2025-11-13T07:53:57-06:00 2024-12-31 222027092 WITHUM SMITH & BROWN PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2024-01-01 150524324 DELAWARE VALLEY HOSPITAL INC DELA 6078652197 1 TITUS PLACE WALTON NY 138561457 LUCINDA RIDER VICE PRESIDENT/CFO 6078652160 2025-11-13 1 0 MARY MADONIA P00405803 7168472651 2025-11-13 2024 2025-03-06 01:10:19Z ROLLAND BOJO 1 TITUS PLACE WALTON NY 138561457 56705974 0 X WWW.NYUHS.ORG X 1950 NY 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. 11 6 278 30 0 0 700115 519618 41787458 54102397 491922 1099683 77070 84018 43056565 55805716 0 0 0 0 13917026 16630643 0 0 0 20742864 26390433 34659890 43021076 8396675 12784640 46572124 61125761 7476903 8244252 39095221 52881509 X SEE SCHEDULE OAS A CRITICAL ACCESS HOSPITAL AND MEMBER OF THE UHS HEALTHCARE SYSTEM, 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, WALK-IN AND PRIMARY CARE, INPATIENT SHORT-TERM ACUTE CARE AND A COMPREHENSIVE REHABILITATION SWING BED PROGRAM. IN ADDITION, WE PROVIDE A WIDE RANGE OF DIAGNOSTIC AND TREATMENT SERVICES; ACCESS TO TOP LOCAL SPECIALTY CARE AND AN OUTPATIENT PHARMACY. 0 0 12967395 9023173 INPATIENT AND ACUTE SERVICES (SEE SCHEDULE O) INPATIENT AND ACUTE SERVICESDELAWARE VALLEY HOSPITAL (DVH) FULFILLS ITS MISSION BY COLLABORATING WITH THE COMMUNITY, PHYSICIANS, AND HEALTHCARE PARTNERS TO ENSURE THE AVAILABILITY AND QUALITY OF SERVICES. THE 25-BED HOSPITAL IN WALTON, NY PROVIDES SHORT-TERM INPATIENT ACUTE CARE (96 HOURS OR LESS), SWING BED, AND ADDICTION TREATMENT SERVICES.PATIENT VOLUME:ACUTE DISCHARGES (PATIENT DAYS) 195 (833)SWING BED DISCHARGES (PATIENT DAYS) 224 (3,581)CLINICAL SERVICES DELIVERED20,375 LAB TESTS3,018 RESPIRATORY TREATMENTS63 X-RAYS, 26 ULTRASOUNDS, 88 CT SCANS, 10 MRIS1,978 PHYSICAL THERAPY SESSIONS, 985 OCCUPATIONAL THERAPY SESSIONS, 69 SPEECH THERAPY SESSIONS187 EKGS743 DIETARY CONSULTSIMAGING CAPABILITIES:3D MAMMOGRAPHY, ULTRASOUND, BONE DENSITY TESTING, X-RAY, AND A 128-SLICE CT SUITE. DVH PROVIDES THE ONLY FULL-TIME MRI SERVICE IN DELAWARE COUNTY, ENSURING LOCAL RESIDENTS HAVE ACCESS TO ADVANCED DIAGNOSTIC IMAGING CLOSE TO HOME. 6317155 8470204 CLINICS (SEE SCHEDULE O)CLINICSDVH OFFERS A FULL RANGE OF PRIMARY AND PREVENTIVE CARE SERVICES AT ITS CENTERS IN WALTON, DOWNSVILLE, AND ROSCOE. THESE CLINICS FORM THE FOUNDATION OF A COORDINATED SYSTEM OF CARE, ADDRESSING THE NEEDS OF UNDERSERVED AREAS.2024 VISITS BY LOCATION:WALTON 16,829ROSCOE 1,777DOWNSVILLE 2,855 18007683 36688838 OUTPATIENT AND AMBULATORY SERVICES (SEE SCHEDULE O) OTHER OUTPATIENT SERVICES:EMERGENCY DEPARTMENT: 6,046 VISITS (INCLUDING 390 OBSERVATIONS)OCCUPATIONAL HEALTH: 262 FIRE DEPARTMENTS/EMERGENCY SQUADS SERVED (3 NEW IN 2024)DIAGNOSTICS & THERAPY: 101,067 LAB TESTS; 9,494 PHYSICAL/OCCUPATIONAL THERAPY SESSIONS; 15,136 IMAGING PROCEDURES (X-RAY, CT, MRI, ULTRASOUND, BONE DENSITY, MAMMOGRAPHY)CARDIAC TESTING: 3,281 (EKGS, ECHOCARDIOGRAMS, HOLTER AND EVENT MONITORS)DIETARY/DIABETES CONSULTS: 3,241AMBULATORY PROCEDURES: 520ENDOSCOPIES: 215CARDIAC/PULMONARY REHAB SERVICES: 1,275OUTPATIENT RETAIL PHARMACY: 80,645 PRESCRIPTIONS FILLED 37292233 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 42 0 1 278 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 NY X ROLLAND BOJO 6078652197 DELAWARE VALLEY HOSPITAL 1 TITUS WALTON NY 138561457 HELEN JOHNSTON BOARD MEMBER/BOARD CHAIR 2.00 X X 0 0 0 JOHN CARRIGG BOARD MEMBER/VICE CHAIR 2.00 55.00 X X 0 1386812 50729 REV LARRY LIGHT BOARD MEMBER 2.00 X 0 0 0 EDWARD SNOW BOARD MEMBER/SECRETARY 2.00 X X 0 0 0 ERIN NEALE BOARD MEMBER 2.00 X 0 0 0 AMANDA HALL BOARD MEMBER/TREASURER 2.00 X X 0 0 0 DR MICHAEL FREEMAN BOARD MEMBER/MEDICAL STAFF PRESIDENT 2.00 55.00 X X 0 279491 40624 ROLLAND BOJO BOARD MEMBER/PRESIDENT/CEO 57.00 X X 305540 0 54538 LUCINDA RIDER VICE PRESIDENT/CFO 55.00 X 180173 0 9876 LAURA NORTHRUP VP PATIENT CARE SERVICES/CNO 55.00 X 164798 0 27844 KIRILL DAVIDOV CHIEF MEDICAL OFFICER 5.00 50.00 X 0 496879 42147 KATHLEEN ULMSCHNEIDER STAFF NURSE 55.00 X 146172 0 35219 TITO ENDAYA LAB MANAGER 55.00 X 151319 0 18730 MARGARET EBELING STAFF NURSE 55.00 X 147702 0 20886 MEGAN HEAPHY DIRECTOR AMBULATORY, ED, WALK-IN, IMAGING 55.00 X 147768 0 45314 CYNTHIA GARDEPE DIRECTOR HUMAN SERVICES 55.00 X 145702 0 20096 DR JEFFREY GRAY FORMER CHIEF MED OFFICER TO 12/31/24 0.00 55.00 X 0 753889 58321 VICTORIA CONKLING FORMER CNO TO 05/24/24 0.00 X 106975 0 11330 1496149 2917071 435654 34 1 1 1 UNITED MEDICAL ASSOCIATES 20 MITCHELL AVE BINGHAMTON NY 13903 PHYSICIAN SERVICES 5295332 AMBULNZ NEW YORK 2 LLC 263 ROUTE 17K SUITE 201 NEWBURGH NY 12550 AMBULANCE SERVICES 967497 SECO PHYSICALOCCUPATIONAL THERAPY 26 CONKY AVE NORWICH NY 13815 PHYSICAL/OCC. THERAPY 897741 CHIANIS AND ANDERSON ARCHITECTS PLLC 31 FRONT ST BINGHAMTON NY 13905 ARCHITECTS 772851 PARK AVE ASSOCIATES IN RADIOLOGY 32-36 HARRISON ST JOHNSON CITY NY 13790 RADIOLOGY SERVICES 499666 13 505884 13734 519618 OUTPATIENT SERVICES 621400 36634790 36634790 INPATIENT AND ACUTE SERVICES 621990 9009881 9009881 CLINICS 621110 8457726 8457726 54102397 1025933 1025933 4200 0 4200 4200 4200 974008 900258 73750 73750 73750 PROFESSIONAL SERVICES RENDERED 900099 69124 69124 ALL OTHER REVENUE 900099 10501 10501 MED RECORD COPY FEES 900099 193 193 79818 55805716 54182215 0 1103883 X 1247460 898584 348876 12246764 10205713 2041051 412619 338348 74271 1792176 1469584 322592 931624 775030 156594 271833 271833 5012 5012 163555 163555 5015 5015 11562796 10551376 1011420 12286 12286 1209347 397243 812104 132880 132880 319119 81587 237532 38460 18907 19553 8804 5049 3755 48503 48503 1429621 1429621 208474 134177 74297 DRUGS 7098593 7098593 BAD DEBT EXPENSE 1663439 1663439 MEDICAL SUPPLIES 970399 970399 LAB SERVICES 964914 964914 277383 277383 43021076 37292233 5728843 0 9374770 18699715 3611142 3608936 503886 620406 615932 601201 33943268 21033650 12090304 12909618 19393560 20962609 318209 318209 664321 3405067 46572124 61125761 2007688 3130159 1412510 1252212 2844761 2109939 1211944 1751942 7476903 8244252 X 38736348 52537397 358873 344112 39095221 52881509 46572124 61125761 12784640 1001648 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5015 5015 0 PART II-B, LINE 1: AMOUNTS DISCLOSED ARE THE LOBBYING PORTIONS OF DUES PAID TO HEALTHCARE ASSOCIATION OF NY (10.08%) AND IROQUOIS HEALTHCARE (50%). 358873 14761 344112 360887 2014 358873 331456 29431 360887 336845 5389 331456 335666 1179 336845 0.92000 0.08000 1 0 51202 51202 16782722 8975729 7806993 15603274 12057921 3545353 1506070 1506070 12909618 SAVINGS - RESTRICTED DONATIONS 42521 SAVINGS ENHANCE NBDC 3226599 OPERATING LEASE ROU 135947 3405067 DUE TO UNITED MED. ASSOC. 484836 DUE TO UHS HOSPITALS 1121056 DUE TO CMH 2148 ROU LEASE 142228 DUE FROM UHSH SBO LOCK BOX 1674 1751942 X 55143925 1001648 1001648 54142277 1663439 1663439 55805716 41357637 0 41357637 1663439 1663439 43021076 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, 2024 AND 2023, 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 2021 TO 2024. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,663,439. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,663,439. 1 1 X 1 X 0 1 1 1 0 1 1 162056 162056 0.00390 7227580 5779006 1448574 0.03520 7389636 5779006 1610630 0.03910 435967 435967 0.01050 57336 57336 0.00140 493303 493303 0.01190 7882939 5779006 2103933 0.05100 19434 19434 0.00050 295 295 0.00000 2450 2450 0.00010 22179 22179 0.00060 0 1663439 174700 6590169 15639505 -9049336 X 1 1 1 1 DELAWARE VALLEY HOSPTITAL 1 TITUS PLACE WALTON NY 13856 X X X DELAWARE VALLEY HOSPTITAL 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X HTTP://WWW.NYUHS.ORG X 1 23 1 HTTP://WWW.NYUHS.ORG 0 1 X 200.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.NYUHS.ORG X HTTP://WWW.NYUHS.ORG X HTTP://WWW.NYUHS.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 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, NYMARGARETVILLE COMMUNITY HOSPITAL, MARGARETVILLE, NY DELAWARE VALLEY HOSPTITAL PART V, SECTION B, LINE 6B: GOVERNMENT: DELAWARE COUNTY PUBLIC HEALTHHOSPITAL AND HEALTH SERVICES: UNITED HEALTH SERVICES - DELAWARE VALLEY HOSPITAL, BASSETT HEALTHCARE-O'CONNOR HOSPITAL AND WESTCHESTER MEDICAL CENTER HEALTH NETWORK- MARGARETVILLE MEMORIAL HOSPITALALLIANCES: RURAL HEALTH NETWORK OF SOUTH CENTRAL NY DELAWARE VALLEY HOSPTITAL PART V, SECTION B, LINE 11: 2022-2024 COMMUNITY SERVICE PLAN PRIORITY: PREVENT CHRONIC DISEASEFOCUS AREA 4: PREVENTIVE CARE AND MANAGEMENTGOAL 4.1 INCREASE CANCER SCREENING RATESOBJECTIVE: THE PERCENTAGE OF ADULT PATIENTS OF DVH, AGE 50-75 YEARS, RECEIVING A COLORECTAL SCREENING WILL INCREASEINTERVENTIONS: - WORK WITH PRIMARY CARE PROVIDERS AND STAFF TO UTILIZE THE TOOLS WITHIN THE NEW EPIC EHR, TO ENSURE BOTH PROVIDERS AND PATIENTS RECEIVE APPROPRIATELY SPACED REMINDERS THROUGH EHR ALERTS, MAIL, PHONE CALLS, EMAIL AND/OR E-CHART NOTIFICATIONS. - WORK TO SECURE ADDITIONAL ACCESS TO GI SPECIALTY CARE AND COLONOSCOPY PROCEDURES- MARKETING STAFF WILL SECURE OR CREATE ADDITIONAL EDUCATIONAL MATERIALS REGARDING COLORECTAL CANCER SO THE GENERAL PUBLIC CAN GAIN A HIGHER AWARENESS OF THE IMPORTANCE OF SCREENINGFAMILY OF MEASURES: - % COMPLIANCE WITH SCREENING GUIDELINES AMONG DVH PATIENTS.- NUMBER OF DAYS GI CONSULTATION AND COLONOSCOPIES ARE AVAILABLE AT DVH.- MATERIALS REGARDING COLORECTAL CANCER ARE MORE ACCESSIBLE TO THE PUBLICPROJECTED YEAR 3 INTERVENTION:BY DECEMBER 2024 THE PERCENTAGE OF PATIENTS RECEIVING SCREENING INCREASED TO 46.9% FROM 33%.GOAL 4.3 PROMOTE EVIDENCE-BASED CARE TO PREVENT AND MANAGE CHRONIC DISEASES INCLUDING ASTHMA, ARTHRITIS, CARDIOVASCULAR DISEASE, DIABETES AND PREDIABETES AND OBESITY.OBJECTIVES:- TO INCREASE THE PERCENTAGE OF PATIENTS, AGE 18-75 YEARS, WITH ADEQUATELY CONTROLLED BLOOD PRESSURE.- TO INCREASE ACCESS TO SPECIALIZED CARDIAC CARE IN THE SERVICE AREA.- TO INCREASE THE PERCENTAGE OF DIABETIC PATIENTS, AGE 18-75 YEARS WHO HAVE AN HBA1C TEST, WITHIN THE PAST YEAR WITH A RESULT <8%- TO INCREASE ACCESS TO SPECIALIZED DIABETES CARE IN THE SERVICE AREA.INTERVENTIONS:- WORK WITH PRIMARY CARE PROVIDERS AND STAFF TO UTILIZE THE TOOLS WITHIN THE NEW EPIC EHR, TO ENSURE BOTH PROVIDERS AND PATIENTS RECEIVE APPROPRIATELY SPACED REMINDERS THROUGH EHR ALERTS, MAIL, PHONE CALLS, EMAIL AND/OR E-CHART NOTIFICATIONS.- MARKETING STAFF WILL SECURE OR CREATE ADDITIONAL EDUCATIONAL MATERIALS REGARDING HYPERTENSION AND ITS RISK SO THE GENERAL PUBLIC CAN GAIN A HIGHER AWARENESS OF THE IMPORTANCE OF ONGOING SCREENING AND THE ROLE DIET PLAYS IN MAINTAINING HEALTHY BLOOD PRESSURE.- RECRUIT A FULL-TIME CARDIOLOGY ADVANCE PRACTICE PROVIDER SO THE RURAL POPULATION WE SERVE HAS THE SAME OPPORTUNITY FOR CARDIAC CARE AS MORE URBAN RESIDENTS.- RECRUIT A FULL-TIME ENDOCRINOLOGY ADVANCE PRACTICE PROVIDER SO THE RURAL POPULATION WE SERVE HAS THE SAME OPPORTUNITY FOR ENDOCRINOLOGY CARE AS MORE URBAN RESIDENTS.FAMILY OF MEASURES:- % OF PATIENTS WHO HAVE ADEQUATELY CONTROLLED BLOOD PRESSURE.- MORE ACCESSIBLE MATERIALS REGARDING HYPERTENSION.- PROVIDER WILL BE RECRUITED.- % OF DIABETIC PATIENTS WHO HAVE HAD AN HGA1C READING OF <8% WITHIN THE PAST YEAR.COMPLETED YEAR 3 INTERVENTION:- THE PERCENTAGE INCREASED TO 74.3% BY DECEMBER 2024. IT NEEDS TO BE NOTED HOWEVER, THAT THE MEASURE CHANGED AT UHS AND THEREFORE AT DVH, TO ONLY MEASURE DIABETIC PATIENTS.- THE CARDIAC NURSE PRACTITIONER BEGAN AT DVH, IN EARLY 2024. THIS MAKES DVH THE ONLY LOCATION IN THE COUNTY WITH FULL-TIME CARDIOLOGY CARE. THIS FREES UP THE CARDIOLOGIST, WHO HAS BEEN COMING TO DVH ON A ONCE OR TWICE A WEEK BASIS FOR YEARS, TO SEE THOSE PATIENTS NEEDING COMPLEX TESTING AND CARE. THIS ALSO ALLOWS DVH TO BRING ECHOCARDIOGRAMS AND STRESS TESTING TO OUR LOCAL AREA, REDUCING THE NEED FOR PATIENTS TO TRAVEL AN HOUR OR MORE FOR SUCH TESTING AND CONSULTATIONS.- THE ENDOCRINOLOGY NURSE PRACTITIONER BEGAN AT DVH, IN EARLY 2024. THIS MAKES DVH THE ONLY LOCATION IN THE COUNTY WITH FULL-TIME DIABETES CARE. THIS REDUCES THE NEED FOR PATIENTS TO TRAVEL AN HOUR OR MORE FOR SUCH CARE. ADDITIONALLY, A FULL-TIME CERTIFIED NURSE DIABETIC EDUCATOR WAS RECRUITED AND BEGAN IN OCTOBER.PRIORITY:PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERSFOCUS AREA 1: PROMOTE WELL-BEINGGOAL 1.1: STRENGTHEN OPPORTUNITIES TO BUILD WELL-BEING AND RESILIENCE ACROSS THE LIFESPAN.OBJECTIVES:- IDENTIFY AND WORK TO ALLEVIATE BARRIERS TO ACCESSING SOCIALIZATION OPPORTUNITIES, TO HELP REDUCE THE ISOLATION AND RESULTING BEHAVIORAL HEALTH ISSUES THAT CAN OCCUR BECAUSE OF IT.INTERVENTIONS:- SURVEY WALTON NY COMMUNITY MEMBERS REGARDING THEIR SOCIALIZATION PRACTICES. COMPLETED IN 2023.- SURVEY WALTON, NY ORGANIZATIONS, BUSINESSES, CHURCHES, SCHOOLS, LIBRARY, LIBRARY, THEATER, CLUBS ETC. REGARDING WHAT THEY OFFER IN TERMS OF ACTIVITIES AND EVENTS THROUGHOUT THE YEAR. COMPLETED IN 2023.- COMPILE RESULTS OF BOTH SURVEYS. COMPLETED IN 2023FAMILY OF MEASURES:- WILL PRESENT THE SURVEY TO AT LEAST 5 GROUPS TO ENCOURAGE PARTICIPATION AS INDIVIDUALS. COMPLETED IN 2023- WILL PRESENT THE SURVEY TO AT LEAST 5 GROUPS TO ENCOURAGE PARTICIPATION OF THEIR GROUP. COMPLETED IN 2023.- REPORT OF THE RESULTS WILL BE PRODUCED. COMPLETED IN 2023.PROJECTED (OR COMPLETED) YEAR 3 INTERVENTION:- A WALKING GROUP STARTED IN WALTON IN 2024. THE LOCAL LIBRARY HOLDS A MYRIAD OF EVENTS FOR ALL AGES, SOME ARE WEEKLY, BI-WEEKLY OR MONTHLY. THEY ALSO SPONSOR SPECIAL EVENTS THROUGHOUT THE YEAR. THEY HAVE A BOOK CLUB THAT MEETS MONTHLY. IN REALITY, AT THIS POINT IN TIME THE LIBRARY IS ADDRESSING MOST OF THE INTERESTS THE RESPONDENTS MENTIONED. THEIR ACTIVITIES AND THOSE OF THE WALKING CLUB ARE PROMINENT ON FACEBOOK. AND IN THE LOCAL NEWSPAPER.- THE FINDINGS DID NOT HIGHLIGHT BARRIERS SUCH AS CHILDCARE OR TRANSPORTATION THAT A GROUP MAY HAVE WORKED ON. HOWEVER, DVH IS PLANNING A MAJOR CONSTRUCTION PROJECT THAT WILL INCLUDE AREAS WHERE LOCAL, COUNTY OR OTHER ORGANIZATIONS CAN HOLD PROGRAMMING, OFFER SERVICES AND WORK WITH DVH STAFF TO BETTER SERVE RESIDENTS THROUGH JOINT NAVIGATION.GOAL 1.2: FACILITATE SUPPORTIVE ENVIRONMENTS THAT PROMOTE RESPECT AND DIGNITY FOR PEOPLE OF ALL AGES.OBJECTIVES:- A STREET-SCAPE PLAN WILL BE DEVELOPED FOR DELAWARE STREET (THE MAIN STREET THROUGH THE VILLAGE OF WALTON) AND INTERVENTIONS PRIORITIZED, AND AN ACTION PLAN DEVELOPED.INTERVENTIONS:- A STREET-SCAPE PLAN THAT WILL ENHANCE THE APPEAL, THE WALKABILITY AND CREATE AGE-FRIENDLY ACCESSIBILITY WILL BE DEVELOPED IN CONJUNCTION WITH DEL CO PLANNING, WALTON CHAMBER AND VILLAGE OF WALTON GOVERNMENT REPRESENTATIVE.FAMILY OF MEASURES:- PLAN IS PRESENTED TO INTERESTED COMMUNITY MEMBERS AND ORGANIZATIONS.PROJECTED (OR COMPLETED) YEAR 3 INTERVENTION- THE WALKING TRAIL WAS COMPLETED. WORK HAS BEGUN TO CREATE KIOSKS SO THAT EVENTS CAN BE REGULARLY POSTED. THE VILLAGE IS REVIEWING OPTIONS TO FURTHER DEVELOP THE MAIN STREET THROUGH TOWN, IN ANTICIPATION OF SUBMITTING A GRANT TO NY STATE'S NY FORWARD PROGRAM. 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. 5 1 - WALTON FAMILY HEALTH CENTER 2 TITUS PLACE WALTON NY 13856 OUTPATIENT PHYSICIAN CLINIC 2 - DOWNSVILLE FAMILY HEALTH CENTER 28315 STATE HWY 206 DOWNSVILLE NY 13755 OUTPATIENT PHYSICIAN CLINIC 3 - ROSCOE FAMILY HEALTH CENTER 1982 OLD ROUTE 17 ROSCOE NY 12776 OUTPATIENT PHYSICIAN CLINIC 4 - PHYSICAL AND OCCUPATIONAL THERAPY 121 STOCKTON AVENUE WALTON NY 13856 REHABILITATION CLINIC 5 - DVH COMMUNITY PHARMACY 121 STOCKTON AVENUE WALTON NY 13856 COMMUNITY PHARMACY 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. ADDITIONALLY, THERE IS NO BAD DEBT EXPENSE IN ANY OF THE COSTS USED IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. PART I, LN 7 COL(F): DELAWARE VALLEY HOSPITAL REPORTED BAD DEBT EXPENSE IN THE AMOUNT OF $1,663,439 IN PART IX, LINE 24B. THE AFOREMENTIONED BAD DEBT EXPENSE WAS SUBTRACTED IN THE CALCULATIONS OF SCHEDULE H, PART I, LINES 7A THRU 7K. PART II, COMMUNITY BUILDING ACTIVITIES: UHS DELAWARE VALLEY HOSPITAL (DVH) ACTIVELY PROMOTES THE HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES THROUGH LEADERSHIP INVOLVEMENT, COLLABORATION WITH COMMUNITY ORGANIZATIONS, AND ONGOING PARTICIPATION IN LOCAL INITIATIVES THAT ADDRESS PUBLIC HEALTH, SAFETY, AND QUALITY OF LIFE.THE PRESIDENT AND CHIEF EXECUTIVE OFFICER IS DEEPLY ENGAGED IN REGIONAL EMERGENCY MEDICAL SERVICES AND HEALTH EDUCATION. HE SERVES AS A MEMBER OF THE HANCOCK FIRE DEPARTMENT/EMERGENCY SERVICES, ADVISES THE DELAWARE COUNTY EMS COORDINATOR, AND HOLDS POSITIONS ON THE BOARDS OF THE CATSKILL HUDSON AREA HEALTH EDUCATION CENTER AND THE SULLIVAN COUNTY DRUG TASK FORCE. IN ADDITION, HE SERVES ON THE NEW YORK STATE RURAL AMBULANCE SERVICE TASK FORCE AND THE SUNY DELHI EXTERNAL ADVISORY COUNCIL.THE DIRECTOR OF SUPPORT SERVICES SERVES ON THE BOARD OF DIRECTORS OF THE DELAWARE COUNTY CHAMBER OF COMMERCE. THE DIRECTOR OF BUSINESS DEVELOPMENT AND FUNDRAISING IS A MEMBER OF THE DELAWARE COUNTY RURAL HEALTHCARE ALLIANCE, THE WALTON CENTRAL SCHOOL COMMUNITY COMMITTEE, UNITED WAY OF MID RURAL NEW YORK, THE HANCOCK AREA CHAMBER OF COMMERCE, THE WALTON CHAMBER OF COMMERCE, AND THE DELAWARE COUNTY BUSINESS ALLIANCE. SHE ALSO SERVES ON THE PLANNING COMMITTEE FOR WALTON'S STRIKE OUT HUNGER EVENT AND PARTICIPATES IN THE DELAWARE COUNTY SCN AND BEHAVIORAL HEALTH COLLABORATION MEETINGS. BOTH THE CEO AND DIRECTOR OF BUSINESS DEVELOPMENT ARE ACTIVE PARTICIPANTS IN THE ANNUAL ST. JUDE CHILDREN'S RESEARCH HOSPITAL THUNDER 102 RADIOTHON, HELPING RAISE FUNDS FOR PEDIATRIC CANCER RESEARCH.DVH SUPPORTS NUMEROUS COMMUNITY PROGRAMS THAT ENHANCE QUALITY OF LIFE AND PROMOTE HEALTH, INCLUDING SPONSORSHIP OF MUSIC ON THE DELAWARE, TWO LOCAL TOY DRIVES, A 5K WALK, AND SIX AREA FIRE DEPARTMENTS AND EMS SQUADS. EACH MAY, THE HOSPITAL HOLDS A WEEKLONG RECOGNITION EVENT FOR EMERGENCY PERSONNEL AND POLICE OFFICERS. THE COMMUNITY RELATIONS DEPARTMENT ALSO HOSTS HEALTH-EDUCATION BOOTHS AT COMMUNITY EVENTS SUCH AS THE DELHI TELEPHONE COMPANY OPEN HOUSE, HANCOCK COMMUNITY EDUCATION FOUNDATION CUSTOMER APPRECIATION DAY, AND THE WALTON FALL FESTIVAL.TO FOSTER COMMUNITY ENGAGEMENT AND FAMILY TOGETHERNESS, DVH PARTICIPATES ANNUALLY IN THE WALTON CHRISTMAS PARADE AND TREE LIGHTING CELEBRATION IN COLLABORATION WITH THE WALTON CHAMBER OF COMMERCE.TO ADDRESS FOOD INSECURITY, THE HOSPITAL'S REGISTERED DIETITIAN PARTNERS WITH THE RURAL HEALTH NETWORK OF SOUTH-CENTRAL NEW YORK TO DISTRIBUTE FRUIT-AND-VEGETABLE VOUCHERS TO LOCAL RESIDENTS. SHE PROVIDES INDIVIDUALIZED NUTRITION COUNSELING TO HELP PARTICIPANTS INCORPORATE MORE HEALTHY FOODS INTO THEIR DIETS. DVH ALSO SPONSORED TWO COMMUNITY DINNERS HELD ON THANKSGIVING AND CHRISTMAS DAY.DVH PROVIDES WEEKLY SPACE FOR REPRESENTATIVES FROM FIDELIS CARE, THE REGION'S LARGEST MEDICAID INSURER, TO MEET WITH AND ENROLL RESIDENTS IN NEED OF HEALTH-CARE COVERAGE.TO PROMOTE CHILD SAFETY AND HEALTH AWARENESS, DVH HOSTS AN ANNUAL TEDDY BEAR CLINIC FOR SECOND-GRADE STUDENTS FROM FIVE AREA SCHOOLS. THE PROGRAM TEACHES CHILDREN ABOUT EMERGENCY CARE AND HOSPITAL SERVICES IN A FRIENDLY, HANDS-ON SETTING. STUDENTS TOUR THE EMERGENCY DEPARTMENT AND RADIOLOGY, EXPLORE AN AMBULANCE AND MEDICAL HELICOPTER, AND MEET LOCAL K-9 OFFICERS TO LEARN ABOUT THEIR ROLE IN COMMUNITY SAFETY.THROUGH THESE DIVERSE INITIATIVES, DELAWARE VALLEY HOSPITAL CONTINUES TO STRENGTHEN COMMUNITY CONNECTIONS, PROMOTE HEALTH EDUCATION, AND IMPROVE ACCESS TO ESSENTIAL SERVICES THROUGHOUT ITS RURAL SERVICE AREA. 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 2024 ACTUAL BAD DEBT WRITE-OFFS RELATED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE TO THE TOTAL 2024 ACTUAL BAD DEBT WRITE-OFFS. THIS CALCULATION DID NOT INCLUDE ESTIMATES OR ACCRUALS. IN 2024, THE WRITE-OFFS RELATED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WAS APPROXIMATELY 41% 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 6 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 RATIO METHODOLOGY UTILIZING AMOUNTS FROM THE 2024 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.UHS HOSPITALS REFRAINS FROM SENDING AN ACCOUNT TO COLLECTION AGENCIES IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION AND THE REQUIRED DOCUMENTATION ARE PROVIDED. UHS HOSPITALS 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 240 DAYS FROM THE DATE OF THE FIRST DISCHARGE BILLING STATEMENT. UHS HOSPITALS 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: UHS DELAWARE VALLEY HOSPITAL (DVH) CONTINUES TO COLLABORATE CLOSELY WITH THE DELAWARE COUNTY PUBLIC HEALTH DEPARTMENT, O'CONNOR HOSPITAL, AND MARGARETVILLE MEMORIAL HOSPITAL TO ASSESS COMMUNITY HEALTH NEEDS AND DEVELOP CORRESPONDING COMMUNITY SERVICE PLANS. TOGETHER, THESE ORGANIZATIONS COMPLETE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES KEY HEALTH PRIORITIES FOR THE REGION.DVH'S CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY SERVICE PLAN (2022-2024), ALONG WITH ANNUAL UPDATES, ARE AVAILABLE ON THE UNITED HEALTH SERVICES WEBSITE AT: HTTPS://NYUHS.WIDEN.NET/S/VVDJSZ9ZH9/DELAWARE-COUNTY-CHA-FINAL-2022-2024-LAST-UPDATED-1.25.23 HTTPS://NYUHS.WIDEN.NET/S/C2MMKPDJQF/FINAL-DELAWARE-VALLEY-HOSPITAL-COMMUNITY-SERVICE-PLAN-2022-TO-2024THESE ASSESSMENTS INFORM THE HOSPITAL'S ONGOING INITIATIVES TO ADDRESS ISSUES SUCH AS CHRONIC DISEASE MANAGEMENT, ACCESS TO CARE, MENTAL HEALTH, SUBSTANCE-USE PREVENTION, AND FOOD INSECURITY ENSURING THAT RESOURCES ARE DIRECTED TOWARD THE MOST PRESSING COMMUNITY HEALTH NEEDS. 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: THE LOCAL HEALTHCARE ENVIRONMENT IN DELAWARE COUNTY IS GREATLY INFLUENCED BY SPECIFIC ASPECTS OF THE PHYSICAL, LEGAL, SOCIAL, AND ECONOMIC ENVIRONMENT WITHIN THE COUNTY. IT IS LOCATED ON THE EASTERN BORDER OF UPSTATE NEW YORK'S SOUTHERN TIER REGION COVERING 1,467 SQUARE MILES, OF WHICH 1,442 MILES ARE LAND AND 25 MILES ARE WATER.THE COUNTY IS CHARACTERIZED BY A MOUNTAINOUS TERRAIN WITH WINDING, TWISTING TWO LANE ROADS, MAKING TRAVEL DIFFICULT AND EVEN HAZARDOUS DURING THE WINTER MONTHS. THE COUNTY HAS NO PUBLIC TRANSPORTATION SYSTEM, MAKING ACCESS TO CARE CHALLENGING. ALTHOUGH A FEW PRIVATE TRANSPORT SERVICES HAD BECOME AVAILABLE IN THE AREA, THE COST CAN BE PROHIBITIVE AND ONE HAS MADE THE DECISION TO ONLY DO SCHOOL TRANSPORTS DUE TO THE CHALLENGES CAUSED BY LIMITED REIMBURSEMENT FROM VARIOUS INSURANCE PROGRAMS. GEOGRAPHICALLY, DELAWARE COUNTY IS THE FOURTH LARGEST OF NEW YORK'S 62 COUNTIES AND IS THE FIFTH MOST RURAL. THE POPULATION DENSITY IS ONLY 30.6 PERSONS PER SQUARE MILE. THE LARGE SIZE OF THE COUNTY IS REFLECTED IN THE FACT THAT IT BORDERS SEVEN COUNTIES (BROOME, CHENANGO, GREENE, OTSEGO, SCHOHARIE, SULLIVAN, AND ULSTER) AS WELL AS THE STATE OF PENNSYLVANIA. ITS SIZE IS COMPARABLE TO THAT OF THE STATE OF RHODE ISLAND. UHS DELAWARE VALLEY HOSPITAL SERVES THE RESIDENTS OF WESTERN DELAWARE COUNTY AND NORTHWESTERN SULLIVAN COUNTY. IT ENCOMPASSES APPROXIMATELY A 30 MILE RADIUS WITH APPROXIMATELY 33,000 RESIDENTS. TO DETERMINE THE PRIMARY AND SECONDARY SERVICE AREA IN 2022, UNIQUE PATIENTS UTILIZING ALL DEPARTMENTS WERE COUNTED AS OPPOSED TO THOSE JUST UTILIZING PRIMARY CARE. THIS PROVIDES A MORE ACCURATE PICTURE OF THE COMMUNITIES SERVED. THE PRIMARY AND SECONDARY SERVICE AREAS REPRESENT THE AREAS WHERE 86% OF DELAWARE VALLEY'S PATIENTS RESIDE. THE PRIMARY SERVICE AREA ENCOMPASSES THOSE COMMUNITIES THAT HAD MORE THAN 200 INDIVIDUALS UTILIZING DVH. THIS INCLUDES THE FOLLOWING LOCATIONS: WALTON, DOWNSVILLE, HANCOCK, ROSCOE, SIDNEY CENTER, DELHI, EAST BRANCH AND HAMDEN. THE SECONDARY SERVICE AREA INCLUDES COMMUNITIES WHERE 100 OR MORE RESIDENTS UTILIZED DVH. THESE COMMUNITIES INCLUDE UNADILLA, FRANKLIN, SIDNEY, DEPOSIT, ONEONTA, DELANCEY AND BAINBRIDGE. UNADILLA MOVED TO THE SECONDARY SERVICE AREA AND TROUT CREEK, LEW BEACH, ANDES, AND FISHES EDDY ALL CAME OFF THE LIST AS THEY ALL HAD LESS THAN 100 RESIDENTS UTILIZING DVH. DELAWARE VALLEY HOSPITAL'S SERVICE AREA IS CENTERED IN DELAWARE COUNTY. USING PERCENTAGES, BASED ON THE NUMBERS OF UNIQUE PATIENTS UTILIZING OUR PRIMARY CARE SITES IN 2022, (AS THAT IS WHERE THE HIGHEST UTILIZATION OCCURS) THE PRIMARY SERVICE AREA ENCOMPASSES WALTON, DOWNSVILLE, ROSCOE, SIDNEY CENTER, DELHI, HAMDEN, EAST BRANCH, HANCOCK AND UNADILLA. THE PRIMARY SERVICE AREA REFLECTS WHERE 80% OF OUR PATIENTS RESIDE. THE SECONDARY SERVICE AREA CONSISTS OF THE COMMUNITIES WHERE THE NEXT 10.4% OF OUR PATIENTS RESIDE. THOSE COMMUNITIES INCLUDE: SIDNEY, DELANCEY, FRANKLIN, DEPOSIT, TROUT CREEK, LEW BEACH, ANDES, FISHS EDDY, BAINBRIDGE AND ONEONTA. DELAWARE COUNTY IS LOCATED ON THE WESTERN EDGE OF THE CATSKILL MOUNTAINS IN RURAL, UPSTATE NEW YORK. ENCOMPASSING 1446.37 SQUARE MILES, THE COUNTY'S 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 FOURTH MOST RURAL COUNTY IN THE STATE WITH JUST 29.78 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.ACCORDING TO THE 2022 AMERICAN COMMUNITY SURVEY 5 YEAR ESTIMATES DATA PROFILES, THE POPULATION OF DELAWARE COUNTY NY IS 44,637. OF THOSE, 3.7% ARE UNDER THE AGE OF 5, WHILE 25.2% ARE AGE 65 AND OVER. THE MEDIAN AGE IS 48.9 VERSUS THAT OF NY STATE AT 38.5. 92.4% OF THE POPULATION IS CAUCASIAN, SO THERE IS LITTLE ETHNIC DISPARITY. THE MEDIAN HOUSEHOLD INCOME IS $58,338, WHICH IS $16,811 LESS THAN THAT OF NYS AND APPROXIMATELY 14.8% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL, WHICH IS AN INCREASE OF 2% OVER 2020. ACCORDING TO THE SAME SOURCE, THE PERCENTAGE OF RELATED CHILDREN UNDER THE AGE OF 18 LIVING BELOW THE POVERTY LEVEL 23.3% WHILE FOR CHILDREN UNDER THE AGE OF 5, THE RATE IS 6.7% IN DELAWARE COUNTY. PART VI, LINE 5: HEALTH PROFESSIONAL EDUCATIONRECRUITING AND RETAINING HEALTHCARE PROFESSIONALS REMAINS A CONTINUAL CHALLENGE IN DVH'S RURAL SERVICE AREA. TO HELP ADDRESS THIS NEED, DELAWARE VALLEY HOSPITAL AND ITS AFFILIATED PRIMARY CARE CENTERS MAINTAIN DESIGNATION AS APPROVED SITES UNDER THE NATIONAL HEALTH SERVICE CORPS, ENABLING PROFESSIONALS TO RECEIVE FINANCIAL ASSISTANCE IN EXCHANGE FOR SERVICE IN UNDERSERVED AREAS.DVH PARTNERS WITH SUNY DELHI TO PROVIDE CLINICAL TRAINING FOR NURSING STUDENTS. HOSPITAL NURSING LEADERS ENGAGE WITH STUDENTS PURSUING BACHELOR'S DEGREES, OFFERING MENTORSHIP AND DISCUSSIONS ON LEADERSHIP, PATIENT CARE, AND NURSING ADMINISTRATION.IN 2024, THE HOSPITAL CONTINUED ITS STUDENT SHADOWING AND VOLUNTEER PROGRAM, ALLOWING PARTICIPANTS TO OBSERVE HEALTHCARE OPERATIONS AND GAIN FIRSTHAND EXPERIENCE IN CLINICAL SETTINGS.DVH ALSO HOSTED ITS ANNUAL MASH CAMP, PROVIDING TWENTY ELEVENTH- AND TWELFTH-GRADE STUDENTS FROM FIVE AREA SCHOOLS WITH HANDS-ON LEARNING EXPERIENCES IN VARIOUS CLINICAL DEPARTMENTS, INCLUDING THE INPATIENT MEDICAL UNIT, EMERGENCY DEPARTMENT, IMAGING, LABORATORY, RESPIRATORY AND PHYSICAL THERAPY, AMBULATORY SERVICES, AND PHARMACY. STUDENTS RECEIVED A BACKPACK WITH CAREER INFORMATION, EDUCATIONAL MATERIALS, AND LUNCH AS PART OF THE FULL-DAY PROGRAM.DVH REPRESENTATIVES ALSO PARTICIPATED IN CAREER DAYS AT WALTON CENTRAL, DOWNSVILLE CENTRAL, AND HANCOCK CENTRAL SCHOOLS, PROVIDING INFORMATION ABOUT HEALTHCARE PROFESSIONS AND PATHWAYS TO LOCAL EMPLOYMENT OPPORTUNITIES.COMMUNITY HEALTH IMPROVEMENT INITIATIVES DELAWARE COUNTY FAIR: DVH STAFFED A BOOTH PROVIDING BLOOD PRESSURE SCREENINGS AND DISTRIBUTING EDUCATIONAL MATERIALS ON HEALTHY LIVING. NUTRITION EDUCATION: THE HOSPITAL'S REGISTERED DIETITIAN PARTNERED WITH THE RURAL HEALTH NETWORK OF SOUTH-CENTRAL NEW YORK, COUNSELING LOCAL RESIDENTS ON HEALTHY EATING AND DISTRIBUTING FRUIT AND VEGETABLE VOUCHERS TO IMPROVE FOOD ACCESS. SHARPS DISPOSAL PROGRAM: DVH CONTINUED TO PROVIDE FREE SHARPS CONTAINERS AND SAFE DISPOSAL FOR RESIDENTS MANAGING CHRONIC CONDITIONS REQUIRING INJECTABLE MEDICATIONS. PATIENT EXPERIENCE ENHANCEMENTS: TO FOSTER COMFORT AND COMPLIANCE, DVH PROVIDES SMALL GESTURES OF KINDNESS SUCH AS STUFFED ANIMALS FOR CHILDREN IN THE LAB OR ER, COMPLIMENTARY GUEST MEALS FOR VISITORS DINING WITH PATIENTS, HOLIDAY-THEMED TRAY DECORATIONS, AND BIRTHDAY TREATS FOR INPATIENTS. TEDDY BEAR CLINIC: APPROXIMATELY 150 SECOND-GRADE STUDENTS FROM FIVE LOCAL SCHOOLS ATTENDED DVH'S ANNUAL EVENT TO REDUCE ANXIETY ABOUT HEALTHCARE EXPERIENCES. CHILDREN TOURED THE ER, IMAGING, AMBULANCE, AND HELICOPTER, INTERACTED WITH LOCAL EMERGENCY PERSONNEL, AND LEARNED ABOUT SAFETY AND EMERGENCY PREPAREDNESS. STRIKE OUT HUNGER: DVH SPONSORED THIS COMMUNITY FUNDRAISER BENEFITING THE LOCAL FOOD BANK, BACKPACK PROGRAM, AND COMMUNITY SUPPER INITIATIVES. VETERANS' APPRECIATION DAY: STAFF DISTRIBUTED PATRIOTIC KNAPSACKS AND WEEKLY PILL ORGANIZERS WHILE HONORING LOCAL VETERANS. PHYSICAL AND OCCUPATIONAL THERAPY EDUCATION: THERAPY STAFF CONDUCTED INTERACTIVE SESSIONS WITH ELEMENTARY STUDENTS, TEACHING THEM ABOUT BONES, MUSCLES, AND STRETCHING THROUGH DEMONSTRATIONS. COMMUNITY EVENTS AND SPONSORSHIPS: DVH SUPPORTED SPEND THE DAY IN WALTON, DOWNSVILLE 5K, CUSTOMER APPRECIATION DAY IN HANCOCK, AND MADE DONATIONS TO LOCAL FIRE DEPARTMENTS, EMERGENCY SQUADS, AND CIVIC EVENTS. OFFICE FOR THE AGING PICNIC: STAFF DISTRIBUTED COMMUNITY RESOURCE DIRECTORIES AND HEALTH EDUCATION MATERIALS. FREE SHREDDING DAY: DVH HOSTED AN EVENT TO HELP RESIDENTS PROTECT THEIR PERSONAL INFORMATION AND REDUCE RISK OF IDENTITY THEFT. DELAWARE OPPORTUNITIES' FAMILY FUN FESTIVAL: DVH STAFF PROVIDED HEALTH EDUCATION, DISTRIBUTED FIRST AID KITS, AND ENGAGED WITH FAMILIES ABOUT HEALTHY LIFESTYLES.COMMUNITY BENEFIT OPERATIONS THE PRESIDENT/CEO SERVES ON THE CATSKILL HUDSON AREA HEALTH EDUCATION CENTER, SULLIVAN COUNTY DRUG TASK FORCE, SUNY DELHI NURSING PROGRAM ADVISORY COUNCIL, HANCOCK FIRE DEPARTMENT, AND DELAWARE COUNTY EMS, AS WELL AS THE NEW YORK STATE RURAL AMBULANCE SERVICE TASK FORCE, WHICH FOCUSES ON IMPROVING EMERGENCY RESPONSE IN RURAL AREAS. THE DIRECTOR OF BUSINESS DEVELOPMENT AND FUNDRAISING SERVES AS A MEMBER OF THE WALTON AND HANCOCK AREA CHAMBERS OF COMMERCE, THE DELAWARE COUNTY BUSINESS ALLIANCE, THE HANCOCK ROTARY CLUB, AND THE UNITED WAY OF MID RURAL NEW YORK. THE DIRECTOR OF SUPPORT SERVICES SERVES ON THE BOARD OF DIRECTORS OF THE DELAWARE COUNTY BUSINESS ALLIANCE. DVH ALSO SPONSORS A LOCAL CHURCH WELLNESS PROGRAM THAT PROMOTES CHAIR YOGA AND HEALTHY EATING FOR OLDER ADULTS. PART VI, LINE 6: DELAWARE VALLEY HOSPITAL, INC. IS AN IMPORTANT MEMBER OF A LARGER SYSTEM OF INTEGRATED DELIVERY OF CARE, WHICH PROVIDES ADDITIONAL BENEFITS TO THE COMMUNITY. AS A RESULT OF THE FORMATION OF UNITED HEALTH SERVICES 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 RELATE TO THE HOSPITAL'S SERVICES AND THE NEEDS OF OUR 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 AND MARGARETVILLE HOSPITAL, ALL IN ONE DOCUMENT. PART VI, LINE 7, REPORTS FILED WITH STATES NY PART VI, LINE 5 CONTINUED: THE CEO AND DIRECTOR OF BUSINESS DEVELOPMENT COLLABORATED WITH BOLD GOLD MEDIA, THE HANCOCK HERALD, AND THE DELAWARE COUNTY BUSINESS ALLIANCE ON THE THUNDER 102 ST. JUDE CHILDREN'S RESEARCH HOSPITAL RADIOTHON, PARTICIPATING IN RADIO INTERVIEWS, FUNDRAISING EVENTS, AND COMMUNITY OUTREACH ACTIVITIES. DVH CONTINUES TO SUPPORT THE OPERATION OF AN ADVANCED LIFE SUPPORT (ALS) AMBULANCE, SERVING A 2530 MILE RADIUS, TO ENSURE RAPID EMERGENCY RESPONSE AND PATIENT TRANSFERS TO HIGHER LEVELS OF CARE.SUMMARYTHROUGH ITS PARTNERSHIPS, OUTREACH, EDUCATION, AND SERVICE INITIATIVES, UHS DELAWARE VALLEY HOSPITAL FULFILLS ITS MISSION TO IMPROVE ACCESS, PROMOTE HEALTH EDUCATION, AND STRENGTHEN THE OVERALL WELLNESS AND SAFETY OF THE RURAL COMMUNITIES IT SERVES. X X X X 0 0 0 0 0 0 0 0 0 JOHN CARRIGG BOARD MEMBER/VICE CHAIR 0 1261668 0 118000 0 7144 0 10350 0 40379 0 1437541 0 0 DR JEFFREY GRAY FORMER CHIEF MED OFFICER TO 12/31/24 0 682039 0 71850 0 0 0 10350 0 47971 0 812210 0 0 KIRILL DAVIDOV CHIEF MEDICAL OFFICER 0 491679 0 5200 0 0 0 10350 0 31797 0 539026 0 0 ROLLAND BOJO BOARD MEMBER/PRESIDENT/CEO 252974 0 52566 0 0 0 15813 0 38725 0 360078 0 0 0 DR MICHAEL FREEMAN BOARD MEMBER/MEDICAL STAFF PRESIDENT 0 273191 0 6300 0 0 0 8624 0 32000 0 320115 0 0 MEGAN HEAPHY DIRECTOR AMBULATORY, ED, WALK-IN, IM 135914 0 11854 0 0 0 7791 0 37523 0 193082 0 0 0 LAURA NORTHRUP VP PATIENT CARE SERVICES/CNO 151875 0 12923 0 0 0 2400 0 25444 0 192642 0 0 0 LUCINDA RIDER VICE PRESIDENT/CFO 164703 0 15470 0 0 0 8998 0 878 0 190049 0 0 0 KATHLEEN ULMSCHNEIDER STAFF NURSE 144472 0 1700 0 0 0 7715 0 27504 0 181391 0 0 0 TITO ENDAYA LAB MANAGER 150969 0 350 0 0 0 0 0 18730 0 170049 0 0 0 MARGARET EBELING STAFF NURSE 147652 0 50 0 0 0 7477 0 13409 0 168588 0 0 0 CYNTHIA GARDEPE DIRECTOR HUMAN SERVICES 131227 0 14475 0 0 0 6230 0 13866 0 165798 0 0 0 VICTORIA CONKLING FORMER CNO TO 05/24/24 90210 0 16765 0 0 0 5361 0 5969 0 118305 0 0 0 FORM 990, PART VII, SECTION A, LINE 5: INDIVIDUAL: MICHAEL FREEMAN UNRELATED ORGANIZATION: UNITED MEDICAL ASSOCIATES, INC. TYPE AND AMOUNT OF COMPENSATION: $320,115 INDIVIDUAL: JEFFREY GRAY UNRELATED ORGANIZATION: UNITED MEDICAL ASSOCIATES, INC. TYPE AND AMOUNT OF COMPENSATION: $812,210 LAURIE GROSS SISTER-IN-LAW OF ROLLAND BOJO, PRESIDENT/CEO 94504 EMPLOYEE WAGES 0 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 UHS, INC., THE ORGANIZATION'S SOLE CORPORATE MEMBER, APPOINTS THE VOTING BOARD MEMBERS. 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 10,551,376. MANAGEMENT AND GENERAL EXPENSES 1,011,420. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,562,796. 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 DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANTS. UNITED HEALTH SERVICES HOSPITALS INC 10-42 MITCHELL AVENUE BINGHAMTON NY 13903 161165049 HOSPITAL NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 PROFESSIONAL HOME CARE 601 RIVERSIDE DRIVE JOHNSON CITY NY 13790 161261977 HOME HEALTH CARE NY 501(C)(3) 10 UNITED HEALTH SERVICES INC 0 IDEAL SENIOR LIVING CENTER 508 HIGH AVENUE ENDICOTT NY 13760 222902896 SENIOR LIVING CENTER NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 IDEAL SENIOR LIVING CENTER HOUSING 508 HIGH AVENUE ENDICOTT NY 13760 222902899 SENIOR HOUSING NY 501(C)(3) 10 UNITED HEALTH SERVICES INC 0 CHENANGO MEMORIAL HOSPITAL 179 NORTH BROAD STREET NORWICH NY 13815 150532180 HOSPITAL NY 501(C)(3) 3 UNITED HEALTH SERVICES INC 0 UNITED HEALTH SERVICES INC 20-40 MITCHELL AVENUE BINGHAMTON NY 13903 222682421 PARENT COMPANY NY 501(C)(3) 10 BOARD OF DIRECTORS UHS INC 0 TWIN TIER HOME HEALTH INC 601 RIVERSIDE DRIVE JOHNSON CITY NY 13790 222438211 HOME HEALTH CARE NY 501(C)(3) 10 UNITED HEALTH SERVICES INC 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0