY TO TRAIN NEW FACILITATORS FOR THE MATTER OF BALANCE CLASS. DVH WILL ALSO OFFER ITS SITE FOR USE FOR ADDITIONAL PROGRAMS. MEASURE: THE NUMBER OF PARTICIPANTS, NUMBER OF GRADUATES, AND NUMBER OF PROGRAMS WILL BE REPORTED. 2017 COMMUNITY SERVICE PLAN UPDATE: DVH DID NOT HOLD THIS PROGRAM THIS YEAR. IN THE SPRING, FOCUS WAS PLACED ON THE CHRONIC DISEASE SELF-MANAGEMENT PROGRAM AND IN THE FALL, THE HOSPITAL'S WELLNESS ROOM UNDERWENT A REMODEL. THE PLAN IS TO BEGIN OFFERING THIS AGAIN IN THE SPRING.2018 COMMUNITY SERVICE UPDATE: DVH DID NOT HOLD THE PROGRAM AGAIN IN 2018. THE OFFICE FOR THE AGING HAD NO ONE ON WAITING LIST AS MOST HAVE MOVED ON TO DOING TAI CHI. DVH ONLY HAS ONE TRAINED STAFF MEMBER SO SHE WOULD HAVE TO TEAM UP WITH SOMEONE ELSE IN ORDER TO HOLD THE CLASS. A NEW PT MANAGER IS BEGINNING AT DVH. DISCUSSIONS WITH HIM WILL TAKE PLACE AND SEE WHAT DVH CAN DO TO ADDRESS THIS ISSUE.STRATEGY 2: SUSTAIN SPONSORSHIP OF DELAWARE COUNTY OFFICE FOR AGING'S TAI CHI CLASSES.DVH WILL CONTINUE TO SPONSOR TAI CHI CLASSES FOR DELAWARE COUNTY'S OFFICE FOR THE AGING (OFA). ALTHOUGH DVH DOES NOT HAVE THE PHYSICAL OR HUMAN RESOURCES TO INDEPENDENTLY OFFER THIS PROGRAM, IT DOES WANT TO SEE THE PROGRAM AVAILABLE TO AREA RESIDENTS SO DVH WILL SPONSOR THE CLASSES BY PAYING FOR THE USE OF THE VENUES SELECTED BY OFA. THE HOSPITAL WILL SPONSOR UP TO 4 PROGRAMS EACH YEAR CONDUCTED IN ITS SERVICE AREA. OFA WILL CONTINUE THEIR ROLE IN RECRUITING BOTH TRAINERS AND PARTICIPANTS. MEASURE: THE IMPACT FOR THIS ACTIVITY WILL BE SHOWN THROUGH THE NUMBER OF PROGRAMS SPONSORED.2017 COMMUNITY SERVICE PLAN UPDATE: ALTHOUGH DVH WAS WILLING TO SPONSOR THE PROGRAM, THE OFFICE FOR THE AGING INFORMED US THAT THEY NOW HAVE USE OF THE VENUE WITHOUT COST. DVH IS STILL COMMITTED TO ASSISTING IF NEEDED. 2018 UPDATE: ALTHOUGH DVH WAS WILLING TO SPONSOR THE PROGRAM; THE OFFICE FOR THE AGING INFORMED US THAT THEY NOW HAVE USE OF THE VENUE WITHOUT COST. DVH IS STILL COMMITTED TO ASSISTING IF NEEDED.PREVENTION STRATEGY: PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE FOCUS AREA: PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL AND BEHAVIORAL DISORDERSGOAL: PREVENT SUICIDES AMONG YOUTH AND ADULTS OBJECTIVE: BY SHARING INFORMATION, PATTERNS AND TRENDS, IF ANY, CAN BE IDENTIFIED AND ADDRESSED. STRATEGY 1: SHARE DATA ON SUICIDE, SUICIDE ATTEMPTS, AND PREVENTION EFFORTS. DVH WILL WORK CLOSELY WITH THE DELAWARE COUNTY SUICIDE PREVENTION NETWORK, MADE UP OF SEVERAL HEALTH AND HUMAN SERVICES PROVIDERS ACROSS DELAWARE COUNTY, TO AGGREGATE DATA ON COMPLETED SUICIDES, SUICIDE ATTEMPTS, AND SUICIDAL IDEATION. THE OBJECTIVE OF SHARING AND AGGREGATING DATA IN PARTNERSHIP WITH THE DELAWARE COUNTY SUICIDE PREVENTION NETWORK WILL BE TO IDENTIFY AND ADDRESS PATTERNS AND TRENDS. THE COLLECTIVE IMPACT ON THE COMMUNITY AND THE IDENTIFIED HEALTH DISPARATE POPULATION WILL BE TO UTILIZE THE INFORMATION TO DEVELOP MITIGATION STRATEGIES, PREVENTING FUTURE SUICIDES AMONG YOUTH AND ADULTS. MEASURE: DVH WILL SHARE THIS DATA ON A MONTHLY BASIS. 2017 COMMUNITY SERVICE PLAN UPDATE: DVH CONTINUES TO SHARE ITS DATA.2018 DVH CONTINUES TO SHARE ITS DATA.STRATEGY 2: IN ADDITION, DVH WILL OFFER A VENUE, AS NEEDED, FOR THE DELAWARE COUNTY PUBLIC HEALTH DEPARTMENT TO COORDINATE AND SCHEDULE GATEKEEPER TRAININGS, EVIDENCE-BASED SUICIDE PREVENTION PROGRAMS SUCH AS ASSIST, SAFE TALK, AND QPR (QUESTION, PERSUADE, REFER). THESE TRAININGS WILL SERVE AS AN AVENUE FOR COMMUNITY MEMBERS AND PROVIDERS ALIKE TO INCREASE TOOLS DESIGNED TO PREVENT SUICIDES. THEY DEVELOP INDIVIDUALS' KNOWLEDGE, ATTITUDES, AND SKILLS TO IDENTIFY THOSE AT RISK AND MAKE REFERRALS WHEN NECESSARY. MEASURE: GATEKEEPER TRAININGS WILL BE MEASURED BY THE NUMBER OF TRAININGS HELD AT THE DVH VENUE.2017 COMMUNITY SERVICE PLAN UPDATE: DURING 2017, GATEKEEPER TRAININGS WERE NOT HELD IN WALTON SO DVH VENUE WAS NOT REQUIRED.DURING 2018, GATEKEEPER TRAININGS WERE NOT HELD IN WALTON SO DVH VENUE WAS NOT REQUIRED. GOAL: PREVENT SUBSTANCE ABUSE STRATEGY 1: BRING STANFORD UNIVERSITY'S EVIDENCE-BASED CHRONIC PAIN SELF-MANAGEMENT PROGRAM (CPSMP) TO DELAWARE COUNTY RESIDENTS. DVH WILL SUPPORT AND FACILITATE THE TRAINING OF UP TO TWO PEER LEADERS TO PARTICIPATE IN THE EVIDENCE-BASED STANFORD UNIVERSITY PAIN SELF-MANAGEMENT COURSE IN THE SUMMER OF 2017. THIS HAS BEEN AN ONGOING OBJECTIVE, AS DVH ALREADY HAS THREE PEER LEADERS TRAINED IN CDSMP, WHICH IS A PRE-REQUISITE FOR THE ONLINE PAIN-MANAGEMENT TRAINING PROGRAM. MEASURE: NUMBER OF PEER LEADERS SUCCESSFULLY COMPLETING TRAINING. 2017 COMMUNITY SERVICE PLAN UPDATE: THIS IS A GOAL FOR 2018 FOR DVH STAFF. HOWEVER IN 2017, DVH BEGAN A PAIN MANAGEMENT CLINIC IN WALTON, IN CONJUNCTION WITH UHS PROVIDERS.2018 UPDATE: THIS IS A GOAL FOR 2018 FOR DVH STAFF. AT THIS TIME, DVH WILL NOT BE SECURING TRAINERS FOR THIS PROGRAM. DVH CONTINUES TO WORK WITH THE UHS PAIN MANAGEMENT STAFF WHO COME TO DVH TWO TIMES A MONTH. THIS INCLUDES A PHYSICIAN, A PHYSICIAN'S ASSISTANT. A CHIROPRACTOR WILL BEGIN IN 2019, MAKING ACCESS TO CARE THREE TIMES A MONTH. DVH WAS ABLE TO GET ITS NEW TELEPSYCHIATRY SERVICE READY TO BEGIN IN JANUARY, 2019. IT IS THOUGHT BY EXPANDING THE TYPES OF SERVICES OFFERED THROUGH THE PAIN CLINIC; PATIENTS WILL HAVE MANY OF THE TOOLS NECESSARY TO DEAL WITH THEIR CONDITION AND CAN THEN ALSO ACCESS THE CHRONIC DISEASE MANAGEMENT WORKSHOPS IF THEY WISH. FOCUS AREA 3: STRENGTHEN INFRASTRUCTURE GOAL: STRENGTHEN THE MENTAL HEALTH INFRASTRUCTURE OBJECTIVE: INCREASE AVAILABILITY OF MENTAL, EMOTIONAL, AND BEHAVIORAL HEALTH SERVICES THROUGH THE USE OF TELEMEDICINE TECHNOLOGY. STRATEGY 1: TELEMEDICINE TECHNOLOGY IS BEING DEVELOPED AT DVH AND WILL BE USED TO PROVIDE MEB SERVICES UTILIZING OUT-OF-AREA PROVIDERS TO STRENGTHEN INFRASTRUCTURE. DELAWARE VALLEY HOSPITAL IS WORKING CLOSELY WITH THE LARGER UHS SYSTEM TO FINALIZE PLANS FOR TELEMEDICINE TECHNOLOGY SO THAT PATIENTS HAVE INCREASED ACCESS TO MENTAL HEALTH PROFESSIONALS BY SPRING 2017. WHILE DVH DEVELOPS SYSTEMS FOR REFERRALS AND PARTNERSHIPS WITH MENTAL HEALTH PROVIDERS, UHS WILL DELIVER THE REQUIRED IT INFRASTRUCTURE. MEASURE: DVH WILL MEASURE THE NUMBER OF TIMES PER MONTH THE SERVICES ARE AVAILABLE TO PATIENTS, THE NUMBER OF VISITS COMPLETED THROUGH TELEMEDICINE EACH MONTH, AND THE NUMBER OF UNIQUE PATIENTS UTILIZING THE SERVICE. 2017 COMMUNITY SERVICE PLAN UPDATE: TELEPSYCHIATRY IS NOW AVAILABLE ON A VERY LIMITED BASIS AT DVH. THE SOLE PROVIDER AT THIS TIME IS A PRIVATE PRACTICE PHYSICIAN WHO TAKES A VERY LIMITED NUMBER OF INSURERS. WORK CONTINUES TO FIND A PROVIDER WHO CAN HELP FILL THIS ROLE. DELAWARE COUNTY MENTAL HEALTH AND DVH WORKED IN CONJUNCTION TO TRY AND SECURE ADDITIONAL MEB PROFESSIONAL PRESCRIBERS. TWO CANDIDATES WERE CONSIDERED. ONE DECIDED TO TAKE A GOVERNMENT JOB; THE OTHER DECIDED NOT TO RE-LOCATE ON A FULL TIME BASIS AT THIS TIME. 2018 UPDATE: TELEPSYCHIATRY WAS AVAILABLE ON A VERY LIMITED BASIS AT DVH. BUT IN 2018, DVH WAS ABLE TO SECURE THE SERVICES OF AN OUTSIDE VENDOR. A LICENSED CLINICAL SOCIAL WORKER AND A PSYCHIATRIC NURSE PRACTITIONER WILL BEGIN TO SEE PATIENTS IN JANUARY OF 2019. THE LCSW WILL HAVE 16 HOURS A WEEK AND THE NP WILL HAVE 8 HOURS PER WEEK TO START.OTHER INITIATIVES:A NARCOTICS ANONYMOUS GROUP MEETS WEEKLY AT DVH. DVH OFFERS FREE SHARPS CONTAINERS TO THOSE BRINGING THEIR SHARPS TO THE HOSPITAL FOR DISPOSAL.DVH STAFF MEMBERS PERFORM FREE SPECIMEN COLLECTION FOR DRUG COURT PARTICIPANTS.
PART V, SECTION B, LINE 11: 2016-2018 ACTION PLAN (CONTINUED) STRATEGY 2: DVH SEEKS TO STRENGTHEN THE INFRASTRUCTURE NOT ONLY WITHIN THE HOSPITAL, BUT ALSO IN THE COMMUNITY BY WORKING WITH THE DELAWARE COUNTY OFFICE OF MENTAL HEALTH (DCMH) ON THIS OBJECTIVE. DISCUSSIONS HAVE BEEN ONGOING THROUGH PARTNERSHIPS DEVELOPED, IN PART, BY THE CARE COMPASS NETWORK PPS TO INTEGRATE PRIMARY CARE AND MENTAL, EMOTIONAL, BEHAVIORAL (MEB) HEALTH SERVICES. DVH, WHICH PROVIDES A HIGH LEVEL OF EXPERTISE AND SERVICE THROUGH THEIR PRIMARY CARE PRACTICES, AND DCMH, WHICH BRINGS THE EXPERTISE OF MEB PROVIDERS, WILL CONTINUE CONVERSATIONS REGARDING THE INTEGRATION OF PRIMARY CARE AND MEB SERVICES. WHILE THESE ARE DIFFICULT SYSTEMS TO INTEGRATE DUE TO REGULATORY ISSUES THAT NEED TO BE WORKED OUT, THE FACILITIES REMAIN COMMITTED TO STRATEGIZING WAYS TO SHARE THE RESOURCES NECESSARY TO PROVIDE MORE HOLISTIC SERVICES TO PATIENTS. MEASURE: SUCCESS FOR THIS ACTIVITY WILL BE MEASURED BY THE NUMBER OF MEETINGS.2017 COMMUNITY SERVICE PLAN UPDATE: DELAWARE COUNTY MENTAL HEALTH AND DVH WORKED IN CONJUNCTION TO TRY AND SECURE ADDITIONAL MEB PROFESSIONAL PRESCRIBERS. TWO CANDIDATES WERE CONSIDERED. ONE DECIDED TO TAKE A GOVERNMENT JOB; THE OTHER DECIDED NOT TO RE-LOCATE ON A FULL TIME BASIS AT THIS TIME.2018 UPDATE: BY BEGINNING THE TELEMENTAL HEALTH PROGRAM IN THE WALTON PRIMARY CARE OFFICE WE HAVE BEGUN TO ADDRESS THIS ISSUE. WE WORK COLLEGIALLY WITH DELAWARE COUNTY MENTAL HEALTH CLINIC; IN FACT THE DIRECTOR OF THE COUNTY SERVICE PARTICIPATED AND PLAYED A KEY ROLE IN THE INTERVIEW PROCESS OF THE FPS AND LCSWS. HER EXPERTISE WAS VITAL IN OUR SECURING COMPETENT PROFESSIONALS TO CARE FOR OUR PATIENTS. RATIONALE FOR FOREGOING SOME PRIORITY AREAS PREVENT CHRONIC DISEASE- FOCUS AREA: REDUCE OBESITY IN CHILDREN AND ADULTS DVH'S CERTIFIED DIETITIAN/NUTRITIONIST CONTINUES TO OFFER THE LIFESTEPS PROGRAM. IN PRIOR YEARS, DVH HAD REACHED OUT TO SCHOOLS TO PARTICIPATE IN AFTER SCHOOL PROGRAMMING, BUT IT NEVER CAME TO FRUITION. THE HOSPITAL HAD ALSO OFFERED COOKING CLASSES AND WHILE THEY WERE VERY WELL RECEIVED, THEY ONLY REACHED A VERY LIMITED NUMBER OF PEOPLE. THEREFORE, DVH HAS DECIDED TO SHIFT ITS FOCUS TO EVIDENCE BASED CHRONIC DISEASE MANAGEMENT PROGRAMMING AS IT CONTAINS NUTRITION AND EXERCISE INFORMATION IN THE CURRICULUM AND WOULD PROVIDE PARTICIPANTS WITH A BETTER UNDERSTANDING OF THEIR DISEASE OVERALL. PROMOTE A HEALTHY AND SAFE ENVIRONMENT AIR AND WATER QUALITY ARE NOT A SERIOUS ISSUE IN OUR AREA.
PART V, SECTION B, LINE 11: 2016-2018 ACTION PLAN (CONTINUED) BUILT ENVIRONMENT THE HOSPITAL DID HELP SECURE BOTH THE WALTON VILLAGE BOARD AND THE TOWN OF COLCHESTER'S BOARD AGREEMENT TO ADOPT COMPLETE STREETS POLICIES. AND IT CONTINUES TO PROMOTE THE PRESCRIPTION TRAILS PROGRAM. PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN DVH DOES NOT OFFER OB/GYN CARE OR DELIVERY CARE. AS A MATTER OF FACT, NO HOSPITALS OFFER THESE SERVICES IN DELAWARE COUNTY. WOMEN ARE TRAVELING OUTSIDE OF THE COUNTY TO SEEK THIS CARE. IT IS FELT THAT THEIR PROVIDERS WILL ENCOURAGE BREAST FEEDING, AS DOES DELAWARE COUNTY PUBLIC HEALTH AND THE WIC OFFICE IN DELAWARE COUNTY IS VERY SUPPORTIVE. 2018: DVH DOES HOLD AN ANNUAL TEDDY BEAR CLINIC FOR LOCAL 2ND GRADERS. IN 2018, 5 SCHOOLS PARTICIPATED AND OVER 120 KIDS PARTICIPATED. THE DAY INCLUDES TIME IN THE ER, RADIOLOGY, AND HELPING TO CARE FOR OUR BOY MANNEQUIN, WHO HAS HAD A BIKE ACCIDENT AND WAS NOT WEARING A HELMET. THE HELICOPTER CAME IN, AS DID THE LOCAL AMBULANCE SQUAD AND THE NYS TROOPERS BROUGHT IN THEIR K9 OFFICER. THE GOAL IS TO EXPOSE KIDS TO SOME OF THE THINGS THEY MAY SEE AND EXPERIENCE IF THEY OR A LOVED ONE HAD TO HAVE CARE. EACH TEACHER ALSO RECEIVED A MR. YUK CLASSROOM ACTIVITY TO HELP KIDS LEARN ABOUT POISONS. A SANTA CLAUS EVENT IS ALSO HELD. CHILDREN SEE SANTA, HAVE THEIR PHOTO TAKEN AND ALSO THEY EACH MAKE A HOLIDAY CRAFT WITH THEIR FAMILY MEMBER. WE HOPE THIS TYPE OF ACTIVITY FOSTERS A STRONGER SENSE OF FAMILY.OVER 100 CHILDREN TOOK PART IN THIS EVENT.PREVENT HIV, STDS, VACCINE PREVENTABLE DISEASES AND HEALTH CARE ASSOCIATED INFECTIONS DVH DOES PROMOTE VACCINATION OF CHILDREN THROUGH ITS PRIMARY CARE PRACTICES AND FLU SHOTS FOR ALL RESIDENTS. DVH'S INFECTION CONTROL NURSE CONTINUALLY PROVIDES INFORMATION REGARDING PPE, HAND WASHING, AND IMMUNIZATIONS. THIS IS DONE AS A PART OF DVH'S NORMAL BUSINESS AND IS NOT CONSIDERED TO BE A SPECIAL INITIATIVE. THE HOSPITAL DID PROVIDE HAND WASHING EDUCATION AT THE COUNTY FAIR FOR THE PAST TWO YEARS. A HAND WASH STATION WAS SET UP, PARTICIPANTS WASHED THEIR HANDS, THEN APPLIED A SPECIAL GEL AND LOOKED AT THEIR HANDS UNDER A BLACK LIGHT TO SEE WHERE THEY MAY HAVE MISSED. IN 2018, DVH STAFF WENT TO THE LOCAL ELEMENTARY SCHOOL AND HELD THE HAND WASH CHALLENGE BY HAVING ALL STUDENTS, WASH THEIR HANDS AND THEN VIEW THEM UNDER THE BLACK LIGHT. THEY WASHED THEIR HANDS AGAIN AND SAW WHERE THEY HAD DONE BETTER AND WHERE THEY STILL COULD USE SOME MORE PRACTICE. THIS EVENT, HELD OVER 2 DAYS, REACHED OVER 500 PRE-K THROUGH 5TH GRADE STUDENTS.HEALTH CARE PROFESSIONAL SHORTAGESA MAJOR CONCERN, ESPECIALLY IN RURAL AREAS IS THE SHORTAGE OF HEALTH CARE PROFESSIONALS. DELAWARE VALLEY TRIES TO HELP ADDRESS THAT CONCERN IN SEVERAL WAYS. BOTH THE LOCAL BOCES SCHOOL AND STATE UNIVERSITY SEND THEIR NURSING STUDENTS TO DVH FOR THEIR CLINICAL EXPERIENCES. DVH NURSING STAFFS SERVE ON THE UNIVERSITY'S EXTERNAL ADVISORY COUNCIL AND WORK WITH THE SCHOOL'S BSN STUDENTS IN PROVIDING REAL LIFE INSIGHT INTO THE VARIOUS FIELDS OF NURSING.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 9
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) 2018
Schedule H (Form 990) 2018
Page 10
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 $613,846 IN PART IX, LINE 24B. THE AFOREMENTIONED BAD DEBT EXPENSE WAS 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 AND WELLNESS COMMITTEE OF THE LOCAL SCHOOL. THE HOSPITAL ALSO HAS REPRESENTATION ON THE COUNTY'S EMERGENCY PREPAREDNESS COMMITTEE (BNICER) COMMITTEE. IN 2018, DVH STAFF TOOK PART IN THE COUNTY'S POINT OF DISTRIBUTION (POD) DRILL. WEEKLY NARCOTICS ANONYMOUS MEETINGS CONTINUE TO BE HELD AT THE HOSPITAL AND HOSPITAL STAFF PERFORMS DRUG TESTING COLLECTION FOR THE COUNTY'S DRUG TREATMENT COURT FREE OF CHARGE. THE DELAWARE COUNTY DRUG TREATMENT COURT'S MISSION IS TO HELP CHANGE THE BEHAVIORS OF ADULT NONVIOLENT DRUG AND ALCOHOL USERS THROUGH SUPERVISION AND TREATMENT RATHER THAN JUST SENDING THEM TO JAIL. THE OVERALL GOAL IS TO HELP ADDICTED INDIVIDUALS ACHIEVE LIFELONG RECOVERY AND BECOME RESPONSIBLE AND PRODUCTIVE MEMBERS OF THE COMMUNITY. DELAWARE COUNTY'S SOLID WASTE MANAGEMENT CENTER ASKED AREA HEALTHCARE PROVIDERS FOR HELP IN MAKING THE PUBLIC AWARE OF HOW TO SAFELY DISPOSE OF NEEDLES. DVH TOOK THE LEAD AND DEVELOPED A NEW BROCHURE TO BE HANDED OUT DURING THE 2017 CLEAN SWEEP WEEK. UHS PRODUCED THE BROCHURES, FREE OF CHARGE SO THEY COULD BE DISTRIBUTED COUNTY WIDE. THESE ARE STILL BEING USED IN 2018.THE HOSPITAL WAS A CO-SPONSOR WITH CARE COMPASS NETWORK AND DELAWARE COUNTY COMMUNITY SERVICES DEPARTMENT TO OFFER A TWO-DAY WORKSHOP: SEQUENTIAL INTERCEPT MODEL (SIM) AS APPROXIMATELY 40 AGENCIES AND ORGANIZATIONS AND INTERESTED STAKEHOLDERS CAME TOGETHER TO MAP OUT AN INTERFACE BETWEEN CRIMINAL JUSTICE AND THE MENTAL HEALTH SYSTEM SO CONCERNS COULD BE ADDRESSED ABOUT THE CRIMINALIZATION OF PEOPLE WITH BOTH MENTAL ILLNESS AND SUBSTANCE USE ADDICTION. THE HOSPITAL CONTINUED TO SUPPORT THE COMMUNITY HOLIDAY DINNER, THE TOWN'S VETERAN'S CLUB, CHAMBER OF COMMERCE, LITTLE LEAGUE ORGANIZATION, THE LOCAL TOY BANK DRIVE AND TWO 5K RUNS, THE AMERICAN CANCER SOCIETY, AMERICAN HEART ASSOCIATION. THE PRESIDENT/CEO OF DELAWARE VALLEY IS AN ACTIVE MEMBER OF THE WALTON LIONS CLUB. THE HOSPITAL CONTROLLER SERVES ON THE BOARD OF THE CULLEMAN CENTER, A DAY CARE CENTER IN SIDNEY, NY. OVER THE COURSE OF EACH YEAR, DVH MEMORIALIZES PEOPLE BY DONATING TO NON-PROFIT ORGANIZATIONS RATHER THAN GETTING FLOWERS. IN 2018, IT DONATED TO THE NORTH CAROLINA HEALTHCARE WORKERS FLOOD FUND.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 CONTINUES TO BE THE LEADING SPONSOR OF THE EVENT AND STAFF SERVE ON THE PLANNING COMMITTEE. DVH CONTINUES TO SUPPLY 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 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. THE HOSPITAL ALSO PROVIDES PHONE AND OFFICE SUPPLIES TO THEM, AT NO CHARGE. A PATIENT AND FAMILY ADVISORY COMMITTEE WAS STARTED IN 2018. THE GROUP PROVIDES DVH WITH INVALUABLE INSIGHT AS TO HOW A PATIENT INTERPRETS A MULTITUDE OF HEALTHCARE TOPICS AND DVH IS ABLE TO PROVIDE THEM WITH INSIGHT TO SOME OF THE REASONS THAT THINGS ARE DONE THE WAY THEY ARE. WE ALSO BELIEVE IN ENCOURAGING FAMILY TOGETHERNESS. WE HELD OUR SECOND SANTA EVENT BUT THIS TIME WE ADDED A CRAFT ACTIVITY FOR EACH CHILD TO DO WITH THEIR PARENT. A LITTLE OVER 100 KIDS CAME TO THE EVENT WITH THEIR PARENTS. TO ENCOURAGE YOUNG CHILDREN TO BE SAFE AND NOT TO BE AFRAID OF HEALTHCARE PROVIDERS OR HOSPITALS, DVH HOSTED 146 SECOND GRADERS FROM 5 AREA SCHOOLS AT A TEDDY BEAR CLINIC. THEY LEARNED LESSONS ABOUT SAFETY HELMETS, SEAT BELTS AND POISON AND GOT TO HAVE HANDS-ON EXPERIENCE IN THE ER, RADIOLOGY, AND HELPING OUR MANNEQUIN PATIENT (A BIKE ACCIDENT PATIENT WHO HAD NOT WORN A HELMET). THEY ALSO TOURED AN AMBULANCE, LOOKED INSIDE THE MEDICAL HELICOPTER AND GOT TO MEET AND LEARN ABOUT WHAT A K9 OFFICER DOES.
PART III, LINE 2: THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED ON A PERCENTAGE ALLOCATION APPLIED TO THE TOTAL BAD DEBT EXPENSE REPORTED ON THE AUDITED FINANCIAL STATEMENTS. THE PERCENTAGE CALCULATION COMPARED THE 2018 ACTUAL BAD DEBT WRITE-OFFS RELATED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE TO THE TOTAL 2018 ACTUAL BAD DEBT WRITE-OFFS. THIS CALCULATION DID NOT INCLUDE ESTIMATES OR ACCRUALS. IN 2018, THE WRITE-OFFS RELATED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WAS APPROXIMATELY 50% OF THE TOTAL BAD DEBT WRITE-OFFS.
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. PLEASE REFER TO FOOTNOTE 1, PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION.
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. DELAWARE VALLEY HOSPITAL USES THE COST TO CHARGE COSTING METHODOLOGY UTILIZING AMOUNTS FROM OUR 2018 MEDICARE COST REPORT FOR ALL PERTINENT CALCULATIONS IN PART III, LINE 6.
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 COMMENCING 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). DVH'S CERTIFIED DIETITIAN/NUTRITIONIST HELD ONE SPECIAL PROGRAM FOR SUNY NURSING STUDENTS REGARDING DIABETES. 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 2018, 16 STUDENTS ATTENDED OVER A TWO DAY PERIOD.THROUGHOUT 2018, 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. SEVERAL MEETINGS WERE HELD THROUGHOUT 2018, IN ORDER TO WORK TOGETHER TO ADDRESS ISSUES RAISED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE INITIATIVES EACH HOSPITAL OUTLINED IN THEIR COMMUNITY SERVICE PLANS. AN UPDATE OF 2018 ACTIVITIES IS LOCATED ON THE NYUHS.ORG WEBSITE.MENTAL HEALTH AND SUBSTANCE ABUSE HAVE BEEN IDENTIFIED IN THE NEEDS ASSESSMENT AS A PRIORITY. IN 2018, 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 IN ACCESSING CARE IS THE LACK OF PROVIDERS TO CARE FOR THESE PATIENTS. IN 2017, DVH BEGAN A TELEPSYCHIATRY PROGRAM WITH A PRIVATE PRACTICE PSYCHIATRIST. UNFORTUNATELY, DUE TO THE PHYSICIAN'S LIMITED PARTICIPATION WITH INSURANCE CARRIERS, MANY PATIENTS IN NEED COULD NOT BE REFERRED. IN 2018, DVH WAS ABLE TO CONTRACT WITH AN OUTSIDE VENDOR TO BEGIN A TELEMENTAL HEALTH PROGRAM. THE PROGRAM OFFICIALLY BEGAN IN JANUARY, 2019 AND A NPP AND LCSW ARE AVAILABLE TO SEE PATIENTS THROUGH THIS TECHNOLOGY. A SECOND NEED IS FOR CHRONIC DISEASE MANAGEMENT AND PREVENTION. THE HOSPITAL HAS 3 STAFF MEMBERS TRAINED TO OFFER THE PROGRAM. IN 2018, THREE PROGRAMS WERE OFFERED TO THE PUBLIC: ONE IN THE SPRING AND TWO IN THE FALL. THE HOSPITAL ALSO ACTIVELY PARTICIPATES IN THE UHS PPS FOR THE DSRIP PROGRAM, NOW CALLED CARE COMPASS NETWORK. THE COMMUNITY RELATIONS DIRECTOR IS ACTIVELY INVOLVED IN THE ORGANIZATION'S EASTERN REGIONAL PERFORMANCE GROUP MEETINGS.
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 HOSPITAL'S FINANCIAL ASSISTANCE POLICY CHANGED TO PROVIDE ALL SELF-PAY PATIENTS AN AUTOMATIC 35% 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. 85% OF DVH'S 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 PROVIDING PATIENT CARE. THE AREA DOES NOT HAVE PUBLIC TRANSPORTATION AND WHILE RECENTLY SOME PRIVATE TRANSPORTATION SERVICES HAVE BEGUN, THEY ARE GENERALLY 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. MANY PROPERTIES HAVE BEEN PURCHASED BY NYC, TO FURTHER PROTECT ITS WATERSHED. 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 CAUCASIAN, 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, WITH NO HUSBAND PRESENT HAS RISEN TO 66.7% FOR CHILDREN UNDER 5 YEARS OF AGE IN DELAWARE COUNTY. THIS IS WELL ABOVE THE 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 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. IN THE IMAGING CENTER X-RAY, 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, AS WELL AS CHRONIC DISEASE MANAGEMENT. 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 A PAIN MANAGEMENT PHYSICIAN, AND PHYSICIAN ASSISTANT.THE PAIN MANAGEMENT CLINIC BEGAN TO HELP PATIENTS UTILIZE ALTERNATIVE TREATMENT METHODS RATHER THAN USING OPIOIDS. THE CLINIC IS HELD TWO DAYS PER MONTH. DELAWARE VALLEY HOSPITAL'S CERTIFIED DIETICIAN/NUTRITIONIST OFFERED A LIFESTEPS SERIES OF WORKSHOPS WHICH FOCUS ON PARTICIPANTS' LIFESTYLES AS RELATED TO DIET AND EXERCISE IN JANUARY, 2018 BUT NO ONE SIGNED UP. BECAUSE THE DIETITIAN/NUTRITIONIST WAS ALREADY CO-LEADING THE CHRONIC DISEASE SELF MANAGEMENT PROGRAM NO ADDITIONAL OUTREACH WAS DONE. THE DIETITIAN/NUTRITIONIST ALSO GAVE A PRESENTATION AT THE HAMDEN SENIOR CITIZENS CLUB ABOUT NUTRITION, AND SHE AND OUR RN CARE COORDINATOR PARTNERED WITH THE RURAL HEALTH NETWORK OF SOUTH CENTRAL NY TO WORK WITH THEIR CLIENTS WHO WERE ELIGIBLE FOR THE FRUIT AND VEGGIE VOUCHER PROGRAM. THE DIETITIAN AND FOOD SERVICE MANAGER EVEN HELD A CELEBRATORY EVENT AT THE END OF THE YEAR; MAKING A HEALTHY SOUP AND SALAD DINNER FOR ALL OF THE PARTICIPANTS. THEY ALSO TEAMED UP TO OFFER A CONTINUOUS GLUCOSE MONITORING SEMINAR.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 438 BLOOD PRESSURE CHECKS, 100 PLAYED THE NUTRITION GAME. 41 EMPLOYEES SPENT A TOTAL OF 347 HOURS EITHER PLANNING OR MANNING THE BOOTH AT THE 6-DAY LONG EVENT.IN 2017, SEVERAL ADDITIONAL WELLNESS INITIATIVES BEGAN. TWO STAFF COMPLETED THE AMERICAN CANCER SOCIETY'S FRESH START TOBACCO CESSATION PROGRAM TRAINING. THEY WENT ON TO HOLD THREE 4 WEEK PROGRAMS IN 2017. IN 2018 ONLY ONE CLASS HAD ANY PARTICIPANTS. FOR 2019, DVH IS GOING TO TRY AND COORDINATE THIS PROGRAM IN CONJUNCTION WITH UHS STAY HEALTHY CENTER AND OFFER IT THROUGH LIVE, INTERACTIVE VIDEOCONFERENCING. THE HOSPITAL ALSO BEGAN A LUNG MATTERS GROUP FOR PATIENTS AND CAREGIVERS DEALING WITH LUNG CONDITIONS. THE GROUP MEETS MONTHLY AND IS MANAGED BY THE HOSPITAL'S CARDIOPULMONARY REHABILITATION NURSE. SHE HAS ALSO INCLUDED HARMONICA PLAYING INTO THE MEETINGS, WHICH IS A HELPFUL TOOL IN BETTER BREATHING. DVH SUPPLIES THE HARMONICAS TO THE PARTICIPANTS FREE OF CHARGE.IN 2017, THREE STAFF MEMBERS WERE TRAINED TO OFFER THE STANFORD UNIVERSITY, EVIDENCED-BASED CHRONIC DISEASE SELF-MANAGEMENT PROGRAM. MARKETED AS, HAPPY HEALTHY AND WISE WORKSHOPS, THREE PROGRAMS WERE OFFERED IN 2017. THE PROGRAM IS GIVEN 2 HOURS A WEEK, FOR SIX WEEKS. IT FEATURES A "TOOLBOX" OF STRATEGIES PARTICIPANTS CAN USE TO HELP MANAGE THEIR CONDITIONS MORE SUCCESSFULLY. THE "TOOLBOX" INCLUDES PROBLEM-SOLVING, ACTION PLANNING, COMMUNICATION, UNDERSTANDING EMOTIONS, WEIGHT MANAGEMENT AND HEALTHY EATING, USING YOUR MIND, SLEEP, PHYSICAL ACTIVITY, MEDICATION MANAGEMENT, DECISION MAKING, BETTER BREATHING AND WORKING WITH HEALTH PROFESSIONALS' STRATEGIES.THE CARDIOPULMONARY REHABILITATION NURSE PRESENTED A PROGRAM TO THE WALTON LIONS CLUB REGARDING THE RELATIONSHIP BETWEEN DIABETES AND HEART DISEASE. STAFF PARTICIPATED IN THE AMERICAN HEART ASSOCIATION'S GO RED FOR WOMEN EVENT AND HEART WALK, AND THE DELAWARE COUNTY SENIOR PICNIC WHERE BALANCE AND FALL PREVENTION WAS A HIGHLIGHT.AN OPEN HOUSE WAS HELD AT THE ROSCOE PRIMARY CARE SITE WHERE PARTICIPANTS RECEIVED INFORMATION ABOUT VARIOUS CONCERNS THEY HAD, AS WELL AS FREE FASTING CHOLESTEROL, BLOOD SUGAR AND PSA LAB TESTING. IN 2018, A NEW EVENT WAS ADDED WHEN THE COMMUNITY RELATIONS STAFF WENT TO THE LOCAL ELEMENTARY SCHOOL AND HELD A HANDWASHING EVENT. STUDENTS WASHED THEIR HANDS, USED SOME GEL AND THEN LOOKED AT THEM UNDER A BLACK LIGHT. SPOTS THEY MISSED SHOWED UP AS WHITE AREAS. THEY WENT BACK AND WASHED AGAIN AND WERE ABLE TO SEE WHERE THEY HAD IMPROVED AND WHERE THEY STILL MAY HAVE NEEDED TO FOCUS. OVER 500 CHILDREN FROM 4 YRS OF AGE THROUGH 5 GRADE PARTICIPATED.
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 ORGANIZATIONS INTO A HEALTH CARE SYSTEM, OUR REGION TODAY OFFERS MORE COMPLETE AND ADVANCED CARE THAN MANY COMMUNITIES FIVE TIMES OUR SIZE. DVH PARTICIPATES IN THE UNITED HEALTH SERVICES SYSTEM STRATEGIC PLANNING PROCESS. CONSISTENT WITH THE MISSION AND VISION, THE PLAN FOCUSES ON CONTINUING TO STRENGTHEN THE HEALTH SYSTEM AND ITS SERVICES TO THE REGION. THE STRATEGIC PLAN IS ORGANIZED AROUND THREE OBJECTIVES: IMPROVE OUR CARE, MANAGE OUR COSTS, AND GROW OUR MARKET SHARE. SPECIFIC DESTINATION METRICS OR MEASURES OF SUCCESS WERE DEVELOPED FOR EACH STRATEGIC OBJECTIVE AND DVH FURTHER DEVELOPS OBJECTIVES AS THEY WOULD RELATE TO THE HOSPITAL'S SERVICES AND THE NEEDS OF IT PATIENTS. THE SPECIFIC INITIATIVES SUPPORTING ACHIEVEMENT OF THE OBJECTIVES ARE REVIEWED ON A REGULAR BASIS. EACH ENTITY CARRIES OUT INITIATIVES BOTH LOCALLY AND REGIONALLY. THE DVH COMMUNITY SERVICE REPORT IS INCLUDED WITH THE DELAWARE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT, ALONG WITH THE COMMUNITY SERVICE PLANS OF O'CONNOR HOSPITAL, TRI-TOWN REGIONAL HOSPITAL, AND MARGARETVILLE HOSPITAL, ALL IN ONE DOCUMENT.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 ELECTRONIC MEDICAL RECORDS 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) 2018
Additional Data


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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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
DELAWARE VALLEY HOSPITAL INC
 
Employer identification number

15-0524324
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .........
1b
 
 
2
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? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
Yes
 
b
Any related organization? ......................
6b
Yes
 
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1JOHN CARRIGG
2ND VICE CHAIR 		(i)

(ii)		 0
-------------
678,078 		0
-------------
151,062 		0
-------------
10,500 		0
-------------
18,500 		0
-------------
20,125 		0
-------------
878,265 		0
-------------
0
2DR MICHAEL FREEMAN
MEDICAL STAFF PRESIDENT 		(i)

(ii)		 236,475
-------------
0 		200
-------------
0 		0
-------------
0 		12,690
-------------
0 		25,358
-------------
0 		274,723
-------------
0 		0
-------------
0
3PAUL SUMMERS
PRESIDENT/CEO 		(i)

(ii)		 204,015
-------------
0 		46,880
-------------
0 		0
-------------
0 		7,884
-------------
0 		12,815
-------------
0 		271,594
-------------
0 		0
-------------
0
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
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
PART I, LINE 6 THE EXECUTIVE COMPENSATION INCENTIVE PLAN HAS VARIOUS PERFORMANCE MEASURES WHICH INCLUDE ONES FOR CLINICAL EXCELLENCE, MARKET GROWTH, AND FINANCIAL STRENGTH. ONE MEASURE UNDER THE FINANCIAL STRENGTH HEADING IS THE COMBINED NET INCOME OF THE UNITED HEALTH SERVICES SYSTEM. A PORTION OF THE 2018 INCENTIVE COMPENSATION PAYMENTS WERE ATTRIBUTABLE TO MEETING THE COMBINED NET INCOME, PATIENT SAFETY, AND QUALITY GOALS.
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 & NON-TAXABLE BENEFITS $274,723.
Schedule J (Form 990) 2018
Additional Data


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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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
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 ............. 5,554,174      
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) 2018

Schedule K (Form 990) 2018
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 ....SchKMediumBullet        
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 ......... SchKMediumBullet        
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) 2018

Schedule K (Form 990) 2018
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) 2018

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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) 2018
Schedule L (Form 990 or 990-EZ) 2018
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?
Yes No
(1) MICHAEL LAYTON BROTHER-IN-LAW OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 59,940 EMPLOYEE WAGES   No
(2) BONNIE CRAIG SISTER OF DEBORAH HITT, V.P. QUALITY/SUPPORT SERVICES 38,355 EMPLOYEE WAGES   No
(3) NANCY VOLLKOMMER SISTER-IN-LAW OF VICKI CONKLING, V.P. NURSING ADMIN./CNO 31,720 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) 2018


Additional Data


Software ID:  
Software Version:  




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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 SOLE CORPORATE MEMBER OF THE ORGANIZATION IS UNITED HEALTH SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS UNITED HEALTH SERVICES, INC.
FORM 990, PART VI, SECTION B, LINE 11B 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 AND INDEPENDENT AUDITORS PRIOR TO FILING. A SUMMARY OF KEY ELEMENTS OF THE 990 IS SHARED WITH THE BOARD OF DIRECTORS FOR INFORMATIONAL PURPOSES.
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 THE 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 THE BASIS FOR ESTABLISHING AN ACCEPTABLE COMPENSATION RANGE 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 5,017,885. MANAGEMENT AND GENERAL EXPENSES 760,445. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,778,330.
FORM 990, PART XI, LINE 9: INTEREST RATE SWAP 84,699.
FORM 990, PART XII, LINE# 2C NEITHER THE PROCESS FOR THE OVERSIGHT OF THE AUDIT NOR THE PROCESS FOR THE SELECTION OF THE INDEPENDENT ACCOUNTANT HAS CHANGED DURING THE YEAR. THE BOARD OF DIRETORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
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?
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) 10 UNITED HEALTH SERVICES INC
 
 
No
(3)IDEAL SENIOR LIVING CENTER
508 HIGH AVENUE

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 AVENUE

ENDICOTT,NY13760
22-2902899 		SENIOR HOUSING NY 501(C)(3) 10 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) 10 BOARD OF DIRECTORS UHS INC
 
 
No
(7)TWIN TIER HOME HEALTH INC
601 RIVERSIDE DRIVE

JOHNSON CITY,NY13790
22-2438211 		HOME HEALTH CARE NY 501(C)(3) 10 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) 10 TWIN TIER HOME HEALTH INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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?



 		(k)
Percentage
ownership
Yes No 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
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
Yes
 
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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) 2018
Schedule R (Form 990) 2018
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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) 2018

Additional Data


Software ID:  
Software Version: