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        <ExplanationTxt>Health Research and Educational Trust ("HRET") has a historic and continuing relationship with its supported organization, American Hospital Association ("AHA")-spanning over a 70-year period-and, as described below, there is a substantial identity of interests between the organizations. Therefore, HRET meets the organizational requirements of a Type I supporting organization. By way of background, in 1943 the AHA's House of Delegates passed a resolution recommending, among other things, federal aid for the construction of hospitals where needed. This was a special challenge because there was no complete inventory of the nation's hospitals by location, ownership, number of beds or services offered. In fact, there was no precise definition for "hospital." These shortcomings made it impossible to study the country's need for hospitals and other medical facilities. The AHA moved to fill this void by commissioning a study to evaluate existing facilities and services, project the need for hospitals, and offer recommendations for action at the end of World War II. In 1944, the AHA established HRET to receive grants for the study. Since that time, HRET has remained an active research and education affiliate of AHA. There is a substantial identity of interests between HRET and AHA. For example, HRET publicly holds itself out as being "in Partnership with AHA" and a "not-for-profit research and education affiliate of the AHA." It is assured that a substantial identity of interests between the organizations is maintained and will continue because the HRET Amended and Restated Trust Agreement provides that the entire Board of Trustees of HRET shall be either members of the AHA Board of Trustees, or appointed by the AHA Board of Trustees. Furthermore, among other things, the Bylaws of HRET provide that the Chair of HRET is appointed by the AHA Board of Trustees; the President of HRET is and AHA Senior Vice President and Chief Medical Officer; and the Treasurer of HRET is the Treasurer of the AHA.</ExplanationTxt>
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        <ExplanationTxt>HRET engages in activities which further the AHA's exempt purpose to advance the health of individuals and communities. HRET does not provide any monetary support to AHA.</ExplanationTxt>
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        <MethodValuationCd>F</MethodValuationCd>
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      <FootnoteTextInd>X</FootnoteTextInd>
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      <InvestmentExpensesNotIncldAmt>12855</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>5003</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>17858</RevenueNotReportedFinclStmtAmt>
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      <OtherExpensesIncludedAmt>52566</OtherExpensesIncludedAmt>
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      <ExpensesSubtotalAmt>36598627</ExpensesSubtotalAmt>
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        <ExplanationTxt>HRET "The Trust" is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Trust follows the provisions of the Accounting for Uncertainty in Income Taxes section of the Income Taxes Topic of the ASC, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under this guidance, the Trust may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. Examples of tax positions include the tax-exempt status of the Trust. The tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. There were no unrecognized tax benefits identified or recorded as liabilities for the reporting periods presented herein. The Trust files Form 990 in the U.S. federal jurisdiction and the State of Illinois.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990</FormAndLineReferenceDesc>
        <ExplanationTxt>FUNDRAISING EXPENSES - 52566</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE - 5003</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990</FormAndLineReferenceDesc>
        <ExplanationTxt>FUNDRAISING EXPENSES - 52566</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE - 5003</ExplanationTxt>
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        <DirectExpenseSummaryEventsAmt>52566</DirectExpenseSummaryEventsAmt>
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          <AddressLine1Txt>4650 SUNSET BLVD</AddressLine1Txt>
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          <CityNm>DETROIT</CityNm>
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          <BusinessNameLine1Txt>CAROLINAS REHABILITATION</BusinessNameLine1Txt>
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          <AddressLine1Txt>5727 PROSPERITY CROSSING DRIVE</AddressLine1Txt>
          <AddressLine2Txt>1400</AddressLine2Txt>
          <CityNm>CHARLOTTE</CityNm>
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          <BusinessNameLine1Txt>MISSION HEALTH</BusinessNameLine1Txt>
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          <CityNm>LIVONIA</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
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        <PurposeOfGrantTxt>2018 MCGAW AWARD</PurposeOfGrantTxt>
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          <AddressLine2Txt>SUITE 1900</AddressLine2Txt>
          <CityNm>HOUSTON</CityNm>
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      <RecipientTable>
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          <AddressLine2Txt>SUITE 400</AddressLine2Txt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>12362</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>205533</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>the president of HRET reports to the American hospital association (aha) president. The HRET board, the aha president and the compensation committee of AHA participate in setting goals for performance of the HRET president and in measuring performance against these goals. the compensation committee of the aha board does not include any individual whose compensation it reviews. the committee engages an independent compensation consultant to produce comparable salary data for the president as appropriate, and makes recommendations for compensation adjustments, consistent with existing compensation agreements, policies and procedures. On an annual basis, the committee evaluates the president's performance against annual performance goals and determines whether any adjustment or performance-based reward should be made. The final compensation package of the HRET president is documented in a written employment agreement. contemporaneous minutes of the committee's deliberations are prepared and review by the committee in a timely manner.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING THE 2019 CALENDAR YEAR, AMERICAN HOSPITAL ASSOCIATION, A RELATED TAX EXEMPT ENTITY, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: - JAY BHATT DURING 2019, THE FOLLOWING CONTRIBUTIONS WERE MADE BY AHA TO THE PLAN: - JAY BHATT - $31,037 DURING 2019, THE FOLLOWING DISTRIBUTIONS WERE MADE BY AHA TO THE PLAN: - JAY BHATT - $20,257 ALL VESTED/PAID OUT AMOUNTS WERE TREATED AS TAXABLE AND INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 7 Non-fixed payments</FormAndLineReferenceDesc>
        <ExplanationTxt>The AHA has established an incentive award program for employees when the AHA meets and exceeds its operational effectiveness goals for a calendar year. Awards are determined after the end of the calendar year and after review and approval of AHA's organizational performance by the AHA Board.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="19010655" softwareVersionNum="2019v5.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4d Description of other program services</FormAndLineReferenceDesc>
        <ExplanationTxt>(Expenses $ 1,252,005 including grants of $ 0)(Revenue $ 55,778) Research and development of resources addressing best practices and models for population health and community partnerships. Leadership training in health care transformation for hospital leaders.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Line 1a Box 3 of Form 1096</FormAndLineReferenceDesc>
        <ExplanationTxt>AMERICAN HOSPITAL ASSOCIATION, A RELATED TAX EXEMPT ORGANIZATION, PROCESSES ALL VENDOR PAYMENTS FOR ALL RELATED ENTITIES AND FILED ALL 1099 FORMS IN 2019. THE INSTITUTE IS CHARGED A MANAGEMENT FEE FOR THIS SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS</FormAndLineReferenceDesc>
        <ExplanationTxt>THE TREASURER OF HRET REPORTS TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) EXECUTIVE VICE PRESIDENT. THE AHA EXECUTIVE VICE PRESIDENT AND THE COMPENSATION COMMITTEE OF AHA PARTICIPATE IN SETTING GOALS FOR PERFORMANCE OF THE TREASURER AND IN MEASURING PERFORMANCE AGAINST THESE GOALS. THE COMPENSATION COMMITTEE OF THE AHA BOARD OF DIRECTORS DOES NOT INCLUDE ANY INDIVIDUAL WHOSE COMPENSATION IT REVIEWS. THE COMMITTEE ENGAGES AN INDEPENDENT CONSULTANT TO PRODUCE COMPARABLE SALARY DATA FOR THE TREASURER, AND MAKES RECOMMENDATIONS FOR COMPENSATION ADJUSTMENTS, CONSISTENT WITH EXISTING COMPENSATION AGREEMENTS, POLICIES AND PROCEDURES. THE COMMITTEE CONSIDERS THE RECOMMENDATIONS FROM THE COMPENSATION CONSULTANT EVALUATES THE TREASURER'S PERFORMANCE AGAINST ANNUAL PERFORMANCE GOALS, AND DETERMINES WHETHER ANY ADJUSTMENT OR PERFORMANCE-BASED REWARD SHOULD BE MADE. THE PROCESS FOR DETERMINING, REVIEWING AND APPROVING COMPENSATION AND ADJUSTMENTS TO COMPENSATION IS UNDERTAKEN ON AN ANNUAL BASIS. CONTEMPORANEOUS MINUTES OF THE COMMITTEE'S DELIBERATIONS AND DECISIONS ARE PREPARED AND REVIEWED BY THE COMMITTEE IN A TIMELY MANNER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>the president of HRET reports to the American hospital association (aha) executive vice president. The HRET board, the aha executive vice president and the compensation committee of AHA participate in setting goals for performance of the HRET president and in measuring performance against these goals. the compensation committee of the aha board does not include any individual whose compensation it reviews. the committee engages an independent compensation consultant to produce comparable salary data for the president as appropriate, and makes recommendations for compensation adjustments, consistent with existing compensation agreements, policies and procedures. On an annual basis, the committee evaluates the president's performance against annual performance goals and determines whether any adjustment or performance-based reward should be made. The final compensation package of the HRET president is documented in a written employment agreement. contemporaneous minutes of the committee's deliberations are prepared and reviewed by the committee in a timely manner.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 4 Significant changes to organizational documents</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HRET BYLAWS WERE UPDATED CONCERNING THE BOARD OF TRUSTEES. THE COMPOSITION (2.1) WAS UPDATED TO INCLUDE 3 MEMBERS, ONE OF WHOM SHALL BE THE HRET PRESIDENT WHO SHALL SERVE EX OFFICIO WITH VOTING RIGHTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's sole corporate member is American Hospital Association, a related tax-exempt organization. As the organization's sole Corporate Member, American Hospital Association has the right to elect or appoint members of the organization's governing body and approve or deny significant decisions of the organization's governing body.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>See narrative for Form 990, Part VI, Line 6.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>See narrative for Form 990, Part VI, Line 6.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The filing organization's management reviews the Form 990 and shares it with the HRET board of directors prior to filing with the IRS</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>On an annual basis, the organization's trustees, officers, and employees are required to read, complete and return a conflict of interest questionnaire. The returned questionnaires are handled jointly by Legal, Human Resources and Audit and Compliance staff. Any questionnaire that raises a potential issue is reviewed and referred to the Association's President for a final determination of any action to be considered or undertaken. Any potential conflict of interest that arises after the questionnaire is completed must be promptly reported. Any restrictions imposed based on information disclosed in a conflict of interest questionnaire or otherwise would be commensurate with the type of conflict identified and would be disclosed to the Board of Trustees.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's governing document and conflict of interest policy are available upon request. The organization's Financial statements are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104 and are not available to the public at this time.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g Other Fees</FormAndLineReferenceDesc>
        <ExplanationTxt>Program Subcontractors - Total Expense: 23886149, Program Service Expense: 22842584, Management and General Expenses: 1036485, Fundraising Expenses: 7080; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ;</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <AddressLine1Txt>155 NORTH WACKER DRIVE SUITE 400</AddressLine1Txt>
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          <BusinessNameLine1Txt>INSTITUTE FOR DIVERSITY IN HEALTHCARE</BusinessNameLine1Txt>
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          <BusinessNameLine1Txt>AHA</BusinessNameLine1Txt>
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          <ZIPCd>20001</ZIPCd>
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        <PrimaryActivitiesTxt>FOR POLITICAL CAMPAIGNS</PrimaryActivitiesTxt>
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        <PrimaryActivitiesTxt>NURSE LEADERSHIP</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>AHA</BusinessNameLine1Txt>
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          <BusinessNameLine1Txt>AONL FOUNDATION FOR NURSING LEADERSHIP RESEARCH AND EDUCATION</BusinessNameLine1Txt>
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          <AddressLine1Txt>800 10th Street NW</AddressLine1Txt>
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          <StateAbbreviationCd>DC</StateAbbreviationCd>
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        <PrimaryActivitiesTxt>NURSE EDUCATION SUPPORT</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>AONL</BusinessNameLine1Txt>
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        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Health Forum Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>155 NORTH WACKER DRIVE</AddressLine1Txt>
          <AddressLine2Txt>STE 400</AddressLine2Txt>
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        <PrimaryActivitiesTxt>Publications</PrimaryActivitiesTxt>
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      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
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      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
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      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
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          <BusinessNameLine1Txt>AMERICAN HOSPITAL ASSOCIATION</BusinessNameLine1Txt>
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        <InvolvedAmt>759651</InvolvedAmt>
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          <BusinessNameLine1Txt>AMERICAN HOSPITAL ASSOCIATION</BusinessNameLine1Txt>
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        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
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          <BusinessNameLine1Txt>AMERICAN HOSPITAL ASSOCIATION</BusinessNameLine1Txt>
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        <TransactionTypeTxt>C</TransactionTypeTxt>
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          <BusinessNameLine1Txt>AMERICAN HOSPITAL ASSOCIATION</BusinessNameLine1Txt>
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