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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOE LEDFORD</PersonNm>
        <TitleTxt>DIRECTOR/PAST CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES BULMAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BRIAN NAGEOTTE</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NICOLA FISHER</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KEVIN KRAELING</PersonNm>
        <TitleTxt>DIRECTOR END 04/21</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CRAIG MULLEN</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TIM GEIBEL</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DANA DEARMENT</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JIM MIALE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>5464033</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>591535</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>113</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ASSOCIATED CLINICAL LAB</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1526 PEACH ST</AddressLine1Txt>
            <CityNm>ERIE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16501</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CLINICAL LAB</ServicesDesc>
        <CompensationAmt>3371386</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>EMCARE</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7032 COLLECTION CENTER DRIVE</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60693</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL</ServicesDesc>
        <CompensationAmt>2675489</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>VITALANT</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>29668 NETWORK PL</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60673</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LAB SERVICES</ServicesDesc>
        <CompensationAmt>1436201</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>MEDICAL SOLUTIONS</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1010 N 102ND ST</AddressLine1Txt>
            <CityNm>OMAHA</CityNm>
            <StateAbbreviationCd>NE</StateAbbreviationCd>
            <ZIPCd>68114</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TEMP MED STAFFING</ServicesDesc>
        <CompensationAmt>1427556</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>HOWE CONTRACTORS INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7045 DUTCH HILL ROAD</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>1243739</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>59</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>177249</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>12984362</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>48363</AllOtherContributionsAmt>
      <TotalContributionsAmt>13209974</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>193458003</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>193458003</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PA RURAL HEALTH MODEL REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>20294808</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>20294808</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY REVENUE</Desc>
        <BusinessCd>446110</BusinessCd>
        <TotalRevenueColumnAmt>1274974</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1274974</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MANAGEMENT FEES</Desc>
        <BusinessCd>561000</BusinessCd>
        <TotalRevenueColumnAmt>1096407</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1096407</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>AFFILIATED ORGANIZATION RENT</Desc>
        <BusinessCd>532000</BusinessCd>
        <TotalRevenueColumnAmt>820021</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>820021</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>2071761</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2071761</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>219015974</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>1038160</TotalRevenueColumnAmt>
        <ExclusionAmt>1038160</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>1437</TotalRevenueColumnAmt>
        <ExclusionAmt>1437</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>799717</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>323612</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>476105</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>476105</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>-203100</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>679205</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>43613764</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>41290476</SecuritiesAmt>
        <OtherAmt>59011</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>2323288</SecuritiesAmt>
        <OtherAmt>-59011</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>2264277</TotalRevenueColumnAmt>
        <ExclusionAmt>2264277</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>INVESTMENT IN EQUITY INVESTEE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2393813</TotalRevenueColumnAmt>
        <ExclusionAmt>2393813</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>INSURANCE PROCEEDS</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>42663</TotalRevenueColumnAmt>
        <ExclusionAmt>42663</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>LOSS ON EXTINGUISHMENT OF DEBT</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>-1111910</TotalRevenueColumnAmt>
        <ExclusionAmt>-1111910</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>1324566</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>237330493</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>219015974</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>-203100</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>5307645</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>293791</TotalAmt>
        <ProgramServicesAmt>293791</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2449247</TotalAmt>
        <ProgramServicesAmt>1085580</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1363667</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>83147657</TotalAmt>
        <ProgramServicesAmt>75782220</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7365437</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>6077048</TotalAmt>
        <ProgramServicesAmt>5588393</ProgramServicesAmt>
        <ManagementAndGeneralAmt>488655</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>17416556</TotalAmt>
        <ProgramServicesAmt>15725264</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1691292</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>5488283</TotalAmt>
        <ProgramServicesAmt>4939455</ProgramServicesAmt>
        <ManagementAndGeneralAmt>548828</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>184862</TotalAmt>
        <ManagementAndGeneralAmt>184862</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>436802</TotalAmt>
        <ManagementAndGeneralAmt>436802</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>24267773</TotalAmt>
        <ProgramServicesAmt>21840996</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2426777</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>0</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>12282381</TotalAmt>
        <ProgramServicesAmt>7411472</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4870909</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>0</TotalAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>1816043</TotalAmt>
        <ProgramServicesAmt>1634439</ProgramServicesAmt>
        <ManagementAndGeneralAmt>181604</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>122227</TotalAmt>
        <ProgramServicesAmt>110004</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12223</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>204077</TotalAmt>
        <ProgramServicesAmt>183669</ProgramServicesAmt>
        <ManagementAndGeneralAmt>20408</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>6530765</TotalAmt>
        <ProgramServicesAmt>5877688</ProgramServicesAmt>
        <ManagementAndGeneralAmt>653077</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>8964025</TotalAmt>
        <ProgramServicesAmt>8067622</ProgramServicesAmt>
        <ManagementAndGeneralAmt>896403</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>1777632</TotalAmt>
        <ProgramServicesAmt>1599869</ProgramServicesAmt>
        <ManagementAndGeneralAmt>177763</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
        <TotalAmt>36132916</TotalAmt>
        <ProgramServicesAmt>36132916</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PROVIDER TAX</Desc>
        <TotalAmt>2841769</TotalAmt>
        <ProgramServicesAmt>2841769</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITING</Desc>
        <TotalAmt>1584653</TotalAmt>
        <ProgramServicesAmt>1584653</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LICENSES, DUES, SUBSCRIPTIONS</Desc>
        <TotalAmt>1183634</TotalAmt>
        <ProgramServicesAmt>1065271</ProgramServicesAmt>
        <ManagementAndGeneralAmt>118363</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>213202141</TotalAmt>
        <ProgramServicesAmt>191765071</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21437070</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>8763490</BOYAmt>
        <EOYAmt>208453</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>58235118</BOYAmt>
        <EOYAmt>70398344</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>13322206</BOYAmt>
        <EOYAmt>17956070</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>4183113</BOYAmt>
        <EOYAmt>4615152</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>2493855</BOYAmt>
        <EOYAmt>2325738</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>270113099</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>200738282</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>69834041</BOYAmt>
        <EOYAmt>69374817</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>23700040</BOYAmt>
        <EOYAmt>29191498</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>3923724</BOYAmt>
        <EOYAmt>5474117</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>9993081</BOYAmt>
        <EOYAmt>16005366</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
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        <EOYAmt>1216973</EOYAmt>
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      <OtherAssetsTotalGrp>
        <BOYAmt>45580323</BOYAmt>
        <EOYAmt>55535035</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>240028991</BOYAmt>
        <EOYAmt>272301563</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>28085926</BOYAmt>
        <EOYAmt>28812371</EOYAmt>
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      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <DeferredRevenueGrp>
        <BOYAmt>4938927</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>85287508</BOYAmt>
        <EOYAmt>95040856</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>16515688</BOYAmt>
        <EOYAmt>17141756</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>2946722</BOYAmt>
        <EOYAmt>5957703</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>88462342</BOYAmt>
        <EOYAmt>71031826</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>226237113</BOYAmt>
        <EOYAmt>217984512</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>5085939</BOYAmt>
        <EOYAmt>43683152</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>8705939</BOYAmt>
        <EOYAmt>10633899</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>13791878</BOYAmt>
        <EOYAmt>54317051</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>240028991</BOYAmt>
        <EOYAmt>272301563</EOYAmt>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>24128352</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>692532</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>15704289</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <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>
    <IRS990ScheduleC documentId="IRS990ScheduleC">
      <TotalGrassrootsLobbyingGrp />
      <TotalDirectLobbyingGrp />
      <TotalLobbyingExpendGrp />
      <OtherExemptPurposeExpendGrp />
      <TotalExemptPurposeExpendGrp />
      <LobbyingNontaxableAmountGrp />
      <GrassrootsNontaxableGrp />
      <TotLbbyngGrassrootMnsNonTxGrp />
      <TotLbbyExpendMnsLbbyngNonTxGrp />
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>true</OtherActivitiesInd>
      <OtherActivitiesAmt>32124</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>32124</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE C, PART II-B, LINE 1(I)</FormAndLineReferenceDesc>
        <ExplanationTxt>LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO ORGANIZATIONS WHICH PARTICIPATE IN LOBBYING ACTIVITIES. THE PORTION OF THE ORGANIZATION'S TOTAL DUES ATTRIBUTABLE TO LOBBYING ARE $11,954 TO THE AMERICAN HOSPITAL ASSOCIATION AND $20,170 TO THE HOSPITAL &amp; HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA. TOTAL DUES ATTRIBUTABLE TO LOBBYING ARE $32,124.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
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      <HeldWorksArtGrp />
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>5249941</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>211487</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>5461428</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>5053512</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>196429</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>5249941</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4892685</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>160827</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>5053512</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4701646</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>191039</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>4892685</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4443052</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>258594</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>4701646</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <PrmnntEndowmentBalanceEOYPct>1.00000</PrmnntEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>false</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>true</EndowmentsHeldRelatedOrgInd>
      <RelatedOrgListSchRInd>true</RelatedOrgListSchRInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>7449171</OtherCostOrOtherBasisAmt>
        <BookValueAmt>7449171</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>29312089</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>110216471</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>93780568</DepreciationAmt>
        <BookValueAmt>45747992</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp />
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>116392122</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>102864805</DepreciationAmt>
        <BookValueAmt>13527317</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>6743246</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4092909</DepreciationAmt>
        <BookValueAmt>2650337</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>69374817</TotalBookValueLandBuildingsAmt>
      <InvstProgramRelatedOrgGrp>
        <Desc>INV IN CLINICAL PATHOLOGY INST</Desc>
        <BookValueAmt>18000</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </InvstProgramRelatedOrgGrp>
      <InvstProgramRelatedOrgGrp>
        <Desc>INVESTMENT IN CHART</Desc>
        <BookValueAmt>6244784</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </InvstProgramRelatedOrgGrp>
      <InvstProgramRelatedOrgGrp>
        <Desc>INTEREST IN NET ASSETS OF TAH</Desc>
        <BookValueAmt>9742582</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </InvstProgramRelatedOrgGrp>
      <TotalBookValueProgramRltdAmt>16005366</TotalBookValueProgramRltdAmt>
      <OtherAssetsOrgGrp>
        <Desc>Due from affiliates</Desc>
        <BookValueAmt>41889513</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Other Receivables</Desc>
        <BookValueAmt>3155295</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>EST AMT DUE FROM 3RD PARTIES</Desc>
        <BookValueAmt>1583789</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Cash Surrender Value</Desc>
        <BookValueAmt>1777358</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Benefi. Interest in Perp Trust</Desc>
        <BookValueAmt>5794924</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>DEFERRED COMPENSATION ASSET</Desc>
        <BookValueAmt>1334156</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>55535035</TotalBookValueOtherAssetsAmt>
      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>EST SELF-INSURANCE COSTS</Desc>
        <Amt>4518108</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED POST-RETIREMENT BEN LIAB</Desc>
        <Amt>5840538</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED PENSION</Desc>
        <Amt>36314286</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO 3RD PARTY PAYERS</Desc>
        <Amt>1203649</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>CONTRACT LIABILITIES</Desc>
        <Amt>20602811</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DEFERRED COMPENSATION LIABILITY</Desc>
        <Amt>1334156</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OPERATING LEASE LIABILITY</Desc>
        <Amt>1218278</Amt>
      </OtherLiabilitiesOrgGrp>
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      <TotalRevEtcAuditedFinclStmtAmt>243584254</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>559766</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>5311372</OtherRevenueAmt>
      <RevenueNotReportedAmt>5871138</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>237713116</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-382623</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-382623</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>237330493</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>213799619</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>382623</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>382623</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>213416996</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>-214855</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>-214855</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>213202141</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART V, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>ENDOWMENT FUNDS: THE ENDOWMENT FUNDS CONSISTS OF TEN SEPARATE FUNDS HELD THROUGH PNC BANK, BANK OF AMERICA, AND MELLON BANK, OF WHICH THE PURPOSE IS TO IMPROVE THE HEALTHCARE FOR RESIDENTS OF THIS COMMUNITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ 5,096,517 CHANGE IN INTEREST OF TAHC 214,855 PENSION EXPENSE -------------- $ 5,311,372</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (59,011) LOSS ON SALE OF FIXED ASSETS (323,612) RENTAL EXPENSES ------------ $ (382,623)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 323,612 RENTAL EXPENSES 59,011 LOSS ON SALE OF FIXED ASSETS ------------ $ 382,623</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ (214,855) PENSION EXPENSE</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="IRS990ScheduleH">
      <FinancialAssistancePolicyInd>true</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>true</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <FreeCareOthPercentageGrp>
        <OtherInd>X</OtherInd>
        <FreeCareOtherPct>300.</FreeCareOtherPct>
      </FreeCareOthPercentageGrp>
      <FPGReferenceDiscountedCareInd>true</FPGReferenceDiscountedCareInd>
      <Percent300Ind>X</Percent300Ind>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>true</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>false</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>false</AnnualCommunityBnftReportInd>
      <FinancialAssistanceAtCostTyp>
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        <NetCommunityBenefitExpnsAmt>824915</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00390</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>28521014</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>16229734</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>12291280</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.05770</TotalExpensePct>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>29345929</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>16229734</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>13116195</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.06160</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>1018617</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>61258</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>957359</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00450</TotalExpensePct>
      </CommunityHealthServicesGrp>
      <HealthProfessionsEducationGrp>
        <TotalCommunityBenefitExpnsAmt>545660</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>284202</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>261458</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00120</TotalExpensePct>
      </HealthProfessionsEducationGrp>
      <SubsidizedHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>33222932</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>17415971</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>15806961</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.07410</TotalExpensePct>
      </SubsidizedHealthServicesGrp>
      <CashAndInKindContributionsGrp>
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        <NetCommunityBenefitExpnsAmt>568026</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00270</TotalExpensePct>
      </CashAndInKindContributionsGrp>
      <TotalOtherBenefitsGrp>
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        <DirectOffsettingRevenueAmt>17761431</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>17593804</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.08250</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
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        <DirectOffsettingRevenueAmt>33991165</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>30709999</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.14410</TotalExpensePct>
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      <BadDebtExpenseReportedInd>true</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>11596811</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>600000</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>94465767</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>88074688</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>6391079</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <CostAccountingSystemInd>X</CostAccountingSystemInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>true</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>true</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>2</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>MEADVILLE MEDICAL CENTER</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>751 LIBERTY ST</AddressLine1Txt>
          <CityNm>MEADVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16335</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.MMCHS.ORG</WebsiteAddressTxt>
        <StateLicenseNum>197101</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>PHYSICIAN PRACTICES</OtherDesc>
        <FacilityReportingGroupCd>1</FacilityReportingGroupCd>
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      <HospitalFacilitiesGrp>
        <FacilityNum>2</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>MEADVILLE MEDICAL CENTER</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>1034 GROVE ST</AddressLine1Txt>
          <CityNm>MEADVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16335</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.MMCHS.ORG</WebsiteAddressTxt>
        <StateLicenseNum>197101</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <OtherDesc>PHYSICIAN PRACTICES</OtherDesc>
        <FacilityReportingGroupCd>1</FacilityReportingGroupCd>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>B</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>12</FacilityNum>
        <FirstLicensedCYOrPYInd>false</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>false</TaxExemptHospitalCYOrPYInd>
        <CHNAConductedInd>true</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <PriorCHNAImpactInd>X</PriorCHNAImpactInd>
        <CHNAConductedYr>18</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>true</CHNAConductedWithOtherFcltsInd>
        <CHNAConductedWithNonFcltsInd>true</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>true</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>SEE PART V, SECTION C</OwnWebsiteURLTxt>
        <OtherWebsiteInd>X</OtherWebsiteInd>
        <OtherWebsiteURLTxt>SEE PART V, SECTION C</OtherWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <RptAvailableThruOtherMethodInd>X</RptAvailableThruOtherMethodInd>
        <ImplementationStrategyAdoptInd>true</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>18</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>true</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>SEE PART V, SECTION C</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>false</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
        <FPGFamilyIncmLmtFreeCarePct>300.</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>0.</FPGFamilyIncmLmtDscntCarePct>
        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
        <UnderinsuranceStatCriteriaInd>X</UnderinsuranceStatCriteriaInd>
        <ExplainedBasisInd>true</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>SEE PART V, SECTION C</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>SEE PART V, SECTION C</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>SEE PART V, SECTION C</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>false</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <OtherActionsTakenInd>X</OtherActionsTakenInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY INPUT: THE RESEARCH PROCESS INCLUDED A WIDE BASED SURVEY OF THE POPULATION. THE SURVEY INCLUDED INPUT FROM UNDERREPRESENTED GROUPS IN PUBLIC HOUSING. BOTH ELECTRONIC SURVEYS AND FACE TO FACE PAPER SURVEYS WERE COMPLETED. A GOOD DIVERSITY OF RESPONSE WAS REALIZED.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 6A</FormAndLineReferenceDesc>
        <ExplanationTxt>CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: MEADVILLE MEDICAL CENTER'S CHNA WAS CONDUCTED WITH ANOTHER HOSPITAL FACILITY, TITUSVILLE AREA HOSPITAL.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 6B</FormAndLineReferenceDesc>
        <ExplanationTxt>CHNA CONDUCTED WITH OTHER NON-HOSPITAL FACILITIES: THE CHNA REPORT WAS CONDUCTED WITH CRAWFORD HEALTH IMPROVEMENT COALITION AND ALLEGHENY COLLEGE.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>HOSPITAL FACILITY'S WEBSITE: HTTPS://WWW.MMCHS.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.A SPX</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>CHNA AVAILABLE ON OTHER WEBSITE: HTTPS://WWW.TITUSVILLEHOSPITAL.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH- NEEDS-ASSESSMENT.ASPX</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 7D</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER METHODS OF PROVIDING THE CHNA TO THE PUBLIC: OTHER METHODS IN WHICH MEADVILLE MEDICAL CENTER MADE ITS CHNA WIDELY AVAILABLE TO THE PUBLIC INCLUDED ITS ANNUAL MEETING OF THE CRAWFORD (COUNTY) HEALTH IMPROVEMENT COALITION, TELEVISING THE RESULTS OF THE REPORT ON LOCAL TELEVISION AND BROADCASTING THE RESULTS OF THE REPORT ON LOCAL RADIO STATIONS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 10B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://WWW.MMCHS.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.A SPX</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>ADDRESSING IDENTIFIED NEEDS: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED IN COLLABORATION BETWEEN MEADVILLE MEDICAL CENTER, TITUSVILLE AREA HOSPITAL AND ALLEGHENY COLLEGE LOOKED AT DATA COLLECTED FROM MORE THAN 1,100 ADULT PARTICIPANTS FROM ACROSS CRAWFORD COUNTY. ONLINE AND IN PERSON SURVEYS FOCUSED ON CANCER PREVENTION, WHICH SHOWED TO BE THE PRIMARY HEALTHCARE ISSUE IN THE 2015 CHNA. THE 2019 CHNA SHOWED THAT THE RATE OF CANCER INCIDENCE IN CRAWFORD COUNTY WAS HIGHER THAN BOTH THE COMMONWEALTH OF PENNSYLVANIA AND THE UNITED STATES, AT RATES OF 494.4 IN CRAWFORD COUNTY, 481.7 IN PENNSYLVANIA AND 441.2 NATIONWIDE PER 100,000 PEOPLE. LUNG CANCER IS 48% HIGHER THAN THE NATIONAL RATE, COLON CANCER IS 28% HIGHER, AND CERVICAL CANCER IS 20% HIGHER. THE MORTALITY RATE FROM CANCER IS ALSO HIGHER IN CRAWFORD COUNTY AT 183.5 PER 100,000, AS COMPARED TO PENNSYLVANIA WHICH IS 171.6 PER 100,000 AND NATIONWIDE AT 163.5 PER 100,000. THE LEADING RISK FACTORS FOR THE INCREASED RATE OF CANCER IN THE COUNTY IS A RESULT OF SMOKING, UNDERSTANDING HUMAN PAPILLOMAVIRUS (HPV) AND PREVENTATIVE SCREENINGS. 35% OF ALL RESPONDENTS REPORTED BEING A CURRENT OR FORMER SMOKER, WITH 70% OF THEM BEING BETWEEN THE AGES OF 18-54. TYPICALLY, THESE RESPONDENTS WERE ASSOCIATED WITH A LOWER LEVEL OF EDUCATION, LOWER RATES OF SCREENING AND/OR DID NOT HAVE A PRIMARY CARE PHYSICIAN. BETWEEN 2015 AND 2018 THE CHNA RESULTS SHOWED A 14% DECREASE IN THE NUMBER OF RESIDENTS REPORTING THEY HAVE A PRIMARY CARE PHYSICIAN. THE MEADVILLE MEDICAL CENTER HEALTH SYSTEM IS COMMITTED TO DECREASING THE RATE OF CANCER AMONG THE RESIDENTS OF CRAWFORD COUNTY BY INCREASING SMOKING CESSATION EDUCATION, INCREASING HPV VACCINATIONS AND CONNECTING RESIDENTS WITH PRIMARY CARE PHYSICIANS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, &amp; 16C</FormAndLineReferenceDesc>
        <ExplanationTxt>FAP, FAP APPLICATION, AND PLS WEBSITE: HTTP://WWW.MMCHS.ORG/PATIENT-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTAN CE.ASPX</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 20E</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER METHODS OF PUBLICIZING FINANCIAL ASSISTANCE POLICY: THE BILLING INVOICE OFFERS A PHONE NUMBER TO CALL FOR EXPLANATION OF THE FINANCIAL ASSISTANCE POLICY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>5</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>YOLANDA G BARCO ONCOLOGY CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>16792 CONNEAUT LAKE ROAD</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
          <FacilityTxt>ONCOLOGY CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>MIND BODY WELLNESS CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18201 CONNEAUT LAKE ROAD</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
          <FacilityTxt>WELLNESS CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>MEADVILLE DERMATOLOGY AND SKIN SURGERY</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>INSTITUTE 149 N MAIN ST</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
          <FacilityTxt>DERMATOLOGY</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>MEADVILLE PAIN MANAGEMENT</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1015 GROVE ST</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
          <FacilityTxt>PAIN MANAGEMENT</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>MEADVILLE SPORTS MEDICINE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>ONE VERNON PLACE</AddressLine1Txt>
            <CityNm>MEADVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16335</ZIPCd>
          </USAddress>
          <FacilityTxt>SPORTS MEDICINE, WORKPLACE HEALTH, LAB, RADIOLOGY</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7, COLUMN F</FormAndLineReferenceDesc>
        <ExplanationTxt>PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR USED WAS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6. OTHER IRS WORKSHEETS USED THE HOSPITAL'S COST ACCOUNTING SYSTEM, WHICH INCLUDED ALL PATIENT SEGMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HEALTH SYSTEM DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2021. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION A, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 WAS DETERMINED USING A MONTHLY AVERAGE OF PATIENTS ATTRIBUTABLE TO CHARITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION A, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION B, LINE 8</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. COST ACCOUNTING WAS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED ON LINE 6.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION C, LINE 9B</FormAndLineReferenceDesc>
        <ExplanationTxt>COLLECTION POLICY: FOR UNINSURED PATIENTS ELIGIBLE FOR DISCOUNTS FROM BILLED TO CHARGES, A MEDICAL ASSISTANCE APPLICATION CAN BE COMPLETED. ONCE COMPLETED, IT WILL BE REVIEWED FOR ELIGIBILITY. A CONTRACT FOR PAYMENT CAN BE NEGOTIATED WITH THE FACILITY'S COLLECTIONS PERSONNEL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>NEEDS ASSESSMENT: MEADVILLE MEDICAL CENTER COMPLETES A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT ON A REGULAR BASIS TO DETERMINE HEALTH CARE NEEDS. THE MOST RECENT PREVIOUS ASSESSMENT WAS COMPLETED IN 2019. MEADVILLE MEDICAL CENTER WORKS WITH MANY COMMUNITY PARTNERS INCLUDING; HEALTH AND HUMAN SERVICE PROVIDERS, EDUCATION, GOVERNMENT, FAITH, LAW ENFORCEMENT, AND OTHER INTERESTED PARTIES IN COMPLETING THE ASSESSMENT OF THE COMMUNITY HEALTH NEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS REVIEWED ACCORDING TO THE U.S. GOVERNMENT'S FEDERAL POVERTY GUIDELINES. MEADVILLE MEDICAL CENTER (MMC) OFFERS A VARIETY OF FINANCIAL ASSISTANCE PROGRAMS TO MEET THE NEEDS OF PATIENTS. PROGRAMS APPLY ONLY TO MEADVILLE MEDICAL CENTER HOSPITAL CHARGES. PATIENTS WILL RECEIVE A SEPARATE BILL FROM EACH INDEPENDENT PRACTITIONER, OR GROUPS OF PRACTITIONERS, FOR CARE, TREATMENT, OR SERVICES PROVIDED. THE MEADVILLE MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM DOES NOT APPLY TO THESE CHARGES. IN ADDITION TO THE MEADVILLE MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAMS, PATIENTS MAY ALSO BE ELIGIBLE FOR PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. APPLYING FOR SUCH PROGRAMS MAY BE REQUIRED PRIOR TO APPLYING FOR A MEADVILLE MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. MEADVILLE MEDICAL CENTER WILL ASSIST PATIENTS WITH STATE FUNDED PUBLIC PROGRAMS AND THE ENROLLMENT PROCESS. THE MEADVILLE MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAMS INCLUDE FOUR PROGRAMS: 1. UNINSURED FINANCIAL ASSISTANCE - AVAILABLE TO UNINSURED PATIENTS, OFFERS FREE CARE OR DISCOUNTED CARE BASED ON FAMILY SIZE AND INCOME ACCORDING TO THE ELIGIBILITY CRITERIA. 2. SELF-PAY DISCOUNT - AVAILABLE TO UNINSURED PATIENTS, OFFERS A 40% DISCOUNT, NO APPLICATION NECESSARY, DOES NOT APPLY TO MEDICARE, MEDICAID, BCBS AND OTHER INSURANCE/THIRD PARTY PAYER DEDUCTIBLE AND CO-INSURANCE AMOUNTS. 3. CATASTROPHIC DISCOUNT - AVAILABLE TO UNINSURED AND INSURED PATIENTS, LIMITS THE OUT-OF-POCKET COSTS WHEN MEDICAL DEBTS SPECIFIC TO MEDICAL CARE AT MEADVILLE MEDICAL CENTER EXCEED 25% OF THE PATIENT'S FAMILY GROSS INCOME. 4. PAYMENT PLAN PROGRAM - AVAILABLE TO UNINSURED AND INSURED PATIENTS, ASSISTS PATIENTS WITH THEIR FINANCIAL OBLIGATIONS BY ESTABLISHING PAYMENT ARRANGEMENTS. TO QUALIFY FOR FREE SERVICES (100% FINANCIAL ASSISTANCE) THE PATIENT'S HOUSEHOLD INCOME MUST BE AT OR BELOW 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY INFORMATION: MEADVILLE MEDICAL CENTER SERVES ANY PERSON IN NEED OF SERVICE, THE MAJORITY OF WHICH RESIDE IN CENTRAL AND WESTERN CRAWFORD COUNTY IN NORTHWESTERN PENNSYLVANIA, PRIMARILY A RURAL AREA. THE POPULATION OF THE PRIMARILY RURAL SERVICE AREA WAS 76,460. THE AREA HAS A HIGH RATE OF POVERTY, LOWER MEDIAN AND HOUSEHOLD INCOME, AND HIGHER RATE OF MEDICAL ASSISTANCE ELIGIBILITY THAN THE SURROUNDING AREAS AND THE STATE AND NATION AS A WHOLE. THE UNIQUE NEEDS OF THE COMMUNITY ARE CONSIDERED IN ALL PLANNING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>PROMOTION OF COMMUNITY HEALTH: MEADVILLE MEDICAL CENTER TAKES THE LEADERSHIP POSITION IN COMMUNITY BUILDING ACTIVITIES THAT PROMOTE HEALTH IN THE AREAS WE SERVE. WE ARE AN ACTIVE PARTICIPANT IN THE CRAWFORD (COUNTY) HEALTH IMPROVEMENT COALITION THAT ASSESSES NEEDS IN AN ONGOING BASIS AND INITIATES NEEDED INTERVENTIONS, MOST RECENTLY FREE FLU SHOTS TO ELDERLY AND LOW INCOME PERSONS. MEADVILLE MEDICAL CENTER SUPPORTS FINANCIALLY AND OPERATIONALLY THE MEADVILLE AREA FREE CLINIC WHICH PROVIDES PRIMARY CARE FOR PERSONS WITH NO HEALTH INSURANCE, MEDICARE OR MEDICAL ASSISTANCE. THE FREE CLINIC IS ALSO SUPPORTED BY THE UNITED WAY COMMUNITY FUND DRIVE AND WAS STARTED TO MEET A COMMUNITY NEED AS DETERMINED IN A PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT. SURPLUS FUNDS ARE INVESTED IN REPLACEMENT EQUIPMENT, NEW AND IMPROVED FACILITIES AND SERVICES TO THE COMMUNITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>AFFILIATED HEALTH CARE SYSTEM: THE PRIMARY PURPOSE OF THE HEALTH SYSTEM IS TO PROVIDE MEDICAL SERVICES TO THE LOCAL AND SURROUNDING COMMUNITIES THROUGH THE OPERATIONS OF THE MEDICAL CENTER, CHS, MPS AND HCC. THE MEDICAL CENTER IS A SOLE COMMUNITY HOSPITAL LOCATED IN MEADVILLE, PENNSYLVANIA, AND PROVIDES PRIMARY ACUTE CARE MEDICAL SERVICES. COMMUNITY HEALTH SERVICES PROVIDES VARIOUS OUTPATIENT SERVICES, SOME OF WHICH ARE FUNDED THROUGH GOVERNMENTAL GRANTS. MEADVILLE PHYSICIANS SERVICES IS COMPRISED OF PHYSICIAN PRACTICES LOCATED WITHIN CRAWFORD COUNTY, PENNSYLVANIA. HOME CARE CONNECTIONS HOLDS THE EQUITY INVESTMENT IN VANTAGE HOLDING COMPANY, LLC AND ORTHOPEDIC ASSOCIATES. THE MEADVILLE MEDICAL CENTER FOUNDATION WAS ESTABLISHED TO RECEIVE, ADMINISTER AND DISTRIBUTE FUNDS AND PROPERTY FOR THE BENEFIT AND SUPPORT OF THE HEALTH SYSTEM. MEADVILLE HOUSING CORPORATION IS A FOR-PROFIT COMPANY THAT RENTS RESIDENTIAL LIVING ACCOMMODATIONS AT TWO HOUSING SITES, BOTH OF WHICH ARE IN OR NEAR MEADVILLE, PENNSYLVANIA. NEEDS ARE ASSESSED AND PLANNING IS CONDUCTED CENTRALLY WITHIN THE ORGANIZATION WITH THE PARTICIPATION OF AFFILIATES. THE MEADVILLE HEALTH CENTER WAS OPENED TO ADDRESS GROWING NEED FOR MEDICAL CARE FOR PERSONS COVERED BY MEDICAL ASSISTANCE IN CENTRAL CRAWFORD COUNTY. TITUSVILLE AREA HEALTH CENTER, INC. AND AFFILIATES (HEALTH CENTER) CONSISTS OF TITUSVILLE AREA HEALTH CENTER, INC. (PARENT), TITUSVILLE AREA HOSPITAL (HOSPITAL), THE TITUSVILLE AREA HEALTH CENTER FOUNDATION (FOUNDATION) AND TITUSVILLE AREA HEALTH SERVICES, INC. (HEALTH SERVICES). THE HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA. THE FOUNDATION WAS ESTABLISHED TO RECEIVE, ADMINISTER AND DISTRIBUTE FUNDS AND PROPERTY FOR THE BENEFIT AND SUPPORT OF THE HEALTH CENTER AND AFFILIATES. HEALTH SERVICES OPERATES SEPARATELY FROM THE HOSPITAL OFFERING MULTISPECIALTY FAMILY MEDICINE PEDIATRICS TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleI documentId="IRS990ScheduleI">
      <GrantRecordsMaintainedInd>true</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>CITY OF MEADVILLE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>894 DIAMOND PARK</AddressLine1Txt>
          <CityNm>MEADVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16335</ZIPCd>
        </USAddress>
        <RecipientEIN>999999999</RecipientEIN>
        <IRCSectionDesc>GOVT</IRCSectionDesc>
        <CashGrantAmt>75000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>DISPENSARY OF HOPE LLC</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>2700 BRICK CHURCH PIKE</AddressLine1Txt>
          <CityNm>NASHVILLE</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>37207</ZIPCd>
        </USAddress>
        <RecipientEIN>581716804</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>7500</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>HOSPICE OF CRAWFORD COUNTY</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1034 GROVE STREET</AddressLine1Txt>
          <CityNm>MEADVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16335</ZIPCd>
        </USAddress>
        <RecipientEIN>251480565</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>170000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>3</Total501c3OrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, SCHEDULE I, PART I, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING USE OF GRANT FUNDS: THE ORGANIZATION DONATES TO CHARITABLE ORGANIZATIONS THAT RELATE TO THE ORGANIZATION'S HEALTH CARE MISSION. THESE DONATIONS ARE APPROVED THROUGH ADMINISTRATION ON A CASE BY CASE BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, SCHEDULE I, PART II, COLUMN B, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>MISSING EIN: CITY OF MEADVILLE FAILED TO PROVIDE AN EIN TO MEADVILLE MEDICAL CENTER. 99-9999999 HAS BEEN ENTERED IN COLUMN B TO ALLOW FOR THE E-FILING OF THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>true</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>true</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>true</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PHILIP PANDOLPH</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>521973</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>203529</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>3734</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>81777</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>37749</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>848762</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RENATO SUNTAY</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>327690</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>100990</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>4140</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>56383</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>25702</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>514905</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DENISE JOHNSON</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>380088</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>54896</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>913</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>29609</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>482606</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARYANN HEWSTON</PersonNm>
        <TitleTxt>CHIEF NURSE EXECUTIVE END 7/19</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>226339</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>19452</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2779</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>248570</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>VALERIE WAID</PersonNm>
        <TitleTxt>CHIEF NURSE EXECUTIVE</TitleTxt>
        <BaseCompensationFilingOrgAmt>231229</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>36800</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>331</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>16386</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>35034</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>319780</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JASON BROWN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>605712</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>40300</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>485</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>46516</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>710113</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BRIAN KARLOVITS</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>618549</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>598</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>34305</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>667702</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>HAKEEM SAM</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>710766</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>43723</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>745</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>15675</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>37006</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>807915</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>HAIBIN WANG</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>601153</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>99792</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>1003</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>38606</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>754804</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CALVIN HAN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>573194</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>40300</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>436</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>34756</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>665786</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>SEVERENACE PAYMENTS: MARYANN HEWSTON, FORMER CHIEF NURSE EXECUTIVE, RECEIVED A SEVERANCE PAYMENT OF $229,118.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING SCHEDULED 457(F) CONTRIBUTIONS WERE MADE ON BEHALF OF MEADVILLE MEDICAL CENTER EMPLOYEES: $ 64,677 PHILIP PANDOLPH $ 39,283 RENATO SUNTAY</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>NON-FIXED PAYMENTS: ALL ADMINISTRATIVE STAFF ARE ELIGIBLE TO RECEIVE, AT THE EMPLOYER'S DISCRETION, AN ANNUAL INCENTIVE BONUS AT THE END OF EACH FISCAL YEAR. THE MAXIMUM OPPORTUNITY FOR THE PARTICIPANTS AND AMOUNTS AWARDED ARE DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS BASED UPON THE ACCOMPLISHMENT OF SPECIFIC PERFORMANCE GOALS AND CRITERIA ESTABLISHED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD. PHYSICIANS HAVE THE POTENTIAL TO RECEIVE A QUARTERLY BONUS BASED ON WORK RELATIVE VALUE UNITS AS COMPUTED USING CMS RBRVS METHODOLOGY AND MUTUALLY AGREED UPON QUALITY METRICS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="IRS990ScheduleK">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CRAWFORD COUNTY HOSPITAL AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>251535164</BondIssuerEIN>
        <CUSIPNum>225004000</CUSIPNum>
        <BondIssuedDt>2016-11-16</BondIssuedDt>
        <IssuePriceAmt>74524579</IssuePriceAmt>
        <PurposeDesc>2016 DEBT REFI &amp; CAPITAL FUNDS</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CRAWFORD COUNTY HOSPITAL AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>251535164</BondIssuerEIN>
        <BondIssuedDt>2018-10-18</BondIssuedDt>
        <IssuePriceAmt>8000000</IssuePriceAmt>
        <PurposeDesc>FY 2019 CAPITAL FUNDS</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CRAWFORD COUNTY HOSPITAL AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>251535164</BondIssuerEIN>
        <BondIssuedDt>2019-12-04</BondIssuedDt>
        <IssuePriceAmt>7000000</IssuePriceAmt>
        <PurposeDesc>FY 2020 CAPITAL FUNDS</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CRAWFORD COUNTY HOSPITAL AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>251535164</BondIssuerEIN>
        <BondIssuedDt>2020-09-09</BondIssuedDt>
        <IssuePriceAmt>10000000</IssuePriceAmt>
        <PurposeDesc>FY 2021 CAPITAL FUNDS</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>0</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>74630397</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>1490492</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>6536100</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>16053919</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>50435068</OtherSpentProceedsAmt>
        <UnspentAmt>0</UnspentAmt>
        <SubstantialCompletionYr>2018</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>0</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>8000000</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>160000</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>0</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>7840000</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>0</OtherSpentProceedsAmt>
        <UnspentAmt>0</UnspentAmt>
        <SubstantialCompletionYr>2019</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>false</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <RetiredAmt>0</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>7000000</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>140000</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>0</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>6860000</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>0</OtherSpentProceedsAmt>
        <UnspentAmt>0</UnspentAmt>
        <SubstantialCompletionYr>2020</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>false</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <RetiredAmt>0</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>10000000</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>166806</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>0</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>9833194</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>0</OtherSpentProceedsAmt>
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        <SubstantialCompletionYr>2021</SubstantialCompletionYr>
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        <BondReferenceCd>A</BondReferenceCd>
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      </TaxExemptBondsPrivateBusUseGrp>
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        <RemedialActionTakenInd>false</RemedialActionTakenInd>
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      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>true</RebateNotDueYetInd>
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        <NoRebateDueInd>false</NoRebateDueInd>
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        <GICProviderName>
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        </GICProviderName>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
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        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART II, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>TOTAL PROCEEDS OF ISSUE: ISSUE PRICE OF $74,524,579 REPORTED ON PART I, LINE A DOES NOT AGREE TO TOTAL PROCEEDS OF ISSUE OF $74,630,397 REPORTED ON PART II, LINE 3 DUE TO THE INCLUSION OF INVESTMENT INCOME ON PROCEEDS DURING THE PROJECT PERIOD.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, SECTION I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>VOLUNTEERS: MEADVILLE MEDICAL CENTER VOLUNTEERS DONATED OVER 40,000 HOURS IN THE PAST YEAR ASSISTING IN VARIOUS AREAS THROUGHOUT THE FACILITY. DUTIES INCLUDE BUT ARE NOT LIMITED TO TASKS SUCH AS TRANSPORTING AND ESCORTING PATIENTS, DELIVERING FLOWERS AND MAIL, PERFORMING CLERICAL DUTIES, ASSISTING IN THE COFFEE &amp; GIFT SHOPS, HANDING OUT BEEPERS IN THE SURGICAL FAMILY WAITING AREA AND MANNING THE INFORMATION DESKS, TO NAME A FEW. WE RECOGNIZE OUR VOLUNTEERS WITH VARIOUS ACTIVITIES THROUGHOUT VOLUNTEER WEEK INCLUDING A RECEPTION AND RECOGNITION GIFT, IN ADDITION TO A YEARLY CHRISTMAS RECEPTION. WE RECOGNIZE THE DEDICATION AND IMPORTANCE OF OUR VOLUNTEERS, AND READILY WELCOME NEW ADDITIONS TO OUR VOLUNTEER WORKFORCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>PROGRAM SERVICE ACTIVITY #1: INPATIENT ACUTE CARE IS THE SYSTEM OF CARE RESERVED AND PROVIDED FOR PATIENTS WHOSE MEDICAL CONDITIONS NECESSITATE THEIR STAY IN A TREATMENT FACILITY WHILE UNDERGOING TREATMENT. PATIENTS SUFFERING FROM DISEASE OR RECOVERING FROM INJURY OR INVASIVE SURGERY TYPICALLY MAKE UP THE LARGEST GROUP OF INPATIENT ACUTE PATIENTS. CONDITIONS UNDER THIS GROUP INCLUDE WOUND CARE, AMPUTEE SERVICES, STROKES AND OTHER TRAUMATIC BRAIN INJURIES, ARTHRITIS AND CANCER. INPATIENT CARE CAN BE QUITE EXPENSIVE FOR PATIENTS. THE FUNDING IS PROVIDED BOTH BY PATIENTS' INSURANCE POLICIES AS WELL AS GOVERNMENT SUBSIDY TO THE CENTER'S BUDGET.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>PROGRAM SERVICE ACTIVITY #2: AT THE ONCOLOGY INSTITUTE, MEADVILLE MEDICAL CENTER IS COMMITTED TO YOUR TOTAL CARE AND SUPPORT. OUR TEAM OF HEALTH CARE PROFESSIONALS ARE EXPERTS IN COUNSELING AND EDUCATING PATIENTS, HELPING THEM UNDERSTAND AND COPE WITH THEIR ILLNESS AND THE TREATMENTS. WE ENCOURAGE PATIENTS TO PARTICIPATE AS MUCH AS POSSIBLE IN THEIR ON-GOING CARE. CARE IS COORDINATED BY AN INTERDISCIPLINARY TEAM OF PROFESSIONALS. THIS TEAM INCLUDES THE FAMILY PHYSICIAN, SURGEONS, MEDICAL AND RADIATION ONCOLOGISTS, NURSES, SOCIAL WORKERS, A FINANCIAL NAVIGATOR, AND OTHER SUPPORT STAFF. CANCER CARE CONFERENCES ARE HELD ON A WEEKLY BASIS AS A FORMALIZED REVIEW AND DISCUSSION. THIS OFFERS AN OPPORTUNITY FOR MULTI-DISCIPLINARY STAFF TO COMMUNICATE IN REFERENCE TO PATIENTS TREATMENT WHILE FOCUSING ON EXISTING OR POTENTIAL CARE CONCERNS FOR PATIENTS WHO ARE UNDERGOING TREATMENT. OUR PHYSICIANS SPECIALIZING IN THE CARE OF CANCER ARE BOARD CERTIFIED MEDICAL ONCOLOGISTS/HEMATOLOGISTS AND BOARD CERTIFIED RADIATION ONCOLOGISTS. THE YOLANDA G. BARCO ONCOLOGY INSTITUTE EMPLOYS FOUR FULL TIME AND THREE PART TIME ONCOLOGIST/HEMATOLOGISTS, ONE PHYSICIAN ASSISTANT, AND ONE FULL TIME AND ONE PART TIME RADIATION ONCOLOGISTS. PATIENTS AT THE YOLANDA G. BARCO ONCOLOGY INSTITUTE ARE CARED FOR BY A MULTI-DISCIPLINARY TEAM CONSISTING OF REGISTERED NURSES WHO ARE CERTIFIED IN ONCOLOGY: NURSE NAVIGATORS, PHYSICISTS, MEDICAL DOSIMETRISTS, REGISTERED RADIATION THERAPISTS, A TUMOR REGISTRAR; LABORATORY TECHNICIANS, PHARMACISTS SPECIALIZING IN ONCOLOGY ALONG WITH PHARMACY TECHNICIANS, A SOCIAL WORKER AND FINANCIAL NAVIGATOR, A TRANSPORTATION SPECIALIST, AND A VARIETY OF CLERICAL AND SUPPORT STAFF. MEADVILLE MEDICAL CENTER PROVIDES STATE-OF-THE-ART DIAGNOSTIC FACILITIES. COMPUTERIZED TOMOGRAPHY (CT) SCANNING AND PET SCANNING TECHNOLOGY ARE AVAILABLE TO HELP DETECT CANCER IN ITS EARLIEST STAGES AND/OR DIAGNOSE THE EXTENT OF THE CANCER. DIGITAL SERVICES ARE PROVIDED FOR SCREENING AND DIAGNOSTIC MAMMOGRAPHY, BREAST ULTRASOUND, AS WELL AS SAME DAY ULTRASOUND GUIDED BREAST PROCEDURES. MAMMOGRAPHY AND ULTRASOUND AT MMC FACILITIES ARE ACCREDITED BY THE ACR. A BREAST NURSE NAVIGATOR IS BASED AT YOLANDA G. BARCO ONCOLOGY INSTITUTE TO ASSIST PATIENTS THROUGH BREAST BIOPSIES AND TREATMENT PROCESSES. MMC IS PROUD TO OFFER 3D TOMOSYNTHESIS WHICH IS ALSO KNOW AS 3D MAMMOGRAPHY. 3D TOMOSYNTHESIS IS MORE SENSITIVE IN DETECTING INVASIVE CANCERS THAT MAY BE MISSED BY TRADITIONAL MAMMOGRAPHY. THIS TYPE OF TESTING REDUCES THE NEED FOR PATIENTS TO COME BACK FOR REPEAT OR ADDITIONAL IMAGES. THE TRILOGY STEREOTACTIC SYSTEM FROM VARIAN MEDICAL SYSTEMS IS AN ADVANCED, SOPHISTICATED RADIATION DELIVERY MACHINE. AS A LEADING IMAGE-GUIDED RADIOTHERAPY (IGRT) SYSTEM, TRILOGY MARKS THE BEGINNING OF A NEW GENERATION OF CANCER CARE. RADIOTHERAPY CAN BE USED TO TREAT MANY DIFFERENT TYPES OF CANCER, WHICH MEANS THAT SOME PATIENTS CAN BE SPARED THE INVASIVE TECHNIQUES OF SURGERY AND/OR CHEMOTHERAPY. MEADVILLE MEDICAL CENTER AND OUR PHYSICIANS RECOGNIZE THE IMPORTANCE OF EARLY DETECTION IN CANCER CARE. TO SUPPLEMENT YOUR ANNUAL PHYSICAL EXAMINATION WE OFFER PROGRAMS SUCH AS LOW COST MAMMOGRAPHY, PERIODIC FREE SCREENINGS FOR CANCERS SUCH AS PROSTATE AND SKIN, AND SPECIAL EDUCATIONAL PROGRAM AND/OR MATERIAL ON MANY TYPES OF CANCER. IN ADDITION TO PROVIDING THE HIGHEST QUALITY MEDICAL CARE, THE PROFESSIONAL SUPPORT STAFF IS PREPARED TO DEAL WITH THE PHYSICAL, PSYCHOLOGICAL AND SOCIAL CONSEQUENCES THAT MAY ARISE AS THE RESULT OF CANCER OR ITS TREATMENT. A SOCIAL WORKER AND FINANCIAL NAVIGATOR WORK ALONG WITH NURSE NAVIGATORS TO PROVIDE GUIDANCE AND ASSIST PATIENTS UPON INITIAL CONSULTATION AT YOLANDA G. BARCO ONCOLOGY INSTITUTE AND THROUGHOUT THEIR JOURNEY. ARRANGEMENTS CAN BE MADE THROUGH MEADVILLE MEDICAL CENTER TO PROVIDE PSYCHO-SOCIAL, NUTRITIONAL, AND PASTORAL CARE FOR PATIENTS. THERAPEUTIC DIETICIANS PROVIDE PRIVATE CONSULTATION TO ASSIST WITH SPECIAL NUTRITIONAL NEEDS. PHARMACISTS, LABORATORY TECHNICIANS, AND OTHERS ARE ALSO AVAILABLE TO ASSIST IN PROVIDING THE TOTAL CARE OF OUR PATIENTS AND THEIR FAMILIES. AT THE HEART OF THE WHOLE-PERSON APPROACH TO HEALTH AND WELLNESS, THE YOLANDA G. BARCO ONCOLOGY INSTITUTE PROVIDES COORDINATED CONSULTATIONS FOR COUNSELING AS WELL AS STRESS REDUCTION OPPORTUNITIES IN THE FORM OF ART OR CRAFTS. AN INNOVATIVE KEYBOARD KNOWN AS THE CLAVINOVA, DEVELOPED BY YAMAHA, ALLOWS PATIENTS WITH NO MUSICAL EXPERIENCE TO SIMPLY FOLLOW KEYBOARD LIGHTS FOR SPECIALLY ARRANGED MUSICAL COMPOSITIONS. THIS MUSICAL "DIVERSION" WILL HELP THEM RELAX AND, AS ONGOING RESEARCH SUGGESTS, REVERSE THE DNA SWITCHES THAT LITERALLY TURN ON THE HUMAN STRESS RESPONSE. ALSO AVAILABLE ARE SERVICES THAT PROMOTE "WHOLE BODY HEALING" - MASSAGE THERAPY, YOGA, EXERCISE CLASSES, MEDITATION, MUSIC THERAPY, NUTRITIONAL COUNSELING, PAIN MANAGEMENT AND SUPPORT GROUPS. DOCTORS SAY THESE LIFESTYLE, BEHAVIOR, DIET, AND OVERALL WELLNESS PROGRAMS WILL HELP PATIENTS BE MORE PRO-ACTIVE IN THEIR CANCER JOURNEY AND SURVIVORSHIP.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4C</FormAndLineReferenceDesc>
        <ExplanationTxt>PROGRAM SERVICE ACTIVITY #3: OVER 70 PERCENT OF SURGERIES ARE DONE ON AN OUTPATIENT BASIS; AND OUTPATIENT SURGERY REMAINS A CONVENIENT, COST-SAVING ALTERNATIVE TO HOSPITAL ADMISSION FOR PATIENTS UNDERGOING CERTAIN PROCEDURES. THESE PATIENTS ARE PROVIDED WITH QUALITY CARE AND SAFETY, PLUS THE AVAILABILITY OF COMPLETE HOSPITAL FACILITIES AND SERVICES IF NEEDED. IN RECENT YEARS THE TREND IS MINIMALLY INVASIVE SURGERY WHICH HELPS PATIENTS TO RECOVER MUCH FASTER, SUFFER LESS PAIN AND RETURN TO WORK MORE QUICKLY. THE HOSPITAL RECENTLY ADDED THE SURGERY CENTER AT GROVE, A NEW WING AT THE GROVE STREET FACILITY THAT BRINGS ALL OUTPATIENT SURGERY AND PROCEDURES TO ONE CONVENIENT, PATIENT- AND FAMILY-FRIENDLY LOCATION ON ONE FLOOR. MOST FREQUENT SURGICAL CASES PERFORMED AT MMC ARE: ORTHOPEDIC -TOTAL HIP REPLACEMENT -TOTAL KNEE REPLACEMENT -JOINT REPLACEMENT -CERVICAL DISCECTOMY WITH FUSION -LUMBAR LAMINECTOMY WITH FUSION (LAPAROSCOPIC, OPEN, AND INNER BODY) -BACK IMPLANT FOR LUMBAR SPINAL FUSION -SHOULDER REPAIR (ARTHROSCOPIC AND OPEN) -KNEE ARTHROSCOPY -HIP AND ANKLE FRACTURES -CARPAL TUNNEL RELEASE -GANGLION CYST EXCISION EYE SURGERY -CATARACT EXTRACTION WITH INTRAOCULAR LENS IMPLANT -TEAR DUCT PROBING AND IRRIGATION -BLEPHAROPLASTY GENERAL SURGERY -LAPAROSCOPIC PROCEDURES (GALL BLADDER, HERNIA, APPENDECTOMY) -OPEN PROCEDURES (GALL BLADDER, HERNIA, APPENDECTOMY) -BREAST BIOPSY -MASTECTOMY -HEMORRHOIDECTOMY OB-GYN -HYSTERECTOMY -ABDOMINAL/VAGINAL (OPEN AND LAPAROSCOPIC ASSISTED) -D &amp; C -ENDOMETRIAL ABLATION -HYSTEROSCOPY -LAPAROSCOPIC TUBAL OCCLUSION -C-SECTION -COLD CONE BIOPSY OF CERVIX VASCULAR SURGERY -INSERTION OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE PLASTIC SURGERY -BREAST REDUCTION -BREAST AUGMENTATION -LIPOSUCTION -LASER THERAPY OF BIRTHMARKS AND PORT WINE STRAINS -RHINOPLASTY PODIATRY -BUNIONECTOMY -HAMMERTOE CORRECTION -ANKLE STABILIZATION UROLOGY -LITHOTRON -ESWL -LASER LITHOTRIPSY -CYSTOSCOPY -VASECTOMY -DIAGNOSTIC LAPAROSCOPY -TURP, TURBT</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER PROGRAM SERVICE ACTIVITIES: MMC OPERATES AN INTENSIVE CARE UNIT. THE INTENSIVE CARE UNIT AT MEADVILLE MEDICAL CENTER IS A 12-BED INTENSIVE CARE UNIT THAT SUPPORTS THE CARDIAC, SURGICAL, AND MEDICAL INTENSIVE CARE PATIENTS. IN ADDITION, A 16-BED TELEMETRY STEP-DOWN NURSING UNIT IS LOCATED ADJACENT TO THE ICU. PATIENTS WITH CARDIAC PROBLEMS ARE MONITORED FROM THEIR ROOMS; WITH THE MOST SOPHISTICATED MONITORING EQUIPMENT AVAILABLE. PHYSICIANS ADMIT THOSE PATIENTS TO THE INTENSIVE CARE UNIT (ICU) WHOM THEY FEEL REQUIRE SPECIALIZED NURSING CARE AFTER SURGERY, AN ILLNESS, OR SOME OTHER SERIOUS MEDICAL CONDITION. AN ICU IS DESIGNED TO PROVIDE 24-HOUR CONCENTRATED MEDICAL AND NURSING CARE TO HELP BRING THE SERIOUSLY ILL PATIENT THROUGH THE CRITICAL PERIOD OF RECOVERY. PATIENTS IN THE ICU ARE TRANSFERRED TO A REGULAR NURSING UNIT WHEN THEIR PHYSICIANS FEEL THAT THE CRITICAL STAGE OF ILLNESS HAS PASSED. IN THE ICU, CONSTANT OBSERVATION AND INDIVIDUALIZED NURSING CARE ARE PROVIDED TO ASSURE THAT THE PATIENT IS COMFORTABLE AND RECEIVES THE BEST IN SKILLED NURSING CARE. THE HIGHLY SKILLED NURSING PERSONNEL WHO STAFF OUR UNIT ARE CERTIFIED CRITICAL CARE REGISTERED NURSES, AND THEY UTILIZE THE LATEST MONITORING AND LIFE-SAVING EQUIPMENT. THIS ATTENTIVE STAFF OF PROFESSIONAL NURSES ENSURES THAT ALL PATIENTS ARE CLOSELY OBSERVED, AND CARED FOR, 24 HOURS A DAY. THE ORGANIZATION ALSO PROVIDES A VARIETY OF OTHER SERVICES, INCLUDING THE FOLLOWING: -MIND BODY WELLNESS CENTER -20 BED INPATIENT PSYCHIATRIC UNIT -22 BED INPATIENT DRUG AND ALCOHOL UNIT -32 BED SKILLED NURSING UNIT -11 BED REHAB UNIT ADDITIONALLY, THE ORGANIZATION DONATES TO CHARITABLE ORGANIZATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART V, LINE 1A, 2A, AND 2B AND PART IX, LINES 5-10</FormAndLineReferenceDesc>
        <ExplanationTxt>REPORTING AGENT: MEADVILLE MEDICAL CENTER (MMC) FILES ALL INFORMATIONAL RETURNS AND EMPLOYMENT TAX RETURNS ON ON BEHALF OF ITS RELATED ORGANIZATIONS. THE TOTAL NUMBER OF 1099S AND W-2S REPORTED ON LINES 1A AND 2A, RESPECTIVELY, INCLUDES THE FORMS FILED ON BEHALF OF THESE RELATED ORGANIZATIONS. THE COMPENSATION, EMPLOYEE BENEFITS AND PAYROLL TAXES AMOUNTS REPORTED ON EACH ORGANIZATIONS' FORM 990, PART IX, LINES 5-10 ARE ALLOCATED TO THE ORGANIZATIONS FOR THE AMOUNT THAT REPRESENTS WORK PERFORMED FOR THE ORGANIZATION. THEREFORE, THE AMOUNT REPORTED ON PART IX, LINES 5-10 OF MMC'S FORM 990 INCLUDES ONLY THOSE AMOUNTS ALLOCATED TO WORK PERFORMED DIRECTLY FOR MMC. THE HIGHEST PAID EMPLOYEES ARE DETERMINED BY THE WORK PERFORMED FOR EACH ORGANIZATION. THEREFORE, THE FIVE HIGHEST PAID EMPLOYEES LISTED ON PART VII AND SCHEDULE J ARE THOSE EMPLOYEES WHO WORK DIRECTLY FOR MMC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6, 7A, &amp; 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>MEMBERS: MEMBERS ARE ELECTED BY THE MEMBERS OF THE CORPORATION, SERVE A TERM OF FIVE YEARS, AND MAY SERVE AN UNLIMITED NUMBER OF TERMS. MEMBERS HAVE SUCH POWERS AND DUTIES AS ARE SET FORTH IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW OF 1988 (NPCL). PART OF THE RESPONSIBILITY OF THE MEMBERS IS TO ELECT THE DIRECTORS AT THEIR ANNUAL MEETING AFTER NOMINATION HAS BEEN COMPLETED. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO ADOPT, AMEND, AND REPEAL ANY ARTICLE AND/OR BYLAW SUBJECT TO THE POWER OF THE MEMBERS TO CHANGE SUCH ACTION. THE MEMBERS RETAIN THE EXCLUSIVE RIGHT TO ADOPT, AMEND, AND REPEAL ANY BYLAW OR ARTICLE ON ANY SUBJECT ENUMERATED IN SECTION 5504(B) OF THE NPCL. ANY PERSON WHO HAS SERVED AS A MEMBER OF THIS CORPORATION MAY, IN THE DISCRETION OF THE BOARD OF DIRECTORS, BE ELECTED TO THE STATUS OF A MEMBER EMERITUS. ALL MEMBERS EMERITUS SHALL HAVE THE RIGHT TO PARTICIPATE IN THE AFFAIRS OF THE CORPORATION IN THE SAME MANNER AS MEMBERS OF THE CORPORATION AS DEFINED IN ARTICLE III OF THE BYLAWS, BUT SHALL NOT BE SUBJECT TO THE FOLLOWING PROVISIONS OF ARTICLE III OF THE BYLAWS. (A) RE-ELECTION ON A FIVE-YEAR BASIS UNDER SECTION 3.1 OF THE BYLAWS. MEMBERS EMERITUS SHALL CONTINUE IN PERPETUITY DURING THEIR LIFETIME, OR UNTIL THEIR SPECIFIC RESIGNATION. (B) SECTION 3.4(A), WHICH PROVIDES FOR REMOVAL IN THE EVENT OF FAILURE TO ATTEND FOUR CONSECUTIVE MEETINGS WITHOUT A JUSTIFIABLE EXCUSE. MEMBERS EMERITUS WILL NOT BE REQUIRED TO ATTEND MEETINGS IN ORDER TO MAINTAIN THEIR STATUS. MEMBERS EMERITUS ARE NOT ENTITLED TO VOTE AND ARE NOT COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM UNDER ARTICLE IV, SECTION 4.3 OF THE BYLAWS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>REVIEW OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF MEADVILLE MEDICAL CENTER. THE 990 IS INITIALLY INTERNALLY REVIEWED IN-DEPTH BY THE CEO, CFO, AND CONTROLLER. AFTER CHANGES ARE MADE FROM THIS REVIEW, THE 990 IS PLACED ON A WEB PORTAL WHERE EACH BOARD MEMBER HAS THE OPPORTUNITY TO REVIEW AND ASK QUESTIONS OR SUGGEST CHANGES BEFORE FILING. AFTER ALL QUESTIONS AND SUGGESTIONS ARE CONSIDERED, THE FORM 990 IS ELECTRONICALLY FILED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION HAS AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. ANY ACTUAL OR POTENTIAL CONFLICTS ARE EVALUATED AND DEEMED TO EITHER MAKE THE INTERESTED PERSON DISQUALIFIED OR INELIGIBLE TO SERVE. THROUGHOUT THE YEAR, EACH AFFECTED PERSON IS ALSO OBLIGATED TO FILE A SUPPLEMENTARY DISCLOSURE STATEMENT IF THERE IS A CHANGE IN CIRCUMSTANCES WHICH COULD CREATE CONFLICT. DETERMINATION OF ACTUAL CONFLICT WILL BE CONDUCTED BY THE BOARD OF DIRECTORS. ANY DIRECTOR, OFFICER OR DISQUALIFIED PERSON WHO IS DEEMED BY THE BOARD TO BE DISQUALIFIED BECAUSE OF AN ACTUAL OR APPARENT CONFLICT OF INTEREST ON ANY MATTER (I) SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, (II) SHALL ABSTAIN FROM VOTING (ALTHOUGH UPON INVITATION OF THE CHAIRMAN, HE OR SHE MAY PARTICIPATE IN BOARD DISCUSSIONS) AND (III) SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHEN PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE EFFECT ON THE QUORUM. AN INDIVIDUAL WHO HAS A RELATIONSHIP WITH AN ENTITY THAT IN THE BOARD'S VIEW MAKES IT DIFFICULT OR IMPOSSIBLE FOR THAT INDIVIDUAL OR ANY OF THE REMAINING DIRECTORS TO DISCHARGE HIS OR HER RESPONSIBILITIES MAY BE DECLARED INELIGIBLE TO SERVE AND SHALL EITHER RESIGN OR MAY BE REMOVED BY A MAJORITY VOTE OF ALL REMAINING DIRECTORS IN OFFICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A &amp; 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION REVIEW: THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEADVILLE MEDICAL CENTER (MMC), WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, MERCER, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES AND REPORTS ITS DECISIONS TO THE FULL BOARD OF DIRECTORS. THE MOST RECENT COMPENSATION REVIEW WAS PERFORMED IN JUNE 2021.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENT DISCLOSURE: UPON REQUEST, PHOTOCOPIES OF GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PICKUP BY THE REQUESTING PERSON.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, SECTION A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION OF OFFICERS: JODI MAXFIELD SERVES AS THE MEDICAL STAFF PRESIDENT BUT DOES NOT RECEIVE COMPENSATION FOR THIS ROLE. JODI ALSO SERVES AS SURGERY MEDICAL DIRECTOR AND IS COMPENSATED FOR THIS POSITION. HER COMPENSATION FOR THIS ROLE HAS BEEN LISTED IN COLUMNS (D) AND (F).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER CHANGES IN NET ASSETS: $ 10,896,220 CHANGE IN DEFINED BENEFIT PENSION PLAN (2,216,408) TRANSFERS TO RELATED PARTIES 6,227,688 CHANGE IN INTEREST OF TITUSVILLE AREA HEALTH CENTER 796,789 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST ------------- $ 15,704,289</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PURCHASED SERVICES TOTAL FEES:22469040</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PHYSICIAN PROFESSIONAL FEES TOTAL FEES:1798733</ExplanationTxt>
      </SupplementalInformationDetail>
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      <DivRelatedOrganizationInd>true</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
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      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
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        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>24700</InvolvedAmt>
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</Return>
