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        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>22261817</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>22261817</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy Sales - Patients</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>642999</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>642999</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>22904816</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>1547</TotalRevenueColumnAmt>
        <ExclusionAmt>1547</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>67114</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>15531</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>51583</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>51583</TotalRevenueColumnAmt>
        <ExclusionAmt>51583</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>Physician Reimbursement</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>339040</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>339040</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Cafeteria Income</Desc>
        <BusinessCd>624200</BusinessCd>
        <TotalRevenueColumnAmt>48082</TotalRevenueColumnAmt>
        <ExclusionAmt>48082</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Rebate Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>18170</TotalRevenueColumnAmt>
        <ExclusionAmt>18170</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>5410</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>5410</RelatedOrExemptFuncIncomeAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>410702</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>23369226</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23249266</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>119382</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1052776</TotalAmt>
        <ProgramServicesAmt>544299</ProgramServicesAmt>
        <ManagementAndGeneralAmt>508477</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>10885491</TotalAmt>
        <ProgramServicesAmt>10278011</ProgramServicesAmt>
        <ManagementAndGeneralAmt>607480</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>270342</TotalAmt>
        <ProgramServicesAmt>256903</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13439</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2016997</TotalAmt>
        <ProgramServicesAmt>1940140</ProgramServicesAmt>
        <ManagementAndGeneralAmt>76857</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>852474</TotalAmt>
        <ProgramServicesAmt>804900</ProgramServicesAmt>
        <ManagementAndGeneralAmt>47574</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>45249</TotalAmt>
        <ManagementAndGeneralAmt>45249</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>6250</TotalAmt>
        <ManagementAndGeneralAmt>6250</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>8420</TotalAmt>
        <ProgramServicesAmt>8420</ProgramServicesAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising></FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1172051</TotalAmt>
        <ProgramServicesAmt>720979</ProgramServicesAmt>
        <ManagementAndGeneralAmt>451072</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>14086</TotalAmt>
        <ManagementAndGeneralAmt>14086</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1139479</TotalAmt>
        <ProgramServicesAmt>700097</ProgramServicesAmt>
        <ManagementAndGeneralAmt>439382</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>0</TotalAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>290955</TotalAmt>
        <ProgramServicesAmt>250291</ProgramServicesAmt>
        <ManagementAndGeneralAmt>40664</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>32959</TotalAmt>
        <ProgramServicesAmt>21214</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11745</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>4660</TotalAmt>
        <ProgramServicesAmt>4660</ProgramServicesAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>164394</TotalAmt>
        <ProgramServicesAmt>134252</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30142</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>2445</TotalAmt>
        <ManagementAndGeneralAmt>2445</ManagementAndGeneralAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>461039</TotalAmt>
        <ProgramServicesAmt>376507</ProgramServicesAmt>
        <ManagementAndGeneralAmt>84532</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>571664</TotalAmt>
        <ProgramServicesAmt>571664</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>2738552</TotalAmt>
        <ProgramServicesAmt>2738552</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Provision for Doubtful Accounts</Desc>
        <TotalAmt>2216367</TotalAmt>
        <ProgramServicesAmt>2216367</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Taxes, Licenses Fees</Desc>
        <TotalAmt>591720</TotalAmt>
        <ProgramServicesAmt>494754</ProgramServicesAmt>
        <ManagementAndGeneralAmt>96966</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Recruiting</Desc>
        <TotalAmt>137665</TotalAmt>
        <ProgramServicesAmt>122590</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15075</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>15322</TotalAmt>
        <ProgramServicesAmt>1430</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13892</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>24691357</TotalAmt>
        <ProgramServicesAmt>22186030</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2505327</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <EOYAmt>-2838831</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <EOYAmt>7617062</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <EOYAmt>2070072</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <EOYAmt>1707846</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <EOYAmt>399791</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>8820358</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>461039</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <EOYAmt>8359319</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsProgramRelatedGrp>
        <EOYAmt>30977</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <EOYAmt>1300000</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <EOYAmt>443689</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>19089925</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <EOYAmt>6406702</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <EOYAmt>10457404</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <EOYAmt>38275</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>16902381</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <EOYAmt>2187544</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>2187544</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>19089925</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-1322131</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>3509675</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="990A" softwareId="19009610" softwareVersionNum="19.2.1.0">
      <HospitalInd>X</HospitalInd>
      <PublicSupportCY170Pct>0.00000</PublicSupportCY170Pct>
      <PublicSupportCY509Pct>0.00000</PublicSupportCY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
    </IRS990ScheduleA>
    <IRS990ScheduleC documentId="990C" softwareId="19009610" softwareVersionNum="19.2.1.0">
      <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>8420</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>8420</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>II-B 1</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization pays membership fees to the American Hospital Association and WV American Hospital Association, which participates in lobbying activities. The amount reported above represents the portion of the dues allocated for lobbying activities.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="990D" softwareId="19009610" softwareVersionNum="19.2.1.0">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>188298</OtherCostOrOtherBasisAmt>
        <BookValueAmt>188298</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>5886574</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>168334</DepreciationAmt>
        <BookValueAmt>5718240</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>264157</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>25499</DepreciationAmt>
        <BookValueAmt>238658</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2468608</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>267206</DepreciationAmt>
        <BookValueAmt>2201402</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>12721</OtherCostOrOtherBasisAmt>
        <BookValueAmt>12721</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>8359319</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Financial derivatives and other financial products</Desc>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>Closely-held equity interests</Desc>
      </OtherSecuritiesGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Federal income taxes</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Long Term Lease Liability</Desc>
        <Amt>-461725</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Self Insurance Liabilities</Desc>
        <Amt>500000</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>38275</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>28331195</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>4946438</OtherRevenueAmt>
      <RevenueNotReportedAmt>4946438</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>23384757</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-15531</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-15531</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>23369226</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>22490521</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>15531</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>15531</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>22474990</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>2216367</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>2216367</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>24691357</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>X 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS, WVUIS and GHC are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2019 and 2018.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XI 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount includes 2,216,367 provision for bad debts that was reported as an offset to revenue on the audited financial statements but is reported as an expense on the Form 990 and 7,162,805 infusion of cash from WVUHS entities at time of transfer of operations that is reported as revenue on the audited financial statements but as a net asset on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XI 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount is 15,531 of rental expenses that is an offset to revenue on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XII 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount is 15,531 of rental expenses that is an offset to revenue on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XII 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount includes provision for bad debts of 2,216,367 that was reported as an offset to revenue on the audited financial statements but are reported as an expense on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="990H" softwareId="19009610" softwareVersionNum="19.2.1.0">
      <FinancialAssistancePolicyInd>true</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>true</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>false</FPGReferenceDiscountedCareInd>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>false</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>false</AnnualCommunityBnftReportInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>199421</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>6471</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>192950</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00860</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>11214294</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>11214294</DirectOffsettingRevenueAmt>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>11413715</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>11220765</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>192950</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00860</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>7083</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>1080</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>6003</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00030</TotalExpensePct>
      </CommunityHealthServicesGrp>
      <CashAndInKindContributionsGrp>
        <TotalCommunityBenefitExpnsAmt>21</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>21</NetCommunityBenefitExpnsAmt>
      </CashAndInKindContributionsGrp>
      <TotalOtherBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>7104</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>1080</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>6024</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00030</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>11420819</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>11221845</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>198974</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00890</TotalExpensePct>
      </TotalCommunityBenefitsGrp>
      <BadDebtExpenseReportedInd>true</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>1076939</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>513452</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>8659201</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>17113456</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-8454255</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <OtherInd>X</OtherInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>true</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>true</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>Summersville Regional Medical Center</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>400 Fairview Heights Road</AddressLine1Txt>
          <CityNm>Summersville</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26651</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>wvumedicine.org/summersville/</WebsiteAddressTxt>
        <StateLicenseNum>168</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <FacilityReportingGroupCd>A</FacilityReportingGroupCd>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>A</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <FirstLicensedCYOrPYInd>false</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>true</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>
        <CHNAConductedYr>18</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>false</CHNAConductedWithOtherFcltsInd>
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        <ImplementationStrategyAdptYr>19</ImplementationStrategyAdptYr>
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        <StrategyWebsiteURLTxt>wvumedicine.org/summersville/2018-community-health-needs-assessment/</StrategyWebsiteURLTxt>
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        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>wvumedicine.org/bill-pay/financial-assistance/</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>wvumedicine.org/bill-pay/financial-assistance/</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>wvumedicine.org/bill-pay/financial-assistance/</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
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        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
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        <GrossChargesInd>true</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>On July 1, 2019, West Virginia Health Care Cooperative Inc. WVHCC, a not-for-profit corporation with its sole membership held by WVUH, entered into a lease agreement with Summersville Regional Medical Center SRMC, a critical access hospital, and City of Summersville Building Commission, to form a lease agreement, to operate SRMC for 50 years. SRMC is included in the accompanying consolidated financial statement based on the control gained through the lease agreement. Consideration of 11,000,000 was exchanged and an intangible asset of 1,300,000 was recognized as a result of this transaction. The System recorded an inherent contribution totaling 7,163,000 in 2019, which represents the excess of the fair value of assets acquired over the fair value of liabilities assumed from the transaction.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The 2018 Community Health Needs Assessment CHNA was prepared by Thomas Bias and Emily Sarkees from the West Virginia University Health Research Center. The CHNA process began with a thorough review of the previous cycles needs assessment report and implementation plan. The CHNA also involved collecting both primary and secondary data. Primary data was comprised of a survey of community members perceptions of health issues followed by a community event focused on reviewing survey data, discussing community resources and assets that impact population health in the area, and working as a group to outline possible implementation strategies for each area of concern. A public survey and interviews with key stakeholders were also sources of primary data. Secondary data included US census data and County Health Rankings Data. The stakeholders represent the broad interests of the communities served by Summersville Regional Medical Center. The CHNA can also be found here https//wvumedicine.org/summersville/2018-community-health-needs-assessment/</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The public survey was collected both online and through hard copies. According to the CHNA, the survey link was distributed through email lists, social media, and the hospital website. Hard copies were distributed through the hospital departments, clinical offices and other local enterprises throughout the community. Six interviews were conducted with key stakeholders with the goal of obtaining their perspective on health issues they saw affecting the local community and the current resources available to address these issues. Finally, a community meeting was hosted by SRMC officials to gain additional information and insight on current health issues affecting the communities SRMC serves. Organizations represented at the community meeting and stakeholder interviews included Camden on Gauley Medical Center, City Government - Mayor, Columbia Forest Products, County Commission, Sheriffs Office, Summersville Baptist Church, SRMC officials and the United Way of Southern WV.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The SRMC leadership team met after the community meeting to review primary and secondary data which had been summarized by the WVU SPH. As this data was furnished, the leadership team began to prioritize the common priority areas that were outlined in the public survey results. Leadership discussed in detail the degree to which the hospital can realistically affect health outcomes for each priority area. By utilizing this prioritization matrix methodology, the SRMC leadership team was able to create a list of the top three health concerns that would be their focus moving forward and with implementation planning. These health concerns included 1. Substance Abuse 2. Cancer and 3. Chronic Disease.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The top health concerns identified by the stakeholders outlined in the CHNA are being addressed by Summersville Regional Medical Center officials in the following ways. For substance abuse, SRMC recognizes this as a top priority and will certainly consider this need in implementation planning and new program services offered in the future. In regards to cancer, hospital leadership believes it can make an immediate impact by utilizing and expanding current cancer screening offerings available to the community. Lastly, chronic disease has been identified as a high priority and leadership is currently working on initiatives that could positively influence the community who struggle with chronic disease as well as aid in the prevention.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 13b</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC offers discounted care only to individuals who qualify for free care. SRMC offers Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/ guarantor must meet certain requirements.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 24</FormAndLineReferenceDesc>
        <ExplanationTxt>All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amount are moved to Charity Care and no longer charged to the patient.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center, with assistance from Thomas Bias, Christiaan Abildso, and Emily Sarkees from West Virginia Universitys School of Public Health, prepared a 2018 implementation plan. This implementation plan included three strategies to address the needs identified in the 2018 CHNA report. These strategies included Elementary School Drug Education Program, Cancer Community Educational Forum and a Walk/Run Event.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 3c</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC uses 200 Federal Poverty Guideline FPG to determine free care eligibility. However, WVUH does not offer discounted care to individuals who fail the 200 FPG test.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>SRMCs community benefit numbers are reported in total with the other hospitals within West Virginia United Health System. The most recent amounts can be found in the WVU Medicine Annual Report available at the following web address https//wvumedicine.org/wp-content/uploads/2018/07/WVU-Medicine-Annual-Report-2017.pdf</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>Total community benefit expense for 2019 is 11,420,819 and is 50.82 of total net expenses. To calculate net expense, bad debt of 2,216,367 was deducted from total expenses of 24,691,357 as shown in Part IX line 25 of the core Form 990, for a net expense of 22,474,990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-Charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad Debt Expense at cost was calculated by multiplying bad debt expense of 2,216,367 by our cost to charge ratio of 50.22 derived from Worksheet 2 in the IRS Schedule H instructions for a total of 1,113,060 less DSH allocations to self-pay patient accounts of 36,120 for a total of 1,076,940.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 5,000. The total of that report was 1,022,405 which we then multiplied by our cost to charge ratio of 50.22 for a total of 513,452.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The estimated bad debt attributable to patients eligible for charity care of 513,452 should be considered community benefit due to the fact that anyone with outstanding balances of 5,000 or greater usually qualifies as catastrophic if the patient completes the application process.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>In our charity care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year. Regardless, that bad debt should be considered community benefit as we provide services to those in need regardless of their ability to pay.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>West Virginia Health Care Cooperative, doing business as, Summersville Regional Medical Center financial statements are prepared on a consolidated basis as a member of the WV United Health System. The footnote for Accounts Receivable is as follows Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters. The System grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor agreements, primarily with Medicare, Medicaid and various commercial insurance companies. The System records accounts receivable net of estimated price concessions and such amounts have historically been within managements expectations. The mix of accounts receivable at December 31, 2019 from patients and third-party payors is as follows Medicare - 27, Medicaid - 17, Blue Cross - 24, Commercial, managed care and other - 26, Patients -6, totaling 100.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>For receivables associated with self-pay patients, which includes both patients without insurance and insured patients with deductible and copayment balances, the System records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the billed rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 8</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount reported in Part III Line 6 17,113,456 was calculated using the total Medicare allowable cost from the Medicare cost report, less Medicare reimbursement of direct GME.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 8</FormAndLineReferenceDesc>
        <ExplanationTxt>SRMCs shortfall, 8,454,255 of Medicare program reimbursement should be considered a community benefit because we are relieving a government burden by providing care in excess of our costs to these patients.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 9b</FormAndLineReferenceDesc>
        <ExplanationTxt>SRMC does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center considers several components in assessing how the organization determines the need of the communities it serves. Through outside consultants to collaborating with various departments, a needs assessment takes into account several factors including physicians to population ratios, physician availability in the entire service area, and general health risks for our community. The Primary Service Area for Summersville Regional Medical Center is Nicholas County, WV. This data is then analyzed to provide general estimates to where SRMC could better care for residents of Nicholas County.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Population and demographic data is provided by WVU Medicines population health and enterprise analytics department.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center employs one financial counselor to meet with patients to discuss financial eligibility for our charity care program. Summersville Regional Medical Center has the qualification requirements, as well as, applications for charity care available at all registration areas. Patients that do not qualify for state or federally funded programs can apply for the charity care program at Summersville Regional Medical Center.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC is a non-profit hospital located in Nicholas County, WV population 24,720 in the city of Summerville, WV. SRMC currently provides acute, emergency, outpatient, clinic, long-term and primary care to primarily Nicholas County residents as well as residents residing in Central West Virginia. The 2019 average household income for Nicholas County residents is 60,762 and the unemployment rate is approximately 8.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The Summersville Regional Medical Center board of directors is a community board, with four members living in or around Nicholas County, WV.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center extends privileges to all qualified medical staff in Nicholas County and surrounding communities to meet its healthcare needs.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The West Virginia Health Care Cooperative is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its service areas, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, Potomac Valley Hospital in Keyser, WV, St. Josephs Hospital of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Hospital, in Glen Dale, WV, Braxton County Memorial Hospital in Gassaway, WV, and Community Health Association, doing business as, Jackson General Hospital in Ripley, WV.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The System also includes the physician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals along with United Summit Center, a behavioral health center located in Clarksburg, WV. In addition to these practices, the System also includes WVUH-East, Inc. and Camden-Clark Health Services which operate as management companies for their respective hospitals. The System also includes University Healthcare Foundation in Martinsburg, WV, United Health Foundation in Bridgeport, WV, Camden-Clark Foundation in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, and Reynolds Memorial Foundation in Glen Dale, WV which perform various fundraising activities for their respective hospitals.</ExplanationTxt>
      </SupplementalInformationDetail>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Benjamin Hensley DO</PersonNm>
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        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Karen Bowling received deferred compensation contributions in the amount of 15,780 from the West Virginia Health Care Cooperative and 15,780 from related organizations.These amounts were properly recorded in deferred compensation on the Form 990 Schedule J.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>Per the WVUHS Incentive Plan incentives are contingent on meeting a net earning target.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part I, Line 1</FormAndLineReferenceDesc>
        <ExplanationTxt>care services to the residents. Summersville Regional Medical Center operates an emergency room taking all patients regardless of insurance in conjunction with a regional medical center approach, connecting patients to tertiary care facilities as necessary for services. Ancillary diagnostic services are also provided including lab, X-ray, CT, MRI, ultrasound, PT/OT, nuclear medicine, surgery, and emergency room. Physician clinics include rural health clinics, surgery practice, womens health practice and orthopedics practice.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The board reviews and approves the Form 990 before it is filed with the IRS. If this cannot be accomplished at a regularly scheduled meeting, a special meeting will be held to uphold this board action.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Conflict of interest statements require a board member with a conflict to excuse themselves from the discussion and boardroom if a matter of discussion and voting would be a conflict of interest with them. Indvidual statements completed by other board members are reviewed by the chairman. The vice-chairman reviews the chairmans conflict of interest statement.</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 by persons. They are not posted on the website at the present time. This has been discussed in public session of the board meetings.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Other changes in net assets include 6,961,793 infusion of cash from WVUH entities at the time of transfer of operations and 3,452,119 WVUHS IT Capitalization.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>