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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lisa Daniels</PersonNm>
        <TitleTxt>Secretary (Until 12/2023)</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Michael Makosky</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>38.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>257622</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33490</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kimberly Slee</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <AverageHoursPerWeekRt>38.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>216157</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33924</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Greg Leis</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>38.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>181460</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>7649</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Tung Nguyen</PersonNm>
        <TitleTxt>ER Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>854352</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23356</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeffery Mandak</PersonNm>
        <TitleTxt>Cardiologist</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>644252</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>35076</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Nicole Debolt</PersonNm>
        <TitleTxt>Physician/Suregeon</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>385395</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23581</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ryan Decort</PersonNm>
        <TitleTxt>Emergency Room Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>263483</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>6047</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Paul Orange</PersonNm>
        <TitleTxt>Primary Care Doctor</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>287057</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>34503</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>3847281</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>228867</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>15</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Qualivis</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 123847</AddressLine1Txt>
            <CityNm>Dallas</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75312</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contracted traveling company</ServicesDesc>
        <CompensationAmt>1669466</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Corro Health</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 654380</AddressLine1Txt>
            <CityNm>Dallas</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>752654380</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contracted billing department</ServicesDesc>
        <CompensationAmt>997377</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Dr John Quinlan</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>201 A South Centre Street</AddressLine1Txt>
            <CityNm>Phillipsburg</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16866</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ER Doctor</ServicesDesc>
        <CompensationAmt>447254</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Pinnacle Health Hospitals</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 223270</AddressLine1Txt>
            <CityNm>Pittsburgh</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>152512270</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Orthopedic doctor</ServicesDesc>
        <CompensationAmt>336000</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Forvis</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 200870</AddressLine1Txt>
            <CityNm>Dallas</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>752300870</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Accountants</ServicesDesc>
        <CompensationAmt>180621</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>15</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>692590</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>449084</GovernmentGrantsAmt>
      <TotalContributionsAmt>1141674</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient and Resident Service Reve</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>49426010</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>49426010</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy Revenue</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>3119731</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3119731</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Other Revenue</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>957625</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>957625</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>53503366</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>777788</TotalRevenueColumnAmt>
        <ExclusionAmt>777788</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <OtherAmt>20008</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>0</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <OtherAmt>20008</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>20008</TotalRevenueColumnAmt>
        <ExclusionAmt>20008</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>55442836</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>53503366</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>797796</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>284432</TotalAmt>
        <ProgramServicesAmt>284432</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1578282</TotalAmt>
        <ProgramServicesAmt>896067</ProgramServicesAmt>
        <ManagementAndGeneralAmt>682215</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>25432597</TotalAmt>
        <ProgramServicesAmt>20265781</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5166816</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>476150</TotalAmt>
        <ProgramServicesAmt>415593</ProgramServicesAmt>
        <ManagementAndGeneralAmt>60557</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>5076421</TotalAmt>
        <ProgramServicesAmt>3992523</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1083898</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1668000</TotalAmt>
        <ProgramServicesAmt>1309148</ProgramServicesAmt>
        <ManagementAndGeneralAmt>358852</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>115252</TotalAmt>
        <ManagementAndGeneralAmt>115252</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>9244842</TotalAmt>
        <ProgramServicesAmt>7255838</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1989004</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>147081</TotalAmt>
        <ProgramServicesAmt>147081</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>43013</TotalAmt>
        <ProgramServicesAmt>14059</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28954</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>884191</TotalAmt>
        <ProgramServicesAmt>784551</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99640</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>58974</TotalAmt>
        <ProgramServicesAmt>53740</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5234</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>13253</TotalAmt>
        <ProgramServicesAmt>2145</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11108</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>2191709</TotalAmt>
        <ProgramServicesAmt>2191709</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>3104309</TotalAmt>
        <ProgramServicesAmt>3104309</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>749999</TotalAmt>
        <ProgramServicesAmt>749999</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>6283150</TotalAmt>
        <ProgramServicesAmt>5929720</ProgramServicesAmt>
        <ManagementAndGeneralAmt>353430</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Licensure</Desc>
        <TotalAmt>250767</TotalAmt>
        <ProgramServicesAmt>238211</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12556</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Dues &amp; Subscription</Desc>
        <TotalAmt>212318</TotalAmt>
        <ProgramServicesAmt>26803</ProgramServicesAmt>
        <ManagementAndGeneralAmt>185515</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Equipment</Desc>
        <TotalAmt>63008</TotalAmt>
        <ProgramServicesAmt>33842</ProgramServicesAmt>
        <ManagementAndGeneralAmt>29166</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>167562</TotalAmt>
        <ProgramServicesAmt>132279</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35283</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>58045310</TotalAmt>
        <ProgramServicesAmt>47827830</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10217480</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>2897919</BOYAmt>
        <EOYAmt>3771949</EOYAmt>
      </CashNonInterestBearingGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>379011</BOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>8509022</BOYAmt>
        <EOYAmt>11189220</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>523372</BOYAmt>
        <EOYAmt>435932</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>1077962</BOYAmt>
        <EOYAmt>997216</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>75902604</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>50345724</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>27669231</BOYAmt>
        <EOYAmt>25556880</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>11743179</BOYAmt>
        <EOYAmt>16743364</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>12071113</BOYAmt>
        <EOYAmt>6637002</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>64870809</BOYAmt>
        <EOYAmt>65331563</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>6400363</BOYAmt>
        <EOYAmt>8043220</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>43249987</BOYAmt>
        <EOYAmt>42304068</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1290294</BOYAmt>
        <EOYAmt>1649274</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <EOYAmt>74645</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>3793072</BOYAmt>
        <EOYAmt>3780298</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>54733716</BOYAmt>
        <EOYAmt>55851505</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>9040713</BOYAmt>
        <EOYAmt>8304508</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>1096380</BOYAmt>
        <EOYAmt>1175550</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>10137093</BOYAmt>
        <EOYAmt>9480058</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>64870809</BOYAmt>
        <EOYAmt>65331563</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-2602474</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>538320</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>1407119</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>556178</OtherCostOrOtherBasisAmt>
        <BookValueAmt>556178</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>26230208</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>13377384</DepreciationAmt>
        <BookValueAmt>12852824</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>41469976</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>31271878</DepreciationAmt>
        <BookValueAmt>10198098</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>7646242</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>5696462</DepreciationAmt>
        <BookValueAmt>1949780</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>25556880</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Estimated Third Party Payor Settlement</Desc>
        <BookValueAmt>1946202</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Due From Affiliates</Desc>
        <BookValueAmt>100000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Interest in Perpetual Trust</Desc>
        <BookValueAmt>1175550</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Investment in Charts</Desc>
        <BookValueAmt>1147848</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Pension Asset</Desc>
        <BookValueAmt>2078037</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Right of Use Asset</Desc>
        <BookValueAmt>22473</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Reserves Payable</Desc>
        <BookValueAmt>166892</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>6637002</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Estimated Amounts Due to Third Parties</Desc>
        <Amt>3762302</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Lease Liability</Desc>
        <Amt>17996</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>3780298</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>57103843</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>538320</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>1122687</OtherRevenueAmt>
      <RevenueNotReportedAmt>1661007</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>55442836</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>55442836</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>57760878</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>57760878</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>284432</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>284432</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>58045310</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Medical Center believes they have appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the financial statements. The entities would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Grant Expense Reclassed from Revenue to Expense -284,432. Pension Liability Adjustment 1,529,302. Valuation Gain 79,170. Net Periodic Pension Benefit Cost -201,353.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Grant Expense Reclassed from Revenue to Expense 284,432.</ExplanationTxt>
      </SupplementalInformationDetail>
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          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>17233</ZIPCd>
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        <ExistingResourcesInd>X</ExistingResourcesInd>
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        <CHNAConductedYr>22</CHNAConductedYr>
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        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>www.fcmcpa.org.</OwnWebsiteURLTxt>
        <RptAvailableThruOtherMethodInd>X</RptAvailableThruOtherMethodInd>
        <ImplementationStrategyAdoptInd>1</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>22</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>1</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>www.fcmcpa.org/community resources</StrategyWebsiteURLTxt>
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        <FPGFamilyIncmLmtDscntCarePct>200.000000000000</FPGFamilyIncmLmtDscntCarePct>
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        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
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        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
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        <ResidencyCriteriaInd>X</ResidencyCriteriaInd>
        <ExplainedBasisInd>1</ExplainedBasisInd>
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        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
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        <FAPAvailableOnWebsiteURLTxt>www.fcmcpa.org/financial-assistance</FAPAvailableOnWebsiteURLTxt>
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        <FAPAppAvailableOnWebsiteURLTxt>www.fcmcpa.org/financial-assistance</FAPAppAvailableOnWebsiteURLTxt>
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        <FAPSummaryOnWebsiteURLTxt>www.fcmcpa.org/financial-assistance</FAPSummaryOnWebsiteURLTxt>
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        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
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        <OtherPublicityInd>X</OtherPublicityInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>0</CollectionActivitiesInd>
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        <LookBackMedicaidMedcrPrvtInd>X</LookBackMedicaidMedcrPrvtInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Fulton County Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: Fulton County Medical Center partnered with BKD, LLP ("BKD") to conduct this community health needs assessment. BKD is one of the largest CPA and advisory firms in the United States, with approximately 3,000 partners and employees in 40 offices. BKD serves hospitals and healthcare systems across the country. The CHNA was conducted during 2021 and 2022.The CHNA was conducted to support its mission responding to the needs in the community it serves and to comply with Internal Revenue Code Section 501(r) and federal tax-exemption requirements. Identified health needs were prioritized to facilitate the effective allocation of hospital resources to respond to the identified health needs. Based on guidance from the United States Treasury and the Internal Revenue Service, the following steps were conducted as part of the CHNA:* Community benefit initiatives, which were implemented over the course of the last three years, were evaluated.* The "community" served by the Medical Center was defined by utilizing inpatient and outpatient data regarding patient origin and is inclusive of medically underserved, low-income, minority populations and people with limited English proficiency. This process is further described in Community Served by the Medical Center.* Population demographics and socioeconomic characteristics of the community were gathered and assessed utilizing various third parties.* The health status of the community was assessed by reviewing community health status indicators from multiple sources, including those with specialized knowledge of public health and members of the underserved, low-income and minority population or organizations serving their interests.* Community input was also obtained through key stakeholder interviews of community leaders. Identified health needs were then prioritized considering the community's perception of the significance of each identified need as well as the ability for the Medical Center to impact overall health based on alignment with its mission and the services it provides. The Medical Center's leadership participated in identifying and prioritizingsignificant health needs.* An inventory of healthcare facilities and other community resources potentially available to address the significant health needs identified through the CHNA was prepared.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Fulton County Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6b: The Fulton County Medical Center (FCMC) community health needs assessment (CHNA) was developed with collaboration from Fulton County Family Partnership (FCFP)</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Fulton County Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 7d: FCMC publicly reported the CHNA at the Fulton County Partnership meeting that meets monthly. It is comprised of members of the health and human services communities of Franklin, Fulton &amp; Bedford counties. The CHNA was printed out and circulated through the partner meeting and is accessible on our website at www.fcmcpa.org.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Fulton County Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: Seven "Priority Areas" have been identified by FCMC and Fulton County Family Partnership based on the needs identified in the community health needs assessment1. Drug and Alcohol Abuse 2. Mental Health3. Senior Living and Housing 4. Healthy Behaviors 5. Transportation 6. Poverty7. Access To Care An action plan with who was responsible for each was developed to address the identified needs associated with the Priority Areas: Goal 1: Improve access and care coordination for behavioral health services1. Increase awareness of available services2. Improve treatment, support, and care coordination3. Minimize barriers (including stigma) to accessing available services 4. Work collaboratively to address youth risk behaviours as identified in the PAYS data.During the fiscal year, the following steps were taken to address the need:1. Reviewed "Where to Go for Help" document2. Distributed 988 suicide and crisis lifeline information3. Held multiple events including Movie Night, Daddy Daughter Dance, Sober September4. Distributed medication lock boxes and deterra bagsGoal 2: Increasing awareness of housing resources and educating the community on utilization of these resources1. Disseminate resources out to the community to increase knowledge2. Provide educational resources surrounding housing and budgeting3. Evaluate local housing needs4. Housing strategies to mitigate homelessnessDuring the fiscal year, the following steps were taken to address the need:1. Hired Homeless Support Coordinator2. Held Fair Housing seminarGoal 3: Improve access to care as it relates to target populations identified in the community needs assessment such as uninsured and underinsured populations, elderly, and low income1. Grow patient volumes at FCMC by adding providers and enhancing the breadth of services offered in Fulton Specialty Services2. Improve treatment, support and care coordinationDuring the fiscal year, the following steps were taken to address the need:1. Increased number of patients served in cardiology2. Reopened sleep lab3. Hired a coordinator for telemedicineGoal 4: Increase healthy behaviors for vulnerable populations1. Continue to develop programs to educate the community on chronic conditions2. Community outreach and engagement3. Add to the Wellness Center to enhance classes and populations served4. Healthy outreach activities for the community as a wholeDuring the fiscal year, the following steps were taken to address the need:1. Hired a new Diabetes Coordinator2. Hired a new Radiology Manager to manage mammography emails3. Reviewed educational/outreach materials4. Held diabetes seminars5. Held Pink Out games at local schools6. Held health screeningsFCMC is focusing on areas within their scope of service listed above. They are addressing Access to care and healthy behaviors. Additionally, some community needs fall out of the scope of expertise and resources of Fulton County Medical Center. Therefore, they have partnered with the Fulton County Family Partnership to support their efforts in the other priority areas like behavioral health services and housing.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Fulton County Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 16j: The CHNA and implementation strategy is reviewed monthly at the Fulton County Family Partnership meetings. It is also reviewed bi-monthly at the FCMC Board Finance Committee meetings through the FCMC Community Benefit Director, as well as, posted on their website and their members.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>1</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>1 - Fulton Co Medical Center Bursing Home</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>214 Peach Orchard Rd</AddressLine1Txt>
            <CityNm>Mcconnellsburg</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>17233</ZIPCd>
          </USAddress>
          <FacilityTxt>Hospital based LT care facility</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c:</FormAndLineReferenceDesc>
        <ExplanationTxt>Patients with no health insurance, private or employer-sponsored insurance, or via governmental programs, are automatically eligible for a financial assistance discount in the following amounts:Inpatient services - 30%Outpatient services - 40%Home health services - 20%Swing bed services - 30%Additional financial assistance may be made available to the patient based on a sliding fee scale, in accordance with financial need, as determined by referencing federal poverty levels (FPL) in effect at the time of the determination. In general, people whose household income is below 200 percent of the federal poverty level are eligible for financial assistance. Families or individuals with higher incomes may qualify on a case-by-case basis.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>Fulton County Medical Center's (FCMC) 990 filing is available to the public upon request. A summary of FCMC's community benefit is described in FCMC's annual report. The annual report is available to the public during the annual meeting, at the hospital, as well as on the hospital website.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>Charity care was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed medicaid on line 7b was calculated using the cost-to-charge ratio derived from worksheet 2. Community health improvement services, line 7e are reported from the community benefit's annual board report. Line 7g was determined using the medicare cost report.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Prior to any account being classified as an implicit price concession, all payments are applied including contractual allowances and discounts, and every effort is made with the patient in an attempt to collect the outstanding balance. Accounts placed in collection for a year with no payment being received within 120 days are written off to implicit price concessions . If a payment is received on an amount previously written off to implicit price concessions, the amount would reduce implicit price concession expense.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>FCMC does not refuse service to patients that generate bad debt. The estimated amount of organization's bad debt expense attributable to patients eligible under the organization's charity care policy is calculated based on an estimate of charity care accounts compared to total bad debt accounts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The allowance for doubtful accounts is based on historical losses and an analysis of currently outstanding amounts for its major payer sources. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients and residents who have third-party coverage, the medical center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectable deductibles and copayments on accounts for which the Third-party payer has not yet paid). For receivables associated with Self-pay patients and residents (which includes both patients and residents without insurance and patients with deductible and payment balances due for which third-party coverage exists for part of the bill), the medical center records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients and residents 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>Medicare services are provided to the elderly which are considered to be a charitable class. As such, we believe the shortfall should be considered as a community benefit.Hospital services rendered on a fee schedule are not included in the Medicare calculations per the 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $136,059.Medicare fee schedule revenue $767,878Medicare estimated costs of care relating to payments $903,936Net (shortage) $(136,059)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Patients applying for charity care or financial assistance, or patients who are known to qualify for free or discounted care will be processed as such before collection efforts start. Once a determination is made on eligibility, any personal portion due is subject to the same collection policy as other accounts. If the patient does not have a third party insurance coverage, they will be informed of the free care program. Eligibility will be determined using the department of health and human services income poverty guidelines category b with no sliding scale. Patients/guarantors who have not met arrangements to pay off their accounts within the allotted time will be forwarded to the hospital's Collection agency. All accounts will be reviewed by the financial advocate prior to agency referral.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Community Health Needs Assessment (CHNA) was conducted in 2021/2022. The Fulton County Medical Center Board of Directors approved the hospital's CHNA in May 2022. The plan was implemented on July 1, 2022, and will run through June 30, 2025. Fulton County Medical Center is an acute care hospital located in McConnellsburg, Pennsylvania. For the purposes of this CHNA, the Medical Center's has defined its "community" as Fulton, Bedford, Blair, Franklin, and Huntington Counties, located in central Pennsylvania, which account for the most significant portion the Medical Center's patients. While the Medical Center may serve patients across a broader region, defining its community will allow it to more effectively focus its resources to address identified significant health needs, targeting areas of greatest need and health disparities.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>The FCMC posts information about the financial assistance program and discounts at the admissions areas, emergency room waiting areas, and financial advocate's office, as well as on their website at www.fcmpa.org . FCMC financial assistance program is called FCMC. Information on financial assistance is routinely on social media and is included in the inpatient and outpatient surgery patient packets. The financial advocate discusses with the patient the availability of financial assistance as well as various government benefits such as Medicaid, and assists the patient with qualification for such programs, where applicable. In addition, patient invoices for FCMC include a number to call for help in applying for financial assistance. The financial assistance application is on the back of the patient invoice as well. When telephone collection calls are made to patients with outstanding balances, they are reminded of our financial assistance program. Beginning July 2022, Healthcare Receivable Solutions, Inc. (HRSI) is available on campus to help Medicaid eligible patients fill out their applications which is a free service FCMC is offering to the community to help complete the Medicaid application.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>According to Data USA, in 2021, Fulton County, PA had a population of 14,529 people with a median age of 45.7 and a median household income of $58,343. Between 2020 and 2021 the population of Fulton County, PA grew from 14,492 to 14,529, a 0.255% increase and its median household income grew from $55,424 to $58,343, a 5.27% increase. The 5 largest ethnic groups in Fulton County, PA are White (Non-Hispanic) (95%), Two+ (Non-Hispanic) (1.38%), Black or African American (Non-Hispanic) (1.27%), Other (Non-Hispanic) (0.626%), and White (Hispanic) (0.564%). None of the households in Fulton County, PA reported speaking a non-English language at home as their primary shared language. This does not consider the potential multi-lingual nature of households, but only the primary self-reported language spoken by all members of the household. 99.7% of the residents in Fulton County, PA are U.S. citizens. In 2021, the median property value in Fulton County, PA was $170,800, and the homeownership rate was 77.6%. Most people in Fulton County, PA drove alone to work, and the average commute time was 32.4 minutes. The average car ownership in Fulton County, PA was 2 cars per household. According to the US Census data the population estimate for Fulton County in 2023 will be 14,533. The FCMC is a critical access hospital with over 50% of its revenues received from the Medicare and Medicaid programs.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>FCMC's board is comprised of citizens from the communities and service areas that benefit from FCMC's services. FCMC is the only hospital, level IV trauma Center and skilled nursing home in this rural service area. In addition, FCMC offers home health services and a specialty services where physician specialists from other geographical areas see patients. This allows residents of the surrounding areas to receive medical care from medical professionals close to home. Patients who come to the emergency room are not denied treatment based on the ability to pay. FCMC offers financial assistance discounts and charity care for those patients who have limited or no means to pay their medical bill. To meet the needs of our community, the hospital extends privileges to licensed medical staff. During the COVID-19 pandemic, the Center had to cancel some on-campus events such as on-campus health fairs and community outreach programs. However, this year, FCMC has started bringing back in-person events while also maintaining outdoor and off-campus events. FCMC began the fiscal year by participating in the Fulton County Fair, where attendees were educated about the Center's services and providers, and different departments provided screenings and information throughout the week. On Senior Citizen Day at the fair, FCMC and TSHC provided blood pressure screenings, service information, and refreshments under the pavilion.FCMC also provides free screenings at the township officials' annual meeting each October, including free cholesterol, glucose, and blood pressure screenings along with service information. CEO Mike Makosky speaks to the officials regarding services offered and operational highlights. In June 2024, the annual kick-off of the drug-free summer campaign was held June 6, 2024. Over 300 attended and there were nearly 30 vendors set up offering services for children, including demonstrations, education, healthy eating tips, and physical activities. The sheriff's office also provided a drug collection booth to turn in outdated and unwanted narcotics. As a critical access hospital and rural healthcare provider, FCMC provides an opportunity to assist in the education of future healthcare workers. Lake Erie College of Osteopathic Medicine (LECOM) medical students rotate to FCMC as part of their education as well as vocational-technical students. In limited capacity due to Covid precautions, high school students have the opportunity to volunteer within the facility or job shadow a professional at the hospital.In January 2023, FCMC launched its upgraded Community Health and Wellness Center and clinical education at its new on-campus location. The Wellness Center increased the services it provides in 2024 and grew to nearly 1,000 members and averaging 1980 visits per month.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>A conflict-of-interest form is completed annually by all officers, directors, and key employees. any possible conflict of interest on the part of a director must be disclosed to the board. The forms are reviewed by the President/CEO. When any interest becomes a matter of board action, the director is not to vote or use personal influence on the matter and is not counted in the quorum for a meeting at which board action is to be taken on the interest. The director may, however, briefly state a position on the matter and answer pertinent questions of board members. the minutes of all actions taken on such matters clearly reflect that these requirements have been met. it is the obligation of each board member to act in the best interest of the medical center. all board information is confidential and is not to be used or discussed other than for appropriate medical center business. failure of a director to maintain the confidentiality of board information is grounds for removal.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The board of directors serves as a compensation committee and reviews and adjusts the compensation of the President/CEO based on evaluations and comparable data. The human resources department either with the help of an outside compensation consultant or independently or both, gathers comparable data and provides information to the board of directors when it is requested. The CFO receives cost of living adjustments as approved through the budget Fulton County Medical Center process by the board of directors each year. The president/CEO, in collaboration with the HR department, reviews and adjusts the compensation of the CFO based on performance and comparability data. If needed, the HR department conducts a survey to gather comparability data and gives this information to the president/CEO when it is requested. This information is shared with the Board of directors for informational purposes.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization makes its governing documents, conflict of interest policy and finacial statement avaliable upon request. The documents are also avaliable at the annual meeting which is open to the general public.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Professional Fees: Program service expenses 2,019,220. Management and general expenses 216,591. Fundraising expenses 0. Total expenses 2,235,811. Purchased Services: Program service expenses 5,236,618. Management and general expenses 1,413,974. Fundraising expenses 0. Total expenses 6,650,592. Other Fees: Program service expenses 0. Management and general expenses 358,439. Fundraising expenses 0. Total expenses 358,439.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Pension Liability Adjustment 1,529,302. Valuation Gain 79,170. Net Periodic Pension Benefit Cost -201,353.</ExplanationTxt>
      </SupplementalInformationDetail>
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        <DisregardedEntityName>
          <BusinessNameLine1Txt>Fulton County Medical Center Foudation</BusinessNameLine1Txt>
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          <AddressLine1Txt>214 Peach Orchard Road</AddressLine1Txt>
          <CityNm>Mcconnellsburg</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>17233</ZIPCd>
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        <PrimaryActivitiesTxt>Fundraising</PrimaryActivitiesTxt>
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      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
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      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Fulton County Medical Center Foundation</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>C</TransactionTypeTxt>
        <InvolvedAmt>692590</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cash Value</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
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          <BusinessNameLine1Txt>Fulton County Medical Center Foundation</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>B</TransactionTypeTxt>
        <InvolvedAmt>284432</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cash Value</MethodOfAmountDeterminationTxt>
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