﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2014v5.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2015-08-11T17:11:00-05:00</ReturnTs>
    <TaxPeriodEndDt>2014-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>520783935</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>SMITH ELLIOTT KEARNS &amp; COMPANY LLC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>19 BROOKWOOD AVE STE 101</AddressLine1Txt>
        <CityNm>CARLISLE</CityNm>
        <StateAbbreviationCd>PA</StateAbbreviationCd>
        <ZIPCd>17015</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2014-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>251546810</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>KEYSTONE RURAL HEALTH CENTER</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>KEYS</BusinessNameControlTxt>
      <PhoneNum>7177097906</PhoneNum>
      <USAddress>
        <AddressLine1Txt>755 NORLAND AVENUE</AddressLine1Txt>
        <AddressLine2Txt>ROOM/SUITE 200</AddressLine2Txt>
        <CityNm>CHAMBERSBURG</CityNm>
        <StateAbbreviationCd>PA</StateAbbreviationCd>
        <ZIPCd>17201</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>JOANNE COCHRAN</PersonNm>
      <PersonTitleTxt>PRESIDENT/CEO</PersonTitleTxt>
      <PhoneNum>7177097906</PhoneNum>
      <SignatureDt>2015-08-05</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>GREGORY P HALL CPA</PreparerPersonNm>
      <PTIN>P00156653</PTIN>
      <PhoneNum>7172439104</PhoneNum>
      <PreparationDt>2015-08-05</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2014</TaxYr>
    <BuildTS>2016-02-25 16:41:14Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="7">
    <IRS990 documentId="RetDoc2" referenceDocumentId="RetDoc5">
      <PrincipalOfficerNm>JOANNE COCHRAN</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>755 NORLAND AVENUE SUITE 200</AddressLine1Txt>
        <CityNm>CHAMBERSBURG</CityNm>
        <StateAbbreviationCd>PA</StateAbbreviationCd>
        <ZIPCd>17201</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>32986206</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.KEYSTONEHEALTH.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1987</FormationYr>
      <LegalDomicileStateCd>PA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>PROVIDER OF HEALTH CARE SERVICES TO THE GENERAL POPULATION TARGETING UNINSURED, LOW-INCOME AND MEDICAL ASSISTANCE INDIVIDUALS. KEYSTONE, FOUNDED IN 1986, IS A PUBLIC NOT-FOR PROFIT ORGANIZATION THAT OFFERS HEALTH CARE AND WHEN NEEDED SOCIAL SERVICES TO UNDERSERVED AND VULNERABLE POPULATIONS AS WELL AS TO THE ENTIRE COMMUNITY POPULATION OF FRANKLIN COUNTY. KEYSTONE IS DESIGNATED BY THE FEDERAL GOVERNMENT AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). BECAUSE OF THIS DESIGNATION KEYSTONE RECEIVES FEDERAL GRANTS AND A PROSPECTIVE PAYMENT RATE REIMBURSEMENT FROM MEDICAID AND MEDICARE FOR PROVIDING SERVICES TO THOSE ELIGIBLE PATIENTS AND TO UNDERSERVED POPULATIONS. KEYSTONE HEALTH IS IDENTIFIED AS AN ESSENTIAL COMMUNITY PROVIDER BY THE NEW AFFORDABLE CARE ACT. AT PRESENT, KEYSTONE HEALTH OPERATES TWELVE PRIMARY CARE PRACTICES IN CHAMBERSBURG, FRANKLIN COUNTY, PENNSYLVANIA. THE SERVICES PROVIDED ARE: FAMILY PRACTICE, AUDIOLOGY AND SPEECH, BEHAVIORAL HEALTH, CRISIS INTERVENTION, CARDIOLOGY, D</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>13</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>13</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>408</TotalEmployeeCnt>
      <TotalVolunteersCnt>47</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>4209994</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>4991915</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>27347005</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>27274350</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>139191</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>205449</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>264720</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>499635</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>31960910</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>32971349</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>19685598</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>22251199</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>21702</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>8728753</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>9989499</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>28414351</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>32240698</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>3546559</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>730651</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>28240628</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>29096003</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>4265593</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>4038075</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>23975035</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>25057928</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>PROVIDER OF HEALTH CARE SERVICES TO THE GENERAL POPULATION TARGETING UNINSURED, LOW-INCOME AND MEDICAL ASSISTANCE INDIVIDUALS. KEYSTONE, FOUNDED IN 1986, IS A PUBLIC NOT-FOR PROFIT ORGANIZATION THAT OFFERS HEALTH CARE AND WHEN NEEDED SOCIAL SERVICES TO UNDERSERVED AND VULNERABLE POPULATIONS AS WELL AS TO THE ENTIRE COMMUNITY POPULATION OF FRANKLIN COUNTY. KEYSTONE IS DESIGNATED BY THE FEDERAL GOVERNMENT AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). BECAUSE OF THIS DESIGNATION KEYSTONE RECEIVES FEDERAL GRANTS AND A PROSPECTIVE PAYMENT RATE REIMBURSEMENT FROM MEDICAID AND MEDICARE FOR PROVIDING SERVICES TO THOSE ELIGIBLE PATIENTS AND TO UNDERSERVED POPULATIONS. KEYSTONE HEALTH IS IDENTIFIED AS AN ESSENTIAL COMMUNITY PROVIDER BY THE NEW AFFORDABLE CARE ACT. AT PRESENT, KEYSTONE HEALTH OPERATES TWELVE PRIMARY CARE PRACTICES IN CHAMBERSBURG, FRANKLIN COUNTY, PENNSYLVANIA. THE SERVICES PROVIDED ARE: FAMILY PRACTICE, AUDIOLOGY AND SPEECH, BEHAVIORAL HEALTH, CRISIS INTERVENTION, CARDIOLOGY, D</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>5067894</ExpenseAmt>
      <RevenueAmt>6424069</RevenueAmt>
      <Desc>PROVIDER OF PEDIATRIC SERVICES TO THE GENERAL POPULATION TARGETING LOW INCOME MEDICARE AND MEDICAL ASSISTANCE INDIVIDUALS. SEE SCHEDULE O.</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>4099484</ExpenseAmt>
        <RevenueAmt>4310028</RevenueAmt>
        <Desc>PROVIDE OF OBSTETRICAL AND GYNECOLOGICAL SERVICES TO THE GENERAL POPULATION TARGETING LOW INCOME MEDICARE AND MEDICAL ASSISTANCE INDIVIDUALS. SEE SCHEDULE O.</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>3087007</ExpenseAmt>
        <RevenueAmt>2626697</RevenueAmt>
        <Desc>PROVIDER OF FAMILY MEDICINE SERVICES TO THE GENERAL POPULATION TARGETING LOW INCOME INDIVIDUALS. SEE SCHEDULE O.</Desc>
      </ProgSrvcAccomActy3Grp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>14438721</ExpenseAmt>
        <RevenueAmt>14413191</RevenueAmt>
        <Desc>PROVIDER OF CARDIOLOGY, DENTAL, BEHAVIORAL HEALTH, INTERNAL MEDICINE, PHARMACY SERVICES, AND HIV SERVICES TO THE GENERAL POPULATION TARGETING LOW INCOME MEDICARE AND MEDICAL ASSISTANCE INDIVIDUALS. IN ADDITION, WE ARE A PROVIDER OF HEALTH CARE SERVICES TO THE MIGRANT WORKER POPULATION OF THE COMMONWEALTH OF PENNSYLVANIA.</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <TotalOtherProgSrvcExpenseAmt>14438721</TotalOtherProgSrvcExpenseAmt>
      <TotalOtherProgSrvcRevenueAmt>14413191</TotalOtherProgSrvcRevenueAmt>
      <TotalProgramServiceExpensesAmt>26693106</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc7">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc3">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc3">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc3">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc3">false</CreditCounselingInd>
      <TempOrPermanentEndowmentsInd referenceDocumentId="RetDoc3">false</TempOrPermanentEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc3">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc3">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc3">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc3">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc3">false</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc3">true</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc3">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc3">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc4">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWithOfficerEntInd>false</BusinessRlnWithOfficerEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc6">false</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc6">true</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>true</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="RetDoc6">false</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc6">false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc6">false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>41</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>408</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>13</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>13</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>PA</StatesWhereCopyOfReturnIsFldCd>
      <OtherWebsiteInd>X</OtherWebsiteInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>JOANNE COCHRAN CEO</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>7177097906</PhoneNum>
        <USAddress>
          <AddressLine1Txt>755 NORLAND AVENUE SUITE 200</AddressLine1Txt>
          <CityNm>CHAMBERSBURG</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>17201</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOANNE COCHRAN</PersonNm>
        <TitleTxt>PRESIDENT/CE</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>341608</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18688</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SAM KING</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LUCILLE STENCE</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHARLES S BENDER II</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAREN JOHNSTON</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SILA ALEGRET-BARTEL</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DOROTHY WINSLET-LUTES</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID KALIST</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL E KUGLER</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM MORGAN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TED RABOLD</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY BETH SHANK</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUE SMITH</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CATHERINE DUSMAN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN MCELWEE</PersonNm>
        <TitleTxt>CHIEF OPERAT</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>296945</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>12484</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS P ORNDORF</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>441034</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>34506</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RAJESH CHINTALA</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>314238</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33057</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>YVETTE BROWN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>273368</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27888</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL J COLLI</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>267854</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>35165</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RAGHAVENDRA TIRUPATHI GOVINDARAJU</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>265782</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26571</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2200829</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>188359</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>38</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UNIFIED SOLUTION GROUP LLL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>975 WAYNE AVENUE PMB 319</AddressLine1Txt>
            <CityNm>CHAMBERSBURG</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>17201</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT SUPPORT</ServicesDesc>
        <CompensationAmt>453180</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>STEVENS &amp; LEE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 679</AddressLine1Txt>
            <CityNm>READING</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>19603</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LEGAL SUPPORT</ServicesDesc>
        <CompensationAmt>415156</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>QUALITY SYSTEMS INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 809390</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60680</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>EMR &amp; BILLING</ServicesDesc>
        <CompensationAmt>403375</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TIDY GLO COMMERCIAL CLEANING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 302</AddressLine1Txt>
            <CityNm>FORT LOUDON</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>17224</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CLEANING</ServicesDesc>
        <CompensationAmt>231535</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>SUASION LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>129 WEST HARRISBURG STREET</AddressLine1Txt>
            <CityNm>DILLSBURG</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>17019</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MARKETING</ServicesDesc>
        <CompensationAmt>126812</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>21886</FederatedCampaignsAmt>
      <GovernmentGrantsAmt>4130580</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>839449</AllOtherContributionsAmt>
      <TotalContributionsAmt>4991915</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE FEES</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>22060646</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>22060646</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER SERVICE REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>4945053</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4945053</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PREMIUM REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>268651</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>268651</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>27274350</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>200632</TotalRevenueColumnAmt>
        <ExclusionAmt>200632</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>19374</SecuritiesAmt>
        <OtherAmt>300</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>14857</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>4517</SecuritiesAmt>
        <OtherAmt>300</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>4817</TotalRevenueColumnAmt>
        <ExclusionAmt>4817</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <OtherRevenueMiscGrp>
        <Desc>ELECTRONIC HEALTH RECORDS</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>395250</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>395250</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS INCOME</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>104385</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>104385</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>499635</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>32971349</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27773985</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>205449</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>669725</TotalAmt>
        <ManagementAndGeneralAmt>669725</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>17840757</TotalAmt>
        <ProgramServicesAmt>15885268</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1940968</ManagementAndGeneralAmt>
        <FundraisingAmt>14521</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>555596</TotalAmt>
        <ProgramServicesAmt>468824</ProgramServicesAmt>
        <ManagementAndGeneralAmt>86772</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1872663</TotalAmt>
        <ProgramServicesAmt>1545943</ProgramServicesAmt>
        <ManagementAndGeneralAmt>323368</ManagementAndGeneralAmt>
        <FundraisingAmt>3352</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1312458</TotalAmt>
        <ProgramServicesAmt>1127355</ProgramServicesAmt>
        <ManagementAndGeneralAmt>185103</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>497965</TotalAmt>
        <ProgramServicesAmt>7900</ProgramServicesAmt>
        <ManagementAndGeneralAmt>490065</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>8225</TotalAmt>
        <ManagementAndGeneralAmt>8225</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1353884</TotalAmt>
        <ProgramServicesAmt>672174</ProgramServicesAmt>
        <ManagementAndGeneralAmt>681710</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>294871</TotalAmt>
        <ProgramServicesAmt>176130</ProgramServicesAmt>
        <ManagementAndGeneralAmt>118741</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>158442</TotalAmt>
        <ProgramServicesAmt>86622</ProgramServicesAmt>
        <ManagementAndGeneralAmt>71820</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>317820</TotalAmt>
        <ProgramServicesAmt>240948</ProgramServicesAmt>
        <ManagementAndGeneralAmt>76872</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>747872</TotalAmt>
        <ProgramServicesAmt>336533</ProgramServicesAmt>
        <ManagementAndGeneralAmt>411339</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>108997</TotalAmt>
        <ProgramServicesAmt>80824</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28173</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>108436</TotalAmt>
        <ProgramServicesAmt>96190</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12246</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>83081</TotalAmt>
        <ProgramServicesAmt>83081</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1063526</TotalAmt>
        <ProgramServicesAmt>928409</ProgramServicesAmt>
        <ManagementAndGeneralAmt>135117</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>73269</TotalAmt>
        <ProgramServicesAmt>11571</ProgramServicesAmt>
        <ManagementAndGeneralAmt>61698</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>4494274</TotalAmt>
        <ProgramServicesAmt>4459305</ProgramServicesAmt>
        <ManagementAndGeneralAmt>31140</ManagementAndGeneralAmt>
        <FundraisingAmt>3829</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RENTAL AND MAINTENANCE</Desc>
        <TotalAmt>177522</TotalAmt>
        <ProgramServicesAmt>112451</ProgramServicesAmt>
        <ManagementAndGeneralAmt>65071</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITMENT EXPENSE</Desc>
        <TotalAmt>140217</TotalAmt>
        <ProgramServicesAmt>136870</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3347</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES</Desc>
        <TotalAmt>101462</TotalAmt>
        <ProgramServicesAmt>63585</ProgramServicesAmt>
        <ManagementAndGeneralAmt>37877</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>259636</TotalAmt>
        <ProgramServicesAmt>173123</ProgramServicesAmt>
        <ManagementAndGeneralAmt>86513</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>32240698</TotalAmt>
        <ProgramServicesAmt>26693106</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5525890</ManagementAndGeneralAmt>
        <FundraisingAmt>21702</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>4915</BOYAmt>
        <EOYAmt>4915</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>4100327</BOYAmt>
        <EOYAmt>3855705</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>143325</BOYAmt>
        <EOYAmt>232773</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2258497</BOYAmt>
        <EOYAmt>2692753</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>6043</BOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>540422</BOYAmt>
        <EOYAmt>472963</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>238306</BOYAmt>
        <EOYAmt>215110</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>18096302</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>5416745</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>13638638</BOYAmt>
        <EOYAmt>12679557</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>7246182</BOYAmt>
        <EOYAmt>8879292</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>63973</BOYAmt>
        <EOYAmt>62935</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>28240628</BOYAmt>
        <EOYAmt>29096003</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2511364</BOYAmt>
        <EOYAmt>2365350</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>2000</BOYAmt>
        <EOYAmt>8000</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1752229</BOYAmt>
        <EOYAmt>1664725</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>4265593</BOYAmt>
        <EOYAmt>4038075</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>23973463</BOYAmt>
        <EOYAmt>25057928</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>1572</BOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>23975035</BOYAmt>
        <EOYAmt>25057928</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>28240628</BOYAmt>
        <EOYAmt>29096003</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>730651</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>352242</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc7">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>6681397</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13391023</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4910111</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4209994</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4991915</CurrentTaxYearAmt>
        <TotalAmt>34184440</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>18710845</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>25773976</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>23943305</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>27542505</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>27773985</CurrentTaxYearAmt>
        <TotalAmt>123744616</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>25392242</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>39164999</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>28853416</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>31752499</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>32765900</CurrentTaxYearAmt>
        <TotalAmt>157929056</TotalAmt>
      </Total509Grp>
      <PublicSupportTotal509Amt>157929056</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>45330</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>26587</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>18083</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>93999</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>200632</CurrentTaxYearAmt>
        <TotalAmt>384631</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>45330</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>26587</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>18083</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>93999</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>200632</CurrentTaxYearAmt>
        <TotalAmt>384631</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>273637</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>363319</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>118659</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>69220</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>104385</CurrentTaxYearAmt>
        <TotalAmt>929220</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>25711209</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>39554905</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>28990158</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>31915718</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>33070917</CurrentTaxYearAmt>
        <TotalAmt>159242907</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99170</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99020</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00000</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART III, LINE 12</FormAndLineReferenceDesc>
        <ExplanationTxt>MISCELLANEOUS INCOME 929,220</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc3">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>557324</OtherCostOrOtherBasisAmt>
        <BookValueAmt>557324</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>12142742</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2094589</DepreciationAmt>
        <BookValueAmt>10048153</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>5396236</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3322156</DepreciationAmt>
        <BookValueAmt>2074080</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>12679557</TotalBookValueLandBuildingsAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>33074921</TotalRevEtcAuditedFinclStmtAmt>
      <DonatedServicesAndUseFcltsAmt>102000</DonatedServicesAndUseFcltsAmt>
      <OtherRevenueAmt>1572</OtherRevenueAmt>
      <RevenueNotReportedAmt>103572</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>32971349</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>32971349</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>32342698</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>102000</DonatedServicesUseFcltsAmt>
      <ExpensesNotReportedAmt>102000</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>32240698</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>32240698</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 3, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CENTER IS A NONPROFIT CORPORATION ORGANIZED UNDER THE PROVISIONS OF THE NON-PROFIT LAWS OF THE COMMONWEALTH OF PENNSYLVANIA. THE CENTER IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. WITH FEW EXCEPTIONS, THE CENTER IS NO LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. THE CENTER FOLLOWS THE FASB ACCOUNTING STANDARDS CODIFICATION, WHICH PROVIDES GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN THE CENTER'S FINANCIAL STATEMENTS. WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS WOULD BE CLASSIFIED AS OTHER OPERATING EXPENSES IN THE STATEMENTS OF OPERATIONS. AT DECEMBER 31, 2014 AND 2013, THERE WAS NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 4, PART XI, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>GRANT FUNDS RELEASED FROM RESTRICTIONS 1,572</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc4">
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOANNE COCHRAN</PersonNm>
        <TitleTxt>PRESIDENT/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>341608</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10400</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8288</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>360296</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOHN MCELWEE</PersonNm>
        <TitleTxt>CHIEF OPERATING OFFI</TitleTxt>
        <BaseCompensationFilingOrgAmt>296945</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10035</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2449</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>309429</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>THOMAS P ORNDORF</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>361034</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>62500</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>17500</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10400</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>24106</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>475540</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RAJESH CHINTALA</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>310383</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>3855</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>11489</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>21568</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>347295</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>YVETTE BROWN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>262599</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>10769</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10097</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>17791</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>301256</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL J COLLI</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>255036</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>12818</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>15303</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>19862</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>303019</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RAGHAVENDRA TIRUPATHI GOVINDARAJU</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>213297</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>34985</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>17500</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10087</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>16484</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>292353</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc5">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION</FormAndLineReferenceDesc>
        <ExplanationTxt>PROVIDER OF HEALTH CARE SERVICES TO THE GENERAL POPULATION TARGETING UNINSURED, LOW-INCOME AND MEDICAL ASSISTANCE INDIVIDUALS. KEYSTONE, FOUNDED IN 1986, IS A PUBLIC NOT-FOR PROFIT ORGANIZATION THAT OFFERS HEALTH CARE AND WHEN NEEDED SOCIAL SERVICES TO UNDERSERVED AND VULNERABLE POPULATIONS AS WELL AS TO THE ENTIRE COMMUNITY POPULATION OF FRANKLIN COUNTY. KEYSTONE IS DESIGNATED BY THE FEDERAL GOVERNMENT AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). BECAUSE OF THIS DESIGNATION KEYSTONE RECEIVES FEDERAL GRANTS AND A PROSPECTIVE PAYMENT RATE REIMBURSEMENT FROM MEDICAID AND MEDICARE FOR PROVIDING SERVICES TO THOSE ELIGIBLE PATIENTS AND TO UNDERSERVED POPULATIONS. KEYSTONE HEALTH IS IDENTIFIED AS AN ESSENTIAL COMMUNITY PROVIDER BY THE NEW AFFORDABLE CARE ACT. AT PRESENT, KEYSTONE HEALTH OPERATES TWELVE PRIMARY CARE PRACTICES IN CHAMBERSBURG, FRANKLIN COUNTY, PENNSYLVANIA. THE SERVICES PROVIDED ARE: FAMILY PRACTICE, AUDIOLOGY AND SPEECH, BEHAVIORAL HEALTH, CRISIS INTERVENTION, CARDIOLOGY, DENTAL, URGENT CARE, PEDIATRICS, WOMEN'S CARE, INFECTIOUS DISEASE, INTERNAL MEDICINE, HIV/STD, AND STD AND FAMILY PLANNING CLINIC. KEYSTONE ALSO OPERATES ITS OWN PHARMACY AND CONTRACTS WITH NINE OTHER PHARMACIES THROUGHOUT FRANKLIN COUNTY FOR A SPECIAL DISCOUNTED PROGRAM (340B) FOR OUR NEEDY PATIENTS. KEYSTONE ALSO MANAGES THE STATE MIGRANT AND SEASONAL FARM WORKER PROGRAM WITH KEYSTONE OPERATED SITES IN ADAMS, BERKS, FRANKLIN AND COLUMBIA COUNTIES. KEYSTONE ALSO CONTRACTS WITH HEALTH CARE PROVIDERS OR PROGRAMS IN CARBON, ERIE, LANCASTER, LUZERNE, SCHUYLKILL, BEDFORD, LEBANON, MONTOUR, SNYDER, JUNIATA, LEHIGH, NORTHUMBERLAND, AND UNION COUNTIES TO PROVIDE SERVICES TO FARM WORKERS. THE STRENGTH OF THE KEYSTONE NETWORK IS THAT ALL SERVICES ARE PROVIDED IN A MISSION-DRIVEN ENVIRONMENT FOCUSING ON ACCESSIBLE, AFFORDABLE, CULTURALLY APPROPRIATE, QUALITY AND COMPASSIONATE CARE OFFERED TO ANYONE AND EVERYONE REGARDLESS OF ABILITY TO PAY, ETHNIC BACKGROUND OR DISEASE. DURING 2014, KEYSTONE TREATED 44,814 INDIVIDUALS THROUGH 172,584 VISITS. THE KEYSTONE SYSTEM WIDE PATIENT MIX WAS AS FOLLOWS: 25% MEDICAID PATIENTS, 11% MEDICARE PATIENTS, 17% UNINSURED PATIENTS AND 47% PRIVATE INSURANCE PATIENTS. THE LOW-INCOME AND MIGRANT FARMWORKERS OF FRANKLIN COUNTY ARE DECLARED A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND FANNETT AND METAL TOWNSHIPS ARE DECLARED A MEDICALLY UNDERSERVED AREA (MUA) AND THE LOW-INCOME AND MIGRANT FARMWORKERS ARE DECLARED A MEDICALLY UNDERSERVED POPULATION (MUP). FRANKLIN COUNTY HAS A MEDICAL, DENTAL AND MENTAL HEALTH HPSA (HEALTH PROFESSIONAL SHORTAGE AREA). DURING 2014, KEYSTONE TREATED 44,815 INDIVIDUALS THROUGH 172,584 VISITS. THE PATIENT COMPOSITION BY REVENUE SOURCE WAS AS FOLLOWS: GROSS PATIENT NET PATIENT PATIENTS SERVICE REVENUE SERVICE REVENUE MEDICARE 10.6% 8.9% 8.6% MEDICAID 25.3% 36.7% 46.2% COMMERCIAL 46.7% 43.5% 36.5% SELF-PAY 17.4% 10.9% 9.2% KEYSTONE DENTAL IS THE ONLY DENTAL PRACTICE IN FOUR COUNTIES THAT ROUTINELY PROVIDES DENTAL CARE TO LOW-INCOME, MEDICAL ASSISTANCE CLIENTS, AND UNINSURED CLIENTS. KEYSTONE PROVIDES A SLIDING FEE WITH DISCOUNTED RATES FOR THOSE WHO QUALIFY FOR THE PROGRAM. IF IT WERE NOT FOR KEYSTONE DENTAL THESE POPULATIONS WOULD HAVE LITERALLY NO ACCESS TO DENTAL CARE. THE PATIENT COMPOSITION BY REVENUE SOURCE FOR KEYSTONE DENTAL 2014 WAS AS FOLLOWS: MEDICARE N/A N/A MEDICAID 56.2% 56.3% COMMERCIAL 28.1% 27.5% SELF-PAY 6.5% 6.4% CHARITY CARE 9.2% 9.8% ONE OF THE GREATEST HEALTH CARE ACCESS BARRIERS FOR FRANKLIN COUNTY RESIDENTS IS FINANCIAL. LOW-INCOME AND UNINSURED INDIVIDUALS REQUIRE A SOURCE OF REGULAR, CONTINUOUS PRIMARY AND PREVENTIVE CARE IN ORDER TO YIELD BETTER HEALTH OUTCOMES AND MINIMIZE HEALTH DISPARITIES. IN ORDER TO ASSURE THAT THE RESIDENTS OF OUR COMMUNITY THAT ARE POOR OR FINANCIALLY NEEDY RECEIVE CARE, KEYSTONE HAS A SYSTEM IN PLACE TO DETERMINE ELIGIBILITY FOR PATIENT DISCOUNTS ADJUSTED ON THE BASIS OF THE PATIENT'S ABILITY TO PAY. THIS SYSTEM PROVIDES FOR FULL DISCOUNTS TO INDIVIDUALS AND FAMILIES WITH ANNUAL INCOMES AT OR BELOW THE POVERTY GUIDELINES (ONLY A NOMINAL FEE IS CHARGED) AND FOR THOSE WITH INCOMES BETWEEN 101% AND 200% OF POVERTY FEES ARE CHARGED IN ACCORDANCE WITH A SLIDING FEE DISCOUNT POLICY BASED ON FAMILY SIZE AND INCOME. MANY CLIENTS DO NOT QUALIFY FOR THE SLIDING FEE BUT STILL DO NOT EARN ENOUGH MONEY TO BE ABLE TO PAY FOR THEIR CARE IN A TIMELY WAY. THESE PATIENTS ARE PLACED ON A PAYMENT PLAN. MANY OF KEYSTONE'S CLIENTS ARE UTILIZING THE PAYMENT PLAN. ANOTHER BARRIER TO HEALTH CARE ACCESS IS LANGUAGE AND CULTURE. ONE IN 18 CLIENTS DOES NOT HAVE ENGLISH AS A PRIMARY LANGUAGE. ALL SERVICES PROVIDED BY KEYSTONE ARE CULTURALLY AND LINGUISTICALLY APPROPRIATE. THROUGH KEYSTONE PROVIDERS AND TRANSLATORS AND ACCESS TO A LANGUAGE LINE, WE ARE FORTUNATE TO HAVE INDIVIDUALS WHO CAN PROVIDE SERVICES TO EVERY PATIENT THAT IS WITHIN THE KEYSTONE SYSTEM INCLUDING THE DEAF. KEYSTONE OFFERS ACCESSIBLE HOURS OF SERVICE INCLUDING EVENING HOURS AND SATURDAY MORNING COVERAGE AT PEDIATRICS AND 8 AM TO 8 PM COVERAGE DAILY AT OUR URGENT CARE CENTER. KEYSTONE OFFERS TIMELY SERVICES THROUGH OUR SAME DAY ACUTE APPOINTMENT SYSTEM AT ALL SITES. KEYSTONE PARTICIPATES IN THE FEDERAL 340B DRUG DISCOUNT PROGRAM. THROUGH THIS PROGRAM, KEYSTONE CAN PURCHASE PHARMACEUTICALS AT REDUCED PRICES AND PASS THE SAVINGS ON TO ITS PATIENTS. THIS GIVES KEYSTONE'S UNINSURED PATIENTS ACCESS TO SIGNIFICANT DISCOUNTS ON THEIR PRESCRIPTION MEDICATIONS. WHILE THIS PROGRAM IS OPEN TO ANY KEYSTONE PATIENT, THOSE WHO BENEFIT THE MOST ARE THE UNINSURED WHO CAN APPLY THEIR SLIDING FEE DISCOUNT TO THE ALREADY REDUCED 340B PROGRAM DISCOUNTS. 2014 - 2015 WERE VERY BUSY YEARS AT KEYSTONE HEALTH. IN MARCH OF 2014, KEYSTONE WALK IN CARE BECAME KEYSTONE URGENT CARE, AND EXPANDED ITS HOURS TO 12 HOURS DAILY TO BETTER SUIT THE NEEDS OF THE COMMUNITY. IN AUGUST, KEYSTONE OPENED ITS FIRST STD CLINIC AT KEYSTONE FAMILY MEDICINE. THE STD CLINIC IS FUNDED BY A GRANT FROM THE DEPARTMENT OF HEALTH AND CARE DELIVERED AT THIS SITE IS COVERED BY THE GRANT. IN MAY 2015, KEYSTONE PLANS TO EXPAND THE STD CLINIC TO INCLUDE A FAMILY PLANNING CLINIC. FRANKLIN COUNTY HAS SEEN A STEADY INCREASE IN THE INCIDENCE AND PREVALENCE OF STD INFECTIONS AND IN TEENAGE PREGNANCY RATES. UNFORTUNATELY THE STD RATES ARE INCREASING IN THE TEENAGE POPULATION AT FAIRLY SIGNIFICANT RATES AND EACH YEAR KEYSTONE DELIVERS CLOSE TO 250 BABIES TO TEENAGE GIRLS. THE FAMILY PLANNING SERVICES WILL BE FUNDED BY A GRANT FROM FAMILY HEALTH COUNCIL OF SOUTHCENTRAL PENNSYLVANIA TO KEYSTONE HEALTH.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>PROVIDER OF CARDIOLOGY, DENTAL, BEHAVIORAL HEALTH, INTERNAL MEDICINE, PHARMACY SERVICES, AND HIV SERVICES TO THE GENERAL POPULATION TARGETING LOW INCOME MEDICARE AND MEDICAL ASSISTANCE INDIVIDUALS. IN ADDITION, WE ARE A PROVIDER OF HEALTH CARE SERVICES TO THE MIGRANT WORKER POPULATION OF THE COMMONWEALTH OF PENNSYLVANIA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION PROVIDED A COPY OF THE FEDERAL FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THE 2014 FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>CONFLICT OF INTEREST POLICY IS REVIEWED AT ANNUAL EMPLOYEE EVALUATIONS AND ANNUALLY WITH THE BOARD OF DIRECTORS' SELF-EVALUATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS MEETS IN A CLOSED SESSION TO DISCUSS THE COMPENSATION AND PERFORMANCE OF THE CEO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION OF ALL OFFICERS AND KEY EMPLOYEES IS REVIEWED WITH THE CEO AS PART OF THE ANNUAL EVALUATION PROCESS. GUIDELINES CONCERNING SALARY ADJUSTMENTS ARE REVIEWED ANNUALLY AS PART OF THE BUDGETING PROCESS. THE BUDGET SUBMISSION IS SUBSEQUENTLY REVIEWED BY THE FINANCE COMMITTEE AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GOVERNING DOCUMENTS ARE MADE AVAILABLE TO REVIEW UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>GRANT FUNDS RELEASED FROM RESTRICTIONS 1,572</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>GRANT FUNDS RELEASED FROM RESTRICTION 1,572</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc6">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>KEYSTONE PHYSICIAN SERVICES</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>755 NORLAND AVENUE</AddressLine1Txt>
          <CityNm>CHAMBERSBURG</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>17201</ZIPCd>
        </USAddress>
        <EIN>200283725</EIN>
        <PrimaryActivitiesTxt>CARDIOLOGY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>KEYSTONE R</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</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>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>