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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 5 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - GRAND VIEW HOSPITAL (GVH) - MAIN CAMPUS. The following were done: 19 Community Meetings that were organized by PACDC and facilitated by the Qualitative Team, made up of experts from Children's Hospital of Philadelphia (CHOP), Jefferson Health, Penn Medicine, Holy Redeemer Health System, Grand View Health, and Chester County Hospital. Analysis of findings from these meetings was done by experts from CHOP, Jefferson Health, and Penn Medicine. 9 Key Stakeholder Focus Groups about steering committee-selected populations of special interest, including African American and Hispanic/Latino communities; individuals experiencing homelessness; Individuals experiencing housing security; prenatal and postpartum women; and individuals with behavioral/mental health conditions. 12 Key Informant Interviews with leadership and staff at Federally Qualified Health Centers (FQHCs), conducted by Health Federation of Philadelphia. Additional Key Informant Interviews with hospital patient advisory groups, employees, and other stakeholders conducted by hospitals and health systems. All data were synthesized by PDPH staff and a list of 16 community health priorities was presented to the Steering Committee. Using a modified Hanlon ranking method, each participating hospital and health system rated the priorities. An average rating was calculated, and the community health priorities were organized in priority order based on: * Size of health problem * Importance to community * Capacity of hospitals/health systems to address * Alignment with mission and strategic direction * Availability of existing collaborative efforts Potential solutions for each of the community health priorities, based on findings from the community meetings, stakeholder focus groups, and key informant interviews, were also included.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6a Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Grand View Hospital. The FY2022, CHNA was conducted in partnership with the following health facilities: Hospitals Children's Hospital of Philadelphia * Children's Hospital of Philadelphia * Middleman Family Pavilion at CHOP, King of Prussia Doylestown Health: Doylestown Hospital Grand View Health: Grand View Hospital Jefferson Health * Einstein Medical Center Elkins Park * Einstein Medical Center Montgomery * Einstein Medical Center Philadelphia * Jefferson Abington Hospital * Jefferson Bucks Hospital * Jefferson Frankford Hospital * Jefferson Hospital for Neuroscience * Jefferson Lansdale Hospital * Jefferson Methodist Hospital * Jefferson Torresdale Hospital * Magee Rehabilitation Hospital * MossRehab * Rothman Orthopedic Specialty Hospital * Thomas Jefferson University Hospital Main Line Health * Bryn Mawr Hospital * Bryn Mawr Rehabilitation Hospital * Lankenau Medical Center * Paoli Hospital * Riddle Hospital Penn Medicine * Chester County Hospital * Hospital of the University of Pennsylvania * Hospital of the University of Pennsylvania - Cedar Avenue * Penn Presbyterian Medical Center * Pennsylvania Hospital Redeemer Health: Holy Redeemer Hospital Temple University Health System * Fox Chase Cancer Center * Temple University Hospital * Temple University Hospital - Episcopal Campus * Temple University Hospital - Jeanes Campus * Temple University Hospital - Northeastern Campus Trinity Health Mid-Atlantic * Mercy Catholic Medical Center, Mercy Fitzgerald Hospital Campus * Nazareth Hospital * St. Mary Medical Center and St. Mary Rehabilitation Hospital</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6b Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Grand View Hospital. The Hospital's FY2022 CHNA was conducted with Philadelphia Department of Public Health, Health Care Improvement Foundation, Philadelphia Association of Community Development Corporation, Chester County Health Department, and Montgomery County Office of Public Health.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - GRAND VIEW HOSPITAL. GVH identified and developed an implementation plan for these FOUR priorities during the hospital's FY2019 COMMUNITY HEALTH NEEDS ASSESSMENT - Behavioral Health Diagnosis and Treatment - Substance opioid use and abuse - Chronic disease prevention (cardiovascular, lung, diabetes/obesity, cancer) - Healthcare and health resource navigation The action plans implemented for these community health priorities are as follows: Behavioral Health Diagnosis and Treatment Behavioral health services were cited by the CHNA as a region-wide, top-priority need. Priority issues for Grand View Health include: - Limited number of behavioral health providers in the area - Long wait times for appointments - Inadequate inpatient resources to provide for psychiatric emergencies - Difficulty finding pediatric/adolescent behavioral health providers Objective: Increase access to behavioral health services through continued development and growth of community partnerships across the healthcare continuum. Action Plan: Expansion of improved transitions (warm handoffs) between care managers and behavioral health providers by creating an indexed resource of all social and other services available. This resource will be available to providers, care givers and transitions coaches across the organization via the hospital website to optimize referral opportunities. Substance opioid use and abuse There are limited substance use disorder providers, and inpatient detox facilities do not always provide ample support after discharge. Patients with substance abuse disorder are being admitted from the ED to inpatient and maternity. Grand View Health hospitalists are able to treat for withdrawal but have limited providers to refer to after discharge. Objective: Increase access to substance abuse disorder services for recovery and ongoing treatment. Action Plan: Reduce prescriptions and utilization of opioids through the work of the opioid stewardship committee. Increase warm handoff projects with post-acute and primary practices. Chronic disease prevention Chronic diseases include cardiovascular disease, diabetes, COPD (pulmonary), obesity, and cancer. The CHNA found that overall rates of cardiovascular disease continue to rise. Obesity rates in the Grand View Health community are 26.9% which is down from 30.6% in the 2016 CHNA, but higher than the Bucks County average of 25.1%. Objective: Increase awareness of the prevention of chronic diseases through healthy lifestyle choices with a combination of education and community outreach. Action Plan: Continue expansion and marketing of wellness programs through education of providers, care givers, and coaches; centralize health and social services resources information on hospital website. Explore technology applications for health education and support. Healthcare and health resource navigation Navigating healthcare services and other health resources, such as enrollment in public benefits and programs, remains a challenge because of a general lack of awareness of what services exist and the fragmented systems. Financial costs and logistics associated with transportation can be a barrier to accessing healthcare and health resources. Grand View Health addresses access and navigation with care coordinators in acute care, Emergency Department (ED), primary care practices, and the Grand View Healthcare Partnership. Objective: Increase access to healthcare navigators and patient advocates. Action Plan: Develop community health resource directories to provide more information about services available to providers, caregivers. and coaches for patient referrals. GVH's approach to community health needs is to focus its response to needs that are both documented in the assessment and that intersect with GVH's strengths, vision, and mission. In prioritizing the unmet needs, GVH's multidisciplinary physician group and executive leaders also considered: 1) whether GVH has the capability to address the need; 2) whether the healthcare need will align with GVH's mission; and 3) whether existing programs in the community address the need. The following identified community health priorities were not specifically addressed in GVH's implementation plan because of at least one of the three criteria described above. - Access to affordable primary and preventative care - Access to affordable specialty care - Food access and affordability - affordable and healthy housing - sexual and reproductive health - linguistically and culturally appropriate healthcare - maternal morbidity and mortality - socioeconomic disadvantage - community violence - racism and discrimination in healthcare settings - neighborhood conditions - homelessness</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>21</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - Sellersville Outpatient Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>915 Lawn Avenue</AddressLine1Txt>
            <CityNm>Sellserville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>Diagnostic OP Center, Wound Care Center, Surgeons, Orthopedics, PT/OT, Pulmonary Rehab</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HARLEYSVILLE OUTPATIENT CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>270 MAIN STREET</AddressLine1Txt>
            <CityNm>HARLEYSVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19438</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC OP CENTER, Orthopedics, OB/GYN, Cardiologist, PT/OT, Workplace Health</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HOME CARE BUILDING</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>LAWN AND EYRE AVENUES</AddressLine1Txt>
            <CityNm>Sellersville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>HOME HEALTH CENTER, Palliative Care</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH- ALDERFER TRAVIS CARDIOLOGY</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>670 LAWN AVE SUITE 3A</AddressLine1Txt>
            <CityNm>SELLERSVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>CARDIOLOGIST, CARDIAC IMAGING</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - SILK MILL OFFICE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18 SOUTH 5TH STREET</AddressLine1Txt>
            <CityNm>QUAKERTOWN</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18951</ZIPCd>
          </USAddress>
          <FacilityTxt>HOSPICE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HEALTH CENTER AT QUAKERTOWN</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>99 NORTH WEST END BLVD</AddressLine1Txt>
            <CityNm>QUAKERTOWN</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18951</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC OP CENTER, Cardiologist, OB/GYN, Orthopedics, Primary Care</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - GRAND VIEW MEDICAL CO</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1561 BETHLEHEM PIKE</AddressLine1Txt>
            <CityNm>HATFIELD</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19440</ZIPCd>
          </USAddress>
          <FacilityTxt>DME PATIENT SERVICES</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - CTR FOR ORTHOPAEDIC &amp; NEUROSURGERY</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>103 BETHLEHEM PIKE</AddressLine1Txt>
            <CityNm>COLMAR</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18915</ZIPCd>
          </USAddress>
          <FacilityTxt>Orthopaedics, NEUROSURGERY, PT/OT, Sports Medicine, Imaging</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - PRIMARY CARE SOUDERTON</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>3456 BETHLEHEM PIKE</AddressLine1Txt>
            <CityNm>SOUDERTON</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18964</ZIPCd>
          </USAddress>
          <FacilityTxt>PRIMARY CARE, PEDIATRIC MEDICAL CARE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - PRIMARY CARE LEDERACH</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>658 HARLEYSVILLE PIKE Suite 120</AddressLine1Txt>
            <CityNm>HARLEYSVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19438</ZIPCd>
          </USAddress>
          <FacilityTxt>PRIMARY CARE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HEALTH CENTER AT CHALFRONT</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>700 HORIZON CIRCLE</AddressLine1Txt>
            <CityNm>CHALFRONT</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18914</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC OP CENTER, OB/GYN, PRIMARY CARE, WEIGHT MANAGEMENT, CANCER SPECIALISTS</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HARLEYSVILLE PRIMARY CARE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>176 MAIN STREET</AddressLine1Txt>
            <CityNm>HARLEYSVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19438</ZIPCd>
          </USAddress>
          <FacilityTxt>PRIMARY CARE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - LMG MEDICAL BUILDING</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1019 S BROAD STREET SUITE D</AddressLine1Txt>
            <CityNm>LANSDALE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19446</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC IMAGING AND TESTING</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - INFECTIOUS DISEASE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>UB MED ARTS 817 LAWN AVE</AddressLine1Txt>
            <CityNm>Sellersville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>INFECTIOUS DISEASE SPECIALIST</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - THE PAVILLION</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>419 SOUTH BROAD STREET</AddressLine1Txt>
            <CityNm>LANDSDALE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19446</ZIPCd>
          </USAddress>
          <FacilityTxt>ENDOCRINOLOGY, OB/GYN, CARDIOLOGIST, ORTHOPEDICS</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - HATFIELD PRIMARY CARE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>2701 COWPATH ROAD</AddressLine1Txt>
            <CityNm>HATFIELD</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19440</ZIPCd>
          </USAddress>
          <FacilityTxt>Primary Care</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - PENNSBURG OUTPATIENT CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>424 POTTSTOWN AVE</AddressLine1Txt>
            <CityNm>PENNSBURG</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18073</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC OP CENTER, CARDIOLOGIST, OB/GYN</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - CARDIAC IMAGING BCA</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>3 LIFE MARK DRIVE</AddressLine1Txt>
            <CityNm>Sellersville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>CARDIAC IMAGING</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - STONERIDGE SLEEP CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>670 LAWN AVENUE</AddressLine1Txt>
            <CityNm>Sellersville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>SLEEP CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - DUBLIN OUTPATIENT CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>145 N Main Street</AddressLine1Txt>
            <CityNm>Dublin</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18917</ZIPCd>
          </USAddress>
          <FacilityTxt>DIAGNOSTIC IMAGING &amp; TESTING, ORTHOPAEDICS, OB/GYN, CARDIOLOGIST, PRIMARY CARE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>GVH - Pulmonary Allergy &amp; Sleep Medicine</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>817 Lawn Ave Suite 4</AddressLine1Txt>
            <CityNm>Sellersville</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18960</ZIPCd>
          </USAddress>
          <FacilityTxt>Pulmonary, Allergy &amp; Sleep Medicine</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7g Subsidized Health Services</FormAndLineReferenceDesc>
        <ExplanationTxt>SOME OF THE SUBSIDIZED HEALTH SERVICES PROVIDED BY GRAND VIEW HOSPITAL INCLUDE PHYSICIAN CLINIC SERVICES. THESE SERVICES INCLUDE: ALS/PARAMEDICS - AVAILABLE TO THOSE RESIDENTS IN NEED OF MEDICAL TRANSPORT AND IMMEDIATE LIFE-SAVING TREATMENT. THESE PROGRAMS AT GRAND VIEW PROVIDED 8,769 OCCASIONS OF SERVICE DURING FISCAL YEAR 2023. GIVEN RECENT DOWNWARD TRENDS IN THE STAFFING OF VOLUNTEER AMBULANCE SQUADS WHO SIMILARLY SERVICE THE REGION, THE NEED FOR GRAND VIEW'S PRESENCE IN THE AREA IS INTENSIFIED. SUCH A COMMITMENT YIELDED LOSSES OF $1,379,663 TO THE HOSPITAL DURING FISCAL YEAR 2023. HOMECARE &amp; PALLIATIVE CARE - PROVIDING 37,882 VISITS TO HOME BOUND AND SERIOUSLY ILL MEMBERS OF THE COMMUNITY DURING FISCAL YEAR 2023, THE HOMECARE AND PALLIATIVE CARE PROGRAMS AT THE HOSPITAL HAVE SEEN CONTINUED GROWTH IN DEMAND FOR SUCH SERVICES. THESE PROGRAMS, DESIGNED TO MEET THE NEEDS OF THE FRAILEST MEMBERS OF THE COMMUNITY, GENERATED LOSSES OF $1,744,014 DURING FISCAL YEAR 2023.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>GRAND VIEW HOSPITAL USED THE WORKSHEETS PROVIDED IN FORM 990 INSTRUCTIONS TO CALCULATE IN PART 1, LINE 7.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount</FormAndLineReferenceDesc>
        <ExplanationTxt>FOR FINANCIAL STATEMENT PURPOSES, GRAND VIEW HOSPITAL HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS, THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 3 Bad Debt Expense Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>BASED ON HISTORICAL EXPERIENCE AND AN ANALYSIS OF THE BAD DEBT EXPENSE OVERALL, THE ORGANIZATION HAS DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>From the Net Patient Services Revenues footnote in the audited financial statements: Settlements with third-party payors for retroactive adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence with the payor and the Foundation's historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are reconciled in future periods as adjustments become known (that is, new information becomes available), or as years are settled or no longer subject to such audits, reviews and investigations. Revenues received under third-party arrangements are subject to audit and retroactive adjustments. Net patient services revenues include favorable adjustments to prior year estimated third-party settlements of approximately $2,400 and $177 in 2023 and 2022, respectively, related to final settlements and/or adjustments of prior year cost reports and other third-party payor adjustments. Generally, patients who are covered by third-party payors are responsible for related deductibles and coinsurance, which vary in amount. The Foundation also provides services to uninsured patients, and offers those uninsured or underinsured patients a discount, either by policy or law, from standard charges. The Foundation estimates the transaction price for patients with deductibles and coinsurance and from those who are uninsured based on historical experience and current market conditions. The initial estimate of the transaction price is determined by reducing the standard charges by any contractual adjustment, discounts and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenues in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay are recorded as provision for bad debts. Consistent with the Foundation's mission, care is provided to patients regardless of their ability to pay. Therefore, the Foundation has determined it has provided implicit price concessions to uninsured patients and other patient balances (for example, copays and deductibles). The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts the Foundation expects to collect based on its collection history with those patients.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 8 Community benefit &amp; methodology for determining medicare costs</FormAndLineReferenceDesc>
        <ExplanationTxt>GRAND VIEW HOSPITAL BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THE HOSPITAL CONTINUES TO PROVIDE CARE TO MEDICARE PATIENTS DESPITE THE ALMOST $20.3 MILLION LOSS INCURRED DURING THE YEAR ENDED JUNE 30, 2023. THE COST METHODOLOGY UTILIZED IS FROM THE MEDICARE COST REPORT. GRAND VIEW HOSPITAL ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. GRAND VIEW HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>GRAND VIEW HOSPITAL'S CREDIT AND COLLECTION POLICY STATES THAT EVERY EFFORT WILL BE MADE BY THE HOSPITAL TO SEE THAT, AS APPLICABLE, APPLICATIONS FOR COVERAGE BY THE MEDICAL ASSISTANCE PROGRAM OF COMMONWEALTH OF PENNSYLVANIA'S DEPT. OF PUBLIC WELFARE AND FINANCIAL ASSISTANCE WILL BE PROVIDED WHENEVER REQUESTED BY A PATIENT OR AS DEEMED APPROPRIATE BY THE HOSPITAL. ALL COLLECTION ATTEMPTS ARE CEASED WHEN A PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE OR WHEN A PATIENT SUBMITS A FINANCIAL ASSISTANCE APPLICATION DURING THE TIME IN WHICH THE APPLICATION IS PROCESSING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FAP website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Grand View Hospital: Line 16a URL: https://www.gvh.org/financial-assistance-gvh;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FAP Application website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Grand View Hospital: Line 16b URL: https://www.gvh.org/financial-assistance-gvh;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FAP plain language summary website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Grand View Hospital: Line 16c URL: https://www.gvh.org/financial-assistance-gvh;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 2 Needs assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN FISCAL YEAR 2023. THE ORGANIZATION REGULARLY ASSESSES COMMUNITY NEEDS THROUGH ITS ONGOING STRATEGIC PLANNING PROCESS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 3 Patient education of eligibility for assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PATIENT FINANCIAL SERVICES STAFF AT GRAND VIEW HOSPITAL SCREENS REGISTERED INPATIENT AND OUTPATIENT ACCOUNTS WHERE THE TOTAL CHARGES ARE REASONABLY ANTICIPATED TO EXCEED $2,000 IN ORDER TO IDENTIFY PATIENT ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE REVIEW AND SCREENING OCCURS BOTH PROSPECTIVELY, AT THE TIME OF ADMISSION OR PROVISION OF SERVICES, AND ALSO DURING THE COURSE OF PATIENT ACCOUNT BILLING AND INSURANCE FOLLOW-UP. CONSIDERATION OF PATIENT ELIGIBILITY FOR FINANCIAL ASSISTANCE MAY OCCUR UPON THE REQUEST OF THE PATIENT OR GUARANTOR. PUBLIC NOTIFICATION CONCERNING THE EXISTENCE OF GRAND VIEW'S FINANCIAL ASSISTANCE POLICY SHALL BE POSTED ON THE HOSPITAL'S WEB SITE AND WITHIN THE HOSPITAL, AS WELL AS SHALL BE PROVIDED TO PATIENTS AT THE TIME OF THEIR REGISTRATION FOR SERVICES. AN ABBREVIATED STATEMENT OF NOTICE WILL ALSO BE PRINTED ON THE INITIAL SELF-PAY INPATIENT AND OUTPATIENT BILLS. UPON REQUEST, A COPY OF THE PERTINENT POLICY WILL BE MADE AVAILABLE BY THE STAFF OF THE PATIENT FINANCIAL SERVICES DEPARTMENT. REFERRALS OF PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE ALSO INITIATED BY THE PREADMISSION TESTING CENTER, PATIENT ACCOUNTING, CASE MANAGEMENT/SOCIAL WORK AND PATIENT RECOGNITION CENTER.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 4 Community information</FormAndLineReferenceDesc>
        <ExplanationTxt>RACIAL COMPOSITION: THE RACIAL COMPOSITION OF GRAND VIEW HOSPITAL'S SERVICE AREA IS A MAJORITY WHITE POPULATION (84%), NEARLY ONE-IN-TEN ARE ASIAN (7%), OTHER MINOR REPRESENTED GROUPS: BLACK (3%) AND HISPANIC/LATINO (2%). AGE: IN THE ORGANIZATION'S SERVICE AREA, NEARLY ONE QUARTER OF RESIDENTS ARE BETWEEN THE AGES 0-17 (22%), ONE THIRD ARE 18-44 (31%), NEARLY ONE-IN-THREE ARE 45-64 (29%), AND 17% ARE 65 OR OLDER. THE PERCENTAGE OF OLDER ADULTS INCREASED BY 1% FROM 2015. WHEN COMPARED WITH 2015, THE SERVICE AREA SAW A SLIGHT DECREASE IN THE PERCENTAGE OF RESIDENTS AGES 0-17 AND 18-44, AND A SMALL INCREASE IN THE PERCENTAGE OF THOSE AGES 45-64 AND 65 AND OLDER. OVERALL, THE 2018 AGE BREAKDOWN OF THE SERVICE AREA'S RESIDENTS IS EXPECTED TO CONTINUE TRENDING TOWARDS AN AGING POPULATION THROUGH 2020. PERCENTAGES OF RESIDENTS IN EACH AGE CATEGORY IN THE SERVICE AREA ARE LARGELY COMPARABLE TO BUCKS AND MONTGOMERY COUNTIES, AS WELL AS THE STATE OF PENNSYLVANIA AS A WHOLE. THE GRAND VIEW CHNA AREA AGE DISTRIBUTION MIRRORS THE AGE DISTRIBUTION PATTERN SEEN IN BUCKS COUNTY AS A WHOLE. THERE ARE CURRENTLY 3 OTHER HOSPITALS SERVING THE COMMUNITY.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 5 Promotion of community health</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S GOVERNING BODY IS COMPRISED PRIMARILY OF INDIVIDUALS WHO REPRESENT THE COMMUNITY SERVED BY GRAND VIEW HOSPITAL AND IS MADE UP OF PRIMARILY INDEPENDENT MEMBERS. THEY LIVE AND WORK IN THE PRIMARY SERVICE AREA OF THE HOSPITAL. THE HOSPITAL USES SURPLUS FUNDS TO EXPAND HEALTHCARE OPERATIONS AND TO PROVIDE ADDITIONAL NEEDED SERVICES TO THE COMMUNITY. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY SERVED.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 6 Affiliated health care system</FormAndLineReferenceDesc>
        <ExplanationTxt>GRAND VIEW HOSPITAL IS A 194 BED ACUTE-CARE HOSPITAL SERVING THE EASTERN MONTGOMERY COUNTY AND UPPER BUCKS COUNTY AREAS OF PENNSYLVANIA. THE GRAND VIEW HEALTH FOUNDATION WAS ESTABLISHED TO RAISE FUNDS FOR THE PROMOTION OF QUALITY HEALTH CARE SERVICES, TO PROMOTE HEALTHCARE AWARENESS IN THE COMMUNITY, AND TO ELECT MEMBERS TO THE BOARD OF GRAND VIEW HOSPITAL. GRAND VIEW - LEHIGH VALLEY HEALTH SERVICES WAS ESTABLISHED TO PROVIDE HIGH QUALITY CARDIOVASCULAR SERVICES TO MONTGOMERY AND BUCKS COUNTIES IN PENNSYLVANIA. TOGETHER, GRAND VIEW HOSPITAL, THE GRAND VIEW HEALTH FOUNDATION, AND GRAND VIEW - LEHIGH VALLEY HEALTH SERVICES WORK TOGETHER TO IMPROVE HEALTH AND PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO THE PRIMARY SERVICE AREA IN MONTGOMERY AND BUCKS COUNTIES.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS</FormAndLineReferenceDesc>
        <ExplanationTxt>(continued from Part III) Our Board of Trustees, leadership and clinical care team embrace these words and share this philosophy throughout the health system. It is incorporated into our culture through employee training, education and through our new-employee orientation program. Since our humble beginnings in 1913, Grand View Health has evolved, growing in size, services and clinical acumen to better serve our community. More than a hospital, Grand View Health is an independent community health system that continues to compassionately serve generations of Bucks and Montgomery County residents through every stage of life. In April 2023, the Pavilion at Grand View Health opened on the Sellersville campus. The 190,000-square-foot, six-story, $198 million hospital expansion project includes 10 new operating rooms, 52 private patient rooms, and a new emergency department equipped with 32 treatment rooms including two trauma bays to support our Level II Trauma Center. The center was most recently re-accredited for two years in September 2022. The Pavilion represents a significant upgrade to hospital facilities, making it possible to support Grand View Health's high-quality programs with the latest technologies including two da VinciXI robots, two Mako Robotic Arm-Assisted Surgery System platforms for joint replacement surgery, a wide-bore MRI, two CT scanners and two hybrid operating rooms. A rooftop helipad facilitates transfers to and from Grand View hospital. The hospital has 194 licensed beds. Plans are underway to repurpose space in the legacy hospital, called the West Building, to further enhance diagnostic imaging, radiation oncology and acute inpatient rehabilitation among other services. Grand View Health offers a range of outpatient services at seven convenient locations: Chalfont, Dublin, Harleysville, Pennsburg, Sellersville, Lansdale, and Quakertown. Additionally, we offer post-acute care services including Grand View Home Care, Grand View Hospice, Grand View Palliative Care and Grand View Medical Company. We operate urgent care facilities in Kulpsville and Quakertown. Grand View also operates Medic 151, a state-certified, licensed provider of routing and emergency medical transport services. The company provides Basic Life Support (BLS) and Advanced Life Support (ALS) emergency services. With nearly 400 affiliated and independent physicians in 45 specialties on its medical staff, Grand View Health offers expertise in family medicine, women's health, pediatrics, infectious disease, cardiology, orthopedics, gastroenterology, neurosurgery, and other specialty areas. Over 100 physicians are employed by Grand View Health, including the staff of our medical practices. Grand View Health has nearly 2,000 employees and supports a diverse work culture. Grand View communicates new services through our website-gvh.org, an annual meeting, through patient emails and classes and Health View information and class catalog mailings, which are distributed three times a year to nearly 125,000 households in our primary and secondary service areas. Our services and events are promoted through social media and other digital and traditional advertising channels. The Grand View Connection Line provides callers in the community with physician referral recommendations, community health class enrollments and hospital service line information. This service is for individuals seeking information about or a referral to a Grand View Health physician or information about other programs offered through the hospital. Patients also have access to a patient portal, mygvh.org, to manage health information. To provide quality health education to the community, Grand View health hosts health education webinars and support groups. Topics range from orthopaedics and cardiovascular health to family and childbirth education. Participants of all ages, genders, and ethnicities are encouraged to attend. Grand View also participates in health fairs, senior expos, and community events. Members of our staff present a variety of health and well-being education, including free screenings, blood drives, Stop the Bleed presentations and smoking cessation programs. Guests can also speak with physical therapists, orthopedic, general and trauma surgeons and other related clinicians. To identity and prioritize the health needs of the community it serves, and to meet requirements of the Affordable Care Act (ACA), Grand View Health is part of PA (SEPA) Regional Community Health Needs Assessment (CHNA), with a specific focus on Bucks, Chester, Montgomery, and Philadelphia counties. The collaborative, community-engaged approach involved collecting and analyzing quantitative and qualitative data from a variety of sources to comprehensively assess the health status of the region. This data provides a detailed look at the specific health challenges that face our community and enables us prioritize outreach, prevention, education and additional healthcare services to meet our communities' most pressing health needs. Several areas identified included substance/opioid use and abuse, behavioral health diagnosis and treatment and access to affordable primary/preventive care. Our Joint Replacement Center offers experienced orthopedic surgeons who provide comprehensive joint replacement services for hip, knee, hand, wrist, shoulder, elbow, and ankle. Patients recover in a designated unit of the hospital and all rooms are private. Advanced joint replacement robot-assisted technologies often result in quicker recoveries and shorter hospital stays. Increasingly, patients return home the same day that they have surgery. Grand View Health provides high-quality, compassionate surgical care for adults and children. We offer our patients convenient parking, a surgical short-stay unit and diagnostic testing locations throughout the community. Our highly experienced surgeons and surgical staff provide hands-on care using leading-edge technologies and techniques, designed for the best possible outcomes. In addition to general surgery, surgical specialties include neurosurgery, colorectal, gynecology/urogynecology, maxillofacial, plastic &amp; reconstructive surgery, podiatry, ophthalmology, otolaryngology, urology, surgical oncology as well as vascular and endovascular options. Other significant services include cardiology - medical and interventional, a 24/7 cardiac catheterization lab, vascular services - surgical and non-surgical interventions, neurology - stroke prevention and management and acute rehab services. Cancer services include inpatient and outpatient cancer care as well as Breast Surgery, surgical oncology, genetic testing, and interventional pulmonology. Grand View Health provides full services for women and children including maternity, neonatology and inpatient pediatrics and emergency services. Grand View Hospital is affiliated with The Children's Hospital of Philadelphia and part of the CHOP care network. As part of a Strategic Alliance with Penn Medicine, Grand View is a member of the Penn Cancer Network, an affiliate of Penn Medicine Orthopaedic Surgery, and an affiliate of the Penn Trauma Network. Grand View Health offers comprehensive nutrition counselling services in which our team works one-on-one with patients to tailor personal nutritional goals designed to improve overall health. Our team of registered dieticians and certified diabetes educators also offer a Diabetes Self-Management Training program for anyone with diabetes or pre-diabetes. The program is recognized by the American Diabetes Association (ADA). Quality Accreditations &amp; Awards GRAND VIEW HEALTH * Grand View Health has The Joint Commission's Gold Seal of Approval for accreditation by demonstrating compliance with standards for healthcare quality and safety. CANCER * Grand View Health has been granted an accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program by the American College of Surgeons. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care. * American Society for Radiation Oncology (ASTRO) through APEx - Accreditation Program for Excellence * Accredited by the Commission on Cancer of the American College of Surgeons for commitment to providing high-quality, multidisciplinary, patient-centered cancer care. * Grand View Health's Breast Care Program has been recognized as a Hidden Scar Center of Excellence for Hidden Scar Breast Cancer Surgery. * Recognized as a Comprehensive Community Cancer Program by the Commission on Cancer of the American College of Surgeons</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's sole corporate member is Grand View Health Foundation, a related tax-exempt organization.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>Grand View Health Foundation has the power to appoint the members of the board of Grand View Hospital</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization does not have any committees with the authority to act on behalf of the governing body.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Trustees delegated responsibility for reviewing the form 990 to the Finance Committee. The Finance Committee was presented with a draft of the report for their review and input. In addition, a draft of the report was provided to the full Board before being filed.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>Grand View Hospital has a Conflict of Interest Policy that is strongly enforced. The Conflict of Interest Policy is reviewed annually and all Board Members and Vice Presidents must disclose any conflicts or potential conflicts of interest. The Board monitors potential conflicts throughout the year. Any person with a conflict is requested to leave the discussion and is not present during any voting about the conflict. In addition, legal counsel may be engaged to assist with resolving the conflict.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Review Committee of the Board of Trustees is charged with annually evaluating the performance and remuneration of the President/Chief Executive Officer, and reviewing the actions taken by the President/Chief Executive Officer with regard to the remuneration and appraisal of the performance of members of the organization's Senior Management team. As part of its charge, this Committee also reviews third party compensation survey data, and has defined a compensation philosophy calling for compensation parameters to be maintained within fair market value ranges.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b Process to establish compensation of other employees</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Review Committee of the Board of Trustees is charged with annually evaluating the performance and remuneration of the other officers and key employees and reviewing the remuneration and appraisal of the performance of members of the organization's Senior Management team. As part of its charge, this Committee also reviews third party compensation survey data, and has defined a compensation philosophy calling for compensation parameters to be maintained within fair market value ranges.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>Grand View Hospital's other governing documents, financial statements and conflict of interest policy are available to the public upon request and at the CEO, CFO or Senior VP, General Counsel's discretion and authorization.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g Other Fees</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Purchased Services - Total Expense: 29092064, Program Service Expense: 27637461, Management and General Expenses: 1454603, Fundraising Expenses: ; Management Services - Total Expense: 7064320, Program Service Expense: 6711104, Management and General Expenses: 353216, Fundraising Expenses: ; Consulting Services - Total Expense: 1051881, Program Service Expense: 999287, Management and General Expenses: 52594, Fundraising Expenses: ; Agency Services - Total Expense: 14323354, Program Service Expense: 13607186, Management and General Expenses: 716168, Fundraising Expenses: ;</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9 Other changes in net assets or fund balances</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Periodic Pension Credit - -421000; Change in Investment in Subsidiary - -3331345; Pension Liability Adjustment - 2319000;</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a Program Service Accomplishments (continued)</FormAndLineReferenceDesc>
        <ExplanationTxt>CARDIOVASCULAR * Get with the Guidelines Heart Failure Gold Plus by the American Heart Association * Get with the Guidelines Afib Silver by the American Heart Association * Grand View Hospital's Cardiac Cath Lab / Coronary Intervention program is accredited by Corizon, Inc., a national leader in services for the cardiovascular specialty. * Cardiac Rehabilitation and Pulmonary Rehabilitation Certifications by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) * Echocardiography/Vascular Lab Accreditation by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories DIAGNOSTIC IMAGING * Breast Ultrasound, Computed Tomography (CT), Nuclear Medicine/PET, MRI and Ultrasound Services Accredited Programs by the American College of Radiology * Breast Imaging Center of Excellence Designation by the American College of Radiology MATERNITY * Blue Distinction Designation for Maternity Care by Independence Blue Cross, an independent licensee of Blue Cross Blue Shield Association * Keystone 10 Initiative Participant by the Pennsylvania Department of Health in partnership with the PA Chapter of the American Academy of Pediatrics and with the support of the Hospital and Health System Association of Pennsylvania ORTHOPAEDICS * Recognized as a "High Performer" for knee surgery and hip fractures by U.S. News &amp; World Reports STROKE * Accredited as a Primary Stroke Center by The Joint Commission for demonstrating compliance with standards for healthcare quality and safety. * Get with the Guidelines Stroke Gold Plus Achievement Award 2023 by the American Heart Association for maintaining specific Stroke care measures over a designated time period. TRAUMA * Level II Adult Trauma Center from the Pennsylvania Trauma Systems Foundation (PTSF)</ExplanationTxt>
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      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>true</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>true</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>true</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>true</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
