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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>KATHY S LANDRETH</PersonNm>
        <TitleTxt>DIRECTOR - TERM ENDED APRIL 2020</TitleTxt>
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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>CHANDLER EWING</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ANDREW T MUELLER</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY A ZWEIFEL</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TIM MCMANUS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALFRED E PILONG</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID S CASHWELL</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT D RUCHTI</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>L STEPHEN JONES</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK NANTZ</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOANNE INMAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEFF LINGERFELT</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTOPHER S BAILEY</PersonNm>
        <TitleTxt>EXECUTIVE VICE PRESIDENT</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <OtherCompensationAmt>59244</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>BRENT RAWLINGS</PersonNm>
        <TitleTxt>VICE PRESIDENT &amp; GENERAL COUNSEL</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ABRAHAM SEGRES</PersonNm>
        <TitleTxt>VICE PRES. QUALITY/PATIENT SAFETY</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ELIZABETH MCNAMEE</PersonNm>
        <TitleTxt>CHIEF FINANCIAL &amp; HR OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES ANDREWS</PersonNm>
        <TitleTxt>VICE PRESIDENT OF FINANCIAL POLICY</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>40958</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>1992279</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>322704</TotalOtherCompensationAmt>
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      <ContractorCompensationGrp>
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          <BusinessName>
            <BusinessNameLine1Txt>SELLERS DORSEY &amp; ASSOCIATES</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1635 MARKET ST SUITE 301</AddressLine1Txt>
            <CityNm>PHILADELPHIA</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19103</ZIPCd>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TROUTMAN SANDERS</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23219</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>REVIVE PUBLIC RELATIONS</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MARION CLINEDINST</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>23 LISA LN</AddressLine1Txt>
            <CityNm>STANDARDSVILLE</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>22973</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BDO</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>300 ARBORETUM PLACE 520</AddressLine1Txt>
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            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23236</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <GovernmentGrantsAmt>6291548</GovernmentGrantsAmt>
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      <TotalContributionsAmt>7174199</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>MEMBERSHIP DUES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>4833584</TotalRevenueColumnAmt>
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        <Desc>MUTUAL ASSISTANCE PROGRAM</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>412986</RelatedOrExemptFuncIncomeAmt>
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        <Desc>HIIN CONTRACT REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>153118</RelatedOrExemptFuncIncomeAmt>
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        <ExclusionAmt>392060</ExclusionAmt>
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        <ExclusionAmt>462425</ExclusionAmt>
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        <TotalRevenueColumnAmt>-41220</TotalRevenueColumnAmt>
        <ExclusionAmt>-41220</ExclusionAmt>
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        <BusinessCd>518210</BusinessCd>
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        <BusinessCd>561000</BusinessCd>
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        <Desc>OTHER</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>14667</RelatedOrExemptFuncIncomeAmt>
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        <EOYAmt>461665</EOYAmt>
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        <EOYAmt>3034082</EOYAmt>
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        <EOYAmt>16962982</EOYAmt>
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      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
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      <FSAuditedInd>1</FSAuditedInd>
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      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
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    <IRS990ScheduleB documentId="RetDoc1234500001">
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          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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      <OnlyInHouseLobbyingInd>0</OnlyInHouseLobbyingInd>
      <AgreeCarryoverPriorYearInd>0</AgreeCarryoverPriorYearInd>
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      <NonDeductibleLbbyngPltclCYAmt>925099</NonDeductibleLbbyngPltclCYAmt>
      <NonDedLbbyngPltclCyovAmt>156407</NonDedLbbyngPltclCyovAmt>
      <NonDeductibleLbbyngPltclTotAmt>1081506</NonDeductibleLbbyngPltclTotAmt>
      <AggregateReportedDuesNtcAmt>1246581</AggregateReportedDuesNtcAmt>
      <TaxableAmt>-165075</TaxableAmt>
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    <IRS990ScheduleD documentId="RetDoc1040000001">
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        <BookValueAmt>661127</BookValueAmt>
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      <BuildingsGrp>
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        <DepreciationAmt>2482157</DepreciationAmt>
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      <TotalBookValueLandBuildingsAmt>3809539</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENT IN VHSSC</Desc>
        <BookValueAmt>1681892</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
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      <TotalBookValueSecuritiesAmt>1681892</TotalBookValueSecuritiesAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>VHHA IS A SECTION 501(C)(6). IT IS EXEMPT FROM INCOME TAXES UNDER THE INTERNAL REVENUE CODE AND THE TAX STATUTES OF THE COMMONWEALTH OF VIRGINIA; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OF LIABILITY FOR FEDERAL AND STATE INCOME TAXES. VHHA HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2020. VHHA IS SUBJECT TO TAX ON ANY UNRELATED BUSINESS INCOME THAT IT MAY GENERATE. VHHA REPORTED NO UNRELATED BUSINESS INCOME FOR THE YEAR ENDED SEPTEMBER 30, 2020.</ExplanationTxt>
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    </IRS990ScheduleD>
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      <ClubDuesOrFeesInd>X</ClubDuesOrFeesInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>0</SubstantiationRequiredInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>1</SupplementalNonqualRtrPlanInd>
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        <PersonNm>SEAN T CONNAUGHTON</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <BaseCompensationFilingOrgAmt>623755</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>106875</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>31722</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>16716</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>779068</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRISTOPHER S BAILEY</PersonNm>
        <TitleTxt>EXECUTIVE VICE PRESIDENT</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>57000</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>439454</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BRENT RAWLINGS</PersonNm>
        <TitleTxt>VICE PRESIDENT &amp; GENERAL COUNSEL</TitleTxt>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>53803</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>361286</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ABRAHAM SEGRES</PersonNm>
        <TitleTxt>VICE PRES. QUALITY/PATIENT SAFETY</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <PersonNm>ELIZABETH MCNAMEE</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JAMES ANDREWS</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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        <FormAndLineReferenceDesc>PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>VHHA HAS A RESTRICTIVE BONUS PLAN IN PLACE FOR THE CEO AND EVP. EACH RECEIVES AN AMOUNT EQUAL TO 10% OF THEIR COMPENSATION TO PAY PREMIUMS ON A LIFE INSURANCE POLICY IN THEIR NAMES AS WELL AS THE RELATED TAX WITHHOLDING. THE PREMIUMS WERE EQUAL TO 75% OF THE PAYMENT AND THE OTHER 25% WAS TREATED AS TAX WITHHOLDING FOR THEM. VHHA PAYS $33/MO TOWARD A MEMBERSHIP AT A FITNESS CLUB FOR ALL BENEFITS ELIGIBLE STAFF. THE BENEFIT IS NOT TREATED AS TAXABLE COMPENSATION.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ASSOCIATION CONTRACTS WITH A RELIABLE AND REPUTABLE CONSULTANT WHO REVIEWS APPROPRIATE COMPARATIVE DATA FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PRESIDENT/CEO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. NO CONTRIBUTIONS WERE MADE TO THE PLAN DURING THE TAX YEAR. THREE HIGHEST COMPENSATED EMPLOYEES (SR. VP AND GENERAL COUNSEL, VP OF GOVERNMENT AFFAIRS AND VP OF QUALITY/SAFETY) ALSO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CONTRIBUTIONS OF $27,800, $16,724 AND $21,202 RESPECTIVELY WERE MADE DURING THE TAX YEAR ON THEIR BEHALF.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CORPORATION SHALL HAVE TWO CLASSES OF MEMBERS WHICH SHALL BE KNOWN AS INSTITUTIONAL MEMBERS AND INDIVIDUAL MEMBERS. THERE SHALL BE THE FOLLOWING TYPES OF INSTITUTIONAL MEMBERS: (A) TYPE I SHALL INCLUDE HOSPITALS (GENERAL, NON-GOVERNMENTAL PSYCHIATRIC AND SPECIAL FACILITIES) WHICH PROVIDE INPATIENT CARE AND HEALTH DELIVERY SYSTEMS. THE BOARD OF DIRECTORS SHALL DETERMINE WHETHER PARTICULAR FACILITIES OR ORGANIZATIONS QUALIFY FOR MEMBERSHIP AS PROVIDED FOR IN THE BYLAWS OF THE CORPORATION. (B) TYPE II SHALL INCLUDE ALL OTHER HEALTH CARE ORGANIZATIONS INELIGIBLE FOR TYPE I MEMBERSHIP, INCLUDING WITHOUT LIMITATION FEDERAL AND STATE LONG-TERM CARE FACILITIES, DISPENSARIES, CLINICS AND SIMILAR ORGANIZATIONS FOR THE DIAGNOSIS AND TREATMENT OF THE SICK AND INJURED. (C) TYPE III SHALL INCLUDE ORGANIZATIONS INTERESTED IN THE PURPOSES OF THE CORPORATION BUT WHICH ARE NOT ELIGIBLE FOR INSTITUTIONAL MEMBERSHIP TYPES I OR II.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MEMBERS OF THE ASSOCIATION ELECT THE CHAIR, VICE CHAIR AND THE SECRETARY/TREASURER ON AN ANNUAL BASIS. DUE TO THE DEMANDS OF COVID-19, THESE TERMS WERE EXTENDED TO 18 MONTHS IN FY20.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>TYPE I MEMBERS ARE ENTITLED TO A NUMBER OF VOTES ON ALL MATTERS SUBMITTED TO THE MEMBERSHIP BASED ON THE NET OPERATING REVENUE OF SUCH MEMBER.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AUDIT COMMITTEE AND MANAGEMENT WILL REVIEW THE 990 AND THEN MAKE AVAILABLE TO THE BOARD OF DIRECTORS ON THE BOARD PORTAL PRIOR TO FILING.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBERS ARE REQUIRED TO DISCLOSE ALL INTERESTS ANNUALLY ON A WRITTEN FORM WHICH IS SIGNED AND DATED. IF A CONFLICT EXISTS, THE ISSUE WILL BE REVIEWED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ASSOCIATION CONTRACTS WITH A RELIABLE AND REPUTABLE CONSULTANT WHO REVIEWS APPROPRIATE COMPARATIVE DATA FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS.</ExplanationTxt>
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        <MethodOfAmountDeterminationTxt>RENT AMOUNT RECEIVED</MethodOfAmountDeterminationTxt>
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        <MethodOfAmountDeterminationTxt>RENT AMOUNT RECEIVED</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VIRGINIA HOSPITAL SHARED SERVICES CORPORATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>C</TransactionTypeTxt>
        <InvolvedAmt>866726</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>AMOUNT TRANSFERRED</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VIRGINIA HOSPITAL SHARED SERVICES CORPORATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>150000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>AMOUNT RECEIVED</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>