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        <FormAndLineReferenceDesc>Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name</FormAndLineReferenceDesc>
        <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 a -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 EXECUTIVE COMMITTEE OF THE Board of Trustees. Furthermore, among other things, the Bylaws of HRET provide that the Chair of HRET is appointed by the AHA EXECUTIVE COMMITTEE OF THE Board of Trustees; the President of HRET is an AHA SENIOR Vice President.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Schedule A, Part IV, Section A, Line 3b Qualified Under 501C(4)(5) Or (6)</FormAndLineReferenceDesc>
        <ExplanationTxt>Annually, the AHA completes a pro forma schedule a, part III. The supporting calculation is kept in HRET's files.</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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        <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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        <ExplanationTxt>Awards are provided to organizations after applications are submitted, reviewed and approved. The restrictions of use are indicated and the grantee is notified of the purpose of the funds. Awards and support of research require attendance and or follow up such as financial reports and written narratives of program participation.</ExplanationTxt>
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        <PersonNm>Marie Cleary-Fishman</PersonNm>
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        <PersonNm>Daniel J Delgado</PersonNm>
        <TitleTxt>Senior Director of Finance and Compliance</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Nancy A Myers PhD</PersonNm>
        <TitleTxt>VP Leadership &amp; System Innovation</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANDREW J JAGER</PersonNm>
        <TitleTxt>SR DIRECTOR, POP HEALTH</TitleTxt>
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        <PersonNm>KRISTIN L PREIHS</PersonNm>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 1a Discretionary spending account</FormAndLineReferenceDesc>
        <ExplanationTxt>TAXABLE BENEFIT ALLOWANCES WERE MADE AVAILABLE TO THE PRESIDENT OF HRET. THE RELATED BENEFIT WAS INCLUDED IN THE PRESIDENT'S TAXABLE COMPENSATION.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>The HRET President is an executive of the American Hospital Association (AHA) and reports to the AHA COO. The AHA COO participates in setting goals for performance of the HRET president and in measuring performance against these goals. The AHA Executive Compensation Committee (Committee) is composed of the members of the Executive Committee of the AHA Board of Trustees excluding the AHA President. The Committee does not include any individual whose compensation it reviews. The Committee engages an independent compensation consultant to produce annual comparable salary data for the AHA executive serving as the HRET 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 compensation of the AHA executive serving as the HRET president based on the annual market assessment completed by the independent compensation consultant. The AHA COO evaluates the performance of the AHA executive serving as the HRET president against annual performance goals and determines any earned performance-based reward. The final compensation package of the AHA executive serving as the HRET President is documented in a written employment agreement.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING THE 2024 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: - CHRISTOPHER DERIENZO DURING 2024, THE FOLLOWING CONTRIBUTIONS WERE MADE BY AHA TO THE PLAN: - CHRISTOPHER DERIENZO - $107,995 DURING 2024, THE FOLLOWING DISTRIBUTIONS (INCLUDING ACCRUED EARNINGS) WERE MADE BY AHA FROM THE PLAN: - NONE ALL VESTED/PAID OUT AMOUNTS WERE TREATED AS TAXABLE AND INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III).</ExplanationTxt>
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      <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 EXECUTIVE COMMITTEE OF THE AHA Board OF TRUSTEES.</ExplanationTxt>
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      <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 2023. THE INSTITUTE IS CHARGED A MANAGEMENT FEE FOR THIS SERVICE.</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>
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      <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 FULL FORM 990 IS REVIEWED BY A PUBLIC ACCOUNTING FIRM AND THE FILING ORGANIZATION'S MANAGEMENT. MANAGEMENT SHARES IT WITH THE HRET BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.</ExplanationTxt>
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      <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 COMPLIANCE STAFF OF THE AMERICAN HOSPITAL ASSOCIATION. 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 REFERRED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR A DETERMINATION ON WHETHER DISCLOSURE TO THE FULL BOARD OF TRUSTEES IS WARRANTED.</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: 715937, Program Service Expense: 448068, Management and General Expenses: 267869, Fundraising Expenses: ; PROFESSIONAL SERVICES - Total Expense: 21429, Program Service Expense: 13410, Management and General Expenses: 8019, Fundraising Expenses: ; CONSULTING SERVICES - Total Expense: 322651, Program Service Expense: 201915, Management and General Expenses: 120736, Fundraising Expenses: ; SPONSORSHIPS / COMMISSIONS - Total Expense: 167290, Program Service Expense: 104690, Management and General Expenses: 62600, Fundraising Expenses: ;</ExplanationTxt>
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          <ZIPCd>20001</ZIPCd>
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        <EIN>362996517</EIN>
        <PrimaryActivitiesTxt>FOR POLITICAL CAMPAIGNS</PrimaryActivitiesTxt>
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          <AddressLine1Txt>800 10th Street NW</AddressLine1Txt>
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          <StateAbbreviationCd>DC</StateAbbreviationCd>
          <ZIPCd>20001</ZIPCd>
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        <EIN>272399044</EIN>
        <PrimaryActivitiesTxt>NURSE EDUCATION SUPPORT</PrimaryActivitiesTxt>
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        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
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