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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID BUUCK</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>557530</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>40500</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PETER HAHN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>488231</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>4900874</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>290000</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>99</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>SOUND PHYSICIANS</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>PO BOX 742936</AddressLine1>
            <City>LOS ANGELES</City>
            <State>CA</State>
            <ZIPCode>90074</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT HOSPITALISTS</ServicesDesc>
        <CompensationAmt>1234248</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>COMPHEALTH</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>PO BOX 972651</AddressLine1>
            <City>DALLAS</City>
            <State>TX</State>
            <ZIPCode>753972651</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>RECRUITER</ServicesDesc>
        <CompensationAmt>175171</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>TUALITY HEALTH ALLIANCE</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>PO BOX 548</AddressLine1>
            <City>HILLSBORO</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BENEFITS ADMINISTRATOR</ServicesDesc>
        <CompensationAmt>109855</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>3</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>636400</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>2170582</GovernmentGrantsAmt>
      <TotalContributionsAmt>2806982</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NON MCR/MCD HOSP REV</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>150922449</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>150922449</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CAFETERIA</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>665675</TotalRevenueColumnAmt>
        <ExclusionAmt>665675</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MANAGEMENT FEES</Desc>
        <BusinessCd>541610</BusinessCd>
        <TotalRevenueColumnAmt>199452</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>199452</UnrelatedBusinessRevenueAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>30602305</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>30602305</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>182389881</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>452121</TotalRevenueColumnAmt>
        <ExclusionAmt>452121</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>44</TotalRevenueColumnAmt>
        <ExclusionAmt>44</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>185649028</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>181524754</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>199452</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1117840</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>174217</TotalAmt>
        <ProgramServicesAmt>174217</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2256260</TotalAmt>
        <ManagementAndGeneralAmt>2256260</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>79667469</TotalAmt>
        <ProgramServicesAmt>79667469</ProgramServicesAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>4259861</TotalAmt>
        <ProgramServicesAmt>4259861</ProgramServicesAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>10938937</TotalAmt>
        <ProgramServicesAmt>10652054</ProgramServicesAmt>
        <ManagementAndGeneralAmt>286883</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>6992389</TotalAmt>
        <ProgramServicesAmt>6809007</ProgramServicesAmt>
        <ManagementAndGeneralAmt>183382</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>422144</TotalAmt>
        <ProgramServicesAmt>313005</ProgramServicesAmt>
        <ManagementAndGeneralAmt>109139</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>1295108</TotalAmt>
        <ProgramServicesAmt>1241907</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53201</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>9563963</TotalAmt>
        <ProgramServicesAmt>9171087</ProgramServicesAmt>
        <ManagementAndGeneralAmt>392876</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>609400</TotalAmt>
        <ProgramServicesAmt>609400</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1618659</TotalAmt>
        <ProgramServicesAmt>1213036</ProgramServicesAmt>
        <ManagementAndGeneralAmt>405623</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>7385536</TotalAmt>
        <ProgramServicesAmt>7385536</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>526348</TotalAmt>
        <ProgramServicesAmt>492366</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33982</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>36492</TotalAmt>
        <ProgramServicesAmt>29</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36463</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>1089324</TotalAmt>
        <ProgramServicesAmt>1089324</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>7108200</TotalAmt>
        <ProgramServicesAmt>6397380</ProgramServicesAmt>
        <ManagementAndGeneralAmt>710820</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>1990537</TotalAmt>
        <ProgramServicesAmt>1791483</ProgramServicesAmt>
        <ManagementAndGeneralAmt>199054</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>18542582</TotalAmt>
        <ProgramServicesAmt>18531666</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10916</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT EXP - DIRECT W</Desc>
        <TotalAmt>15408004</TotalAmt>
        <ProgramServicesAmt>15408004</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PROVIDER TAX</Desc>
        <TotalAmt>7521934</TotalAmt>
        <ProgramServicesAmt>7521934</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EQUIPMENT RENTAL AND MA</Desc>
        <TotalAmt>6856302</TotalAmt>
        <ProgramServicesAmt>6814012</ProgramServicesAmt>
        <ManagementAndGeneralAmt>42290</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>4776439</TotalAmt>
        <ProgramServicesAmt>3725320</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1051119</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>189040105</TotalAmt>
        <ProgramServicesAmt>183268097</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5772008</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>29885339</BOYAmt>
        <EOYAmt>38078652</EOYAmt>
      </CashNonInterestBearingGrp>
      <AccountsReceivableGrp>
        <BOYAmt>28743414</BOYAmt>
        <EOYAmt>28536233</EOYAmt>
      </AccountsReceivableGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>318883</BOYAmt>
        <EOYAmt>676402</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>2629142</BOYAmt>
        <EOYAmt>2682904</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>1856564</BOYAmt>
        <EOYAmt>2184677</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>163003620</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>128687180</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>34538302</BOYAmt>
        <EOYAmt>34316440</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>19671818</BOYAmt>
        <EOYAmt>21432594</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>19299456</BOYAmt>
        <EOYAmt>15247038</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>136942918</BOYAmt>
        <EOYAmt>143154940</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>53225250</BOYAmt>
        <EOYAmt>56943322</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>15633471</BOYAmt>
        <EOYAmt>14994144</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>632295</BOYAmt>
        <EOYAmt>1123275</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>178802</BOYAmt>
        <EOYAmt>847899</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>69669818</BOYAmt>
        <EOYAmt>73908640</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>67166100</BOYAmt>
        <EOYAmt>69113700</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>107000</BOYAmt>
        <EOYAmt>132600</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>67273100</BOYAmt>
        <EOYAmt>69246300</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>136942918</BOYAmt>
        <EOYAmt>143154940</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-3391077</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>1555437</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>3808840</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolAndSepBasisFinclStmtInd>X</ConsolAndSepBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <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="RetDoc1040000001">
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        <BeginningYearBalanceAmt>5255722</BeginningYearBalanceAmt>
        <ContributionsAmt>977540</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>632924</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>14069</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>1110757</OtherExpendituresAmt>
        <EndYearBalanceAmt>5741360</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4571447</BeginningYearBalanceAmt>
        <ContributionsAmt>1001098</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>773916</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>13609</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>1077130</OtherExpendituresAmt>
        <EndYearBalanceAmt>5255722</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4008067</BeginningYearBalanceAmt>
        <ContributionsAmt>911906</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>688295</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>22507</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>1014315</OtherExpendituresAmt>
        <EndYearBalanceAmt>4571446</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
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        <ContributionsAmt>948326</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>-27010</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>23876</GrantsOrScholarshipsAmt>
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        <EndYearBalanceAmt>4008067</EndYearBalanceAmt>
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      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>4402566</BeginningYearBalanceAmt>
        <ContributionsAmt>800425</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>255430</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>31410</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>984018</OtherExpendituresAmt>
        <EndYearBalanceAmt>4442993</EndYearBalanceAmt>
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      <TermEndowmentBalanceEOYPct>0.57000</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>1</EndowmentsHeldRelatedOrgInd>
      <RelatedOrgListSchRInd>1</RelatedOrgListSchRInd>
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>2407626</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>2407626</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
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        <DepreciationAmt>47505755</DepreciationAmt>
        <BookValueAmt>9000682</BookValueAmt>
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      <LeaseholdImprovementsGrp>
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        <BookValueAmt>5276486</BookValueAmt>
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      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>97670005</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>80305321</DepreciationAmt>
        <BookValueAmt>17364684</BookValueAmt>
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      <OtherLandBuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>266962</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>266962</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>34316440</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>SECURITIES AND OTHER INVESTMENTS</Desc>
        <BookValueAmt>21432594</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
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      <TotalBookValueSecuritiesAmt>21432594</TotalBookValueSecuritiesAmt>
      <OtherAssetsOrgGrp>
        <Desc>OTHER ASSETS</Desc>
        <BookValueAmt>14795938</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTEREST IN NET ASSETS OF FOUNDATION</Desc>
        <BookValueAmt>132600</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>GOODWILL</Desc>
        <BookValueAmt>318500</BookValueAmt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>AFFILIATES</Desc>
        <Amt>847899</Amt>
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      <TotalRevEtcAuditedFinclStmtAmt>188854300</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>1555437</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>1649835</OtherRevenueAmt>
      <RevenueNotReportedAmt>3205272</RevenueNotReportedAmt>
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      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>185649028</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>185210578</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>185210578</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>3829527</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>3829527</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>189040105</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
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      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>DIRECT WRITE-OFF METHOD IN EXCESS OF GAAP BAD DEBT EXPENSE 3,829,527.</ExplanationTxt>
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    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="RetDoc1041500001">
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      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
      <Percent400Ind>X</Percent400Ind>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>1</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>0</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>1</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>4048064</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>4048064</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.02330</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>30990468</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>19836205</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>11154263</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.06420</TotalExpensePct>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>35038532</TotalCommunityBenefitExpnsAmt>
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        <OwnWebsiteURLTxt>www.tuality.org</OwnWebsiteURLTxt>
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        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>www.tuality.org</OwnWebsiteURLTxt>
        <RptAvailableUponRequestInd>X</RptAvailableUponRequestInd>
        <AdoptImplementationStrategyInd>X</AdoptImplementationStrategyInd>
        <ExecImplementationStrategyInd>X</ExecImplementationStrategyInd>
        <DevelopCommunityWidePlanInd>X</DevelopCommunityWidePlanInd>
        <ExecCommunityWidePlanInd>X</ExecCommunityWidePlanInd>
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        <AdoptBudgetInd>X</AdoptBudgetInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Community Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 3: The Community Health Needs Assessment was conducted as a rigorous process with other health care organizations in the four-county Portland metropolitan areas as part of the Healthy Columbia Willamette Collaborative. Community citizens were engaged through focus group participation, stakeholder interviews and advice from content experts.Input from over 1,000 community stakeholders has helped establish the community health needs and the subsequent decision making process. This input was collected indirectly by the Collaborative through other recently conducted community engagement projects. Three phases of the assessment model used the Community Themes and Strengths Assessment, the Local Community Health System Assessment &amp; Forces of Change Assessment, and Community Listening Sessions. All engaged the community to help identify health needs in the region. In August 2013, content experts from the identified health focus areas (Access to Affordable Health Care, Behavioral Health, and Chronic Disease) were invited to provide information regarding best practices and recommendations for strategies that the Collaborative could consider moving forward with. These content experts contributed to the Collaborative's selection of final Health Improvement Teams (Access to Affordable Health, Suicide Prevention, Opiate Prescribing Policy, Breastfeeding Promotion, and Tobacco Prevention/Cessation).Because the Healthy Columbia Willamette Collaborative understands the importance of working with the community to ensure the process yields the most accurate results and is trusted by the public, in years two (June 2013-May 2014) and three (June 2014-May 2015) of the assessment there has been a larger role for the greater community to participate in decisions. During year 2, the Collaborative invited community/content stakeholders to participate on each of the Health Improvement Teams to ensure that strategies were developed to maximize benefits to the regional community. The Collaborative also worked with community partners to identify data gaps from the Community Health Needs Assessment and explore options on how to fill these gaps for future assessments.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Forest Grove Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 3: The Community Health Needs Assessment was conducted as a rigorous process with other health care organizations in the four-county Portland metropolitan areas as part of the Healthy Columbia Willamette Collaborative. Community citizens were engaged through focus group participation, stakeholder interviews and advice from content experts.Input from over 1,000 community stakeholders has helped establish the community health needs and the subsequent decision making process. This input was collected indirectly by the Collaborative through other recently conducted community engagement projects. Three phases of the assessment model used the Community Themes and Strengths Assessment, the Local Community Health System Assessment &amp; Forces of Change Assessment, and Community Listening Sessions. All engaged the community to help identify health needs in the region. In August 2013, content experts from the identified health focus areas (Access to Affordable Health Care, Behavioral Health, and Chronic Disease) were invited to provide information regarding best practices and recommendations for strategies that the Collaborative could consider moving forward with. These content experts contributed to the Collaborative's selection of final Health Improvement Teams (Access to Affordable Health, Suicide Prevention, Opiate Prescribing Policy, Breastfeeding Promotion, and Tobacco Prevention/Cessation).Because the Healthy Columbia Willamette Collaborative understands the importance of working with the community to ensure the process yields the most accurate results and is trusted by the public, in years two (June 2013-May 2014) and three (June 2014-May 2015) of the assessment there has been a larger role for the greater community to participate in decisions. During year 2, the Collaborative invited community/content stakeholders to participate on each of the Health Improvement Teams to ensure that strategies were developed to maximize benefits to the regional community. The Collaborative also worked with community partners to identify data gaps from the Community Health Needs Assessment and explore options on how to fill these gaps for future assessments.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Community Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 4: Adventist Medical Center, Clackamas County Public Health Division, Clark County Public Health Department, FamilyCare, Health Share of Oregon, Kaiser Sunnyside Hospital, Kaiser Westside Medical Center, Legacy Emanuel Medical Center, Legacy Good Samaritan Medical Center, Legacy Meridian Park Medical Center, Legacy Mount Hood Medical Center, Legacy Salmon Creek, Multnomah County Health Department, Oregon Health &amp; Science University, PeaceHealth Southwest Medical Center, Providence Milwaukie, Providence Portland, Providence St. Vincent, Providence Willamette Falls, Tuality Healthcare/Tuality Community Hospital and Washington County Public Health Division.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Forest Grove Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 4: Adventist Medical Center, Clackamas County Public Health Division, Clark County Public Health Department, FamilyCare, Health Share of Oregon, Kaiser Sunnyside Hospital, Kaiser Westside Medical Center, Legacy Emanuel Medical Center, Legacy Good Samaritan Medical Center, Legacy Meridian Park Medical Center, Legacy Mount Hood Medical Center, Legacy Salmon Creek, Multnomah County Health Department, Oregon Health &amp; Science University, PeaceHealth Southwest Medical Center, Providence Milwaukie, Providence Portland, Providence St. Vincent, Providence Willamette Falls, Tuality Healthcare/Tuality Community Hospital and Washington County Public Health Division.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Community Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 20d: Average of all negotiated commercial insurance rates.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Tuality Forest Grove Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 20d: Average rate of all negotiated commerial insurance rates.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>17</FacilityNum>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Tuality Urgent Care at Reedville</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>7545 SE Tualatin Valley Hwy</AddressLine1>
            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Tuality Healthplace</BusinessNameLine1>
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          <USAddress>
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            <State>OR</State>
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        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
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          </BusinessName>
          <USAddress>
            <AddressLine1>299 SE 9th Ave</AddressLine1>
            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>OP Radiation Therapy</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Tuality Home Health</BusinessNameLine1>
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          <USAddress>
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            <City>Forest Grove</City>
            <State>OR</State>
            <ZIPCode>97116</ZIPCode>
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          <BusinessName>
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          </BusinessName>
          <USAddress>
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            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>MOB</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
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          <USAddress>
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            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>MOB</FacilityTxt>
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          <BusinessName>
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          <USAddress>
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            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>MOB</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Tuality Forest Grove Medical Plaza</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>3201 19th Ave</AddressLine1>
            <City>Forest Grove</City>
            <State>OR</State>
            <ZIPCode>97116</ZIPCode>
          </USAddress>
          <FacilityTxt>MOB</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
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          </BusinessName>
          <USAddress>
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            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>North Plains Medical Clinic</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>10245 NW Glencoe Rd</AddressLine1>
            <City>North Plains</City>
            <State>OR</State>
            <ZIPCode>97133</ZIPCode>
          </USAddress>
          <FacilityTxt>Physician Offices</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Tuality Obstetrics &amp; Gynecology</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>364 SE 8th Ave Ste 205</AddressLine1>
            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>Physician Offices</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Westside Medical Clinic</BusinessNameLine1>
          </BusinessName>
          <USAddress>
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            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97124</ZIPCode>
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          <FacilityTxt>Physician Offices</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
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          </BusinessName>
          <USAddress>
            <AddressLine1>364 SE 8th Ave Ste 105</AddressLine1>
            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
          </USAddress>
          <FacilityTxt>Physician Offices</FacilityTxt>
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            <City>North Plains</City>
            <State>OR</State>
            <ZIPCode>97133</ZIPCode>
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          <FacilityTxt>Physician Offices</FacilityTxt>
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          </BusinessName>
          <USAddress>
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            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97124</ZIPCode>
          </USAddress>
          <FacilityTxt>Physician Offices</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
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          </BusinessName>
          <USAddress>
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            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97124</ZIPCode>
          </USAddress>
          <FacilityTxt>Physician Offices</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
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          </BusinessName>
          <USAddress>
            <AddressLine1>364 SE 8th Ave Ste 101</AddressLine1>
            <City>Hillsboro</City>
            <State>OR</State>
            <ZIPCode>97123</ZIPCode>
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          <FacilityTxt>Physician Offices</FacilityTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7, Column (f):</FormAndLineReferenceDesc>
        <ExplanationTxt>The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 15,408,004.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II, Community Building Activities:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Tuality Health Education Center is a hub for many community activities and organizations in the greater Hillsboro area. The facility provides meeting space for a number of community organizations, ranging from the Hillsboro Rotary Club to Washington County Community Action. The facility also plays host to dozens of Tuality sponsored classes and healthcare presentations. These range from classes on diabetes, yoga and car seat safety to presentations by doctors and other healthcare providers on topics as diverse as COPD, stroke prevention and weight-loss surgery. Tuality also provides free or low-cost blood pressure, cholesterol and blood glucose screenings at many community events.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Accounts receivable are stated at unpaid balances (net of contractual allowances) and are reduced by an allowance for amounts that could become uncollectible in the future. Substantially all of the Company's receivables are related to providing healthcare services to its hospitals' patients. The Company estimates the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable without regard to aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. For all other non-self-pay payer categories, the Company reserves 100% of all accounts aging over 365 days from the date of discharge. The percentage used to reserve for all self-pay accounts is based on the Company's collection history. The Company collects substantially all of its third-party insured receivables, which include receivables from governmental agencies. Collections are impacted by the economic ability of patients to pay and the effectiveness of the Company's collection efforts. Significant changes in payer mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect the Company's collection of accounts receivable and the estimates of the collectability of future accounts receivable. The process of estimating the allowance for doubtful accounts requires the Company to estimate the collectability of self-pay accounts receivable, which is primarily based on its collection history, adjusted for expected recoveries and, if available, anticipated changes in collection trends. The Company also continually reviews its overall reserve adequacy by analyzing current period net revenue and admissions by payer classification, aged accounts receivable by payer, and days revenue outstanding.The allowance for uncollectible accounts is decreased by charge-offs (net of recoveries). Accounts receivable are written off after collection efforts have been followed in accordance with the Company's policies.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to referencing and accessing our internal Tuality Financial Assistance program (before, during, and after services are rendered), we also recognize other Portland providers' (hospitals, physician, ambulance, DME, etc) financial assistance determination (with written proof).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Tuality Healthcare's leadership interacts with the citizens of western Washington County in a variety of ways. Tuality is actively involved as a sponsor in a long list of community events, from the Washington County Airshow, the premier airshow in the Pacific Northwest, to the North Plains Garlic Festival. In addition, we engage our residents through our many partnerships with a host of worthwhile organizations like Pacific University, Virginia Garcia Memorial Health Center, Essential Health Clinic, Hospice of Washington County and many others. Tuality strives to get feedback from our customers through surveys and questionnaires that tell us how well we are doing with current services, as well as what new and improved services may be needed by the community.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Requests for financial assistance may be made at any point before, during, or after the provision of care. Information related to eligibility for financial assistance is located in the lobbies of the hospital and available on the Tuality.org website. Financial assistance requests may be proposed by sources other than the patient, such as the patient's physician, family members, community or religious groups, social services, or hospital personnel. Anyone wishing to make application for financial assistance with Tuality Healthcare will be given a Financial Assistance Application, which includes instructions on how to apply. All private pay admits are screened for Medicaid/Social Security disability coverage and a hold is placed on the account while we assist the patient and /or their family in applying for government benefits.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Tuality Healthcare serves a large geographic area of western Washington County that stretches from the suburban Portland cities of Aloha and Beaverton to the Coast Range. The market includes the cities of Hillsboro and Forest Grove, sites of Tuality's two hospitals, plus smaller towns such as Cornelius, Gaston, North Plains and Banks. This region is roughly 250,000 people and is one of the fastest growing areas in Oregon. In addition, Tuality is one of the region's largest employers with a staff of over 1,600. Tuality provides financial, material and medical assistance to many community partners in the region. Tuality Healthcare is designated a "Disproportionate Share Hospital" by the Centers for Medicare and Medicaid Services, due to the larger than normal percentage of care we provide to the low income and indigent population in our area.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>When it comes to community, everyone has a part to play. For us, it's an honor and a duty to help those near us receive the best medical care possible. That's why, since our beginnings in 1918, we've worked hard to provide quality, convenient care for people in western Washington County. Today, we're the only local, independent, community-governed healthcare system in the area, offering inpatient and outpatient treatment, specialty services, health education, and more.Of course, our goal isn't only to treat you when you're sick, but also to help you stay well. For that reason, you'll often find us at local events and other public places, offering free or low-cost health screenings and educational courses. For those who need it, we even provide transportation to and from medical appointments.Many of these services are offered at Tuality Health Education Center and other locations. We really are your neighbors! Many of our 1,600 employees live just a short distance from work.Our larger facilities include Tuality Community Hospital in Hillsboro and Tuality Forest Grove Hospital. In addition, we have numerous other medical centers and outpatient facilities. By keeping up with the latest advances in medical science, we've earned a sterling reputation for the quality of our heart, cancer, stroke, and diagnostic imaging services.In this way, we are able to offer the best possible medical care to the Tualatin Valley cities and communities in western Washington County, such as Aloha, Beaverton, Hillsboro, Forest Grove, Cornelius, and the smaller communities of the Coastal Range foothills.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>N/A</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 7, Reports Filed With States</FormAndLineReferenceDesc>
        <ExplanationTxt>OR</ExplanationTxt>
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        <PersonNm>TODD SADOWSKI</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ROBERT SCHMIDT</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>GREGORY ROSENBLATT</PersonNm>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID BUUCK</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <TotalCompensationFilingOrgAmt>598030</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PETER HAHN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Richard Stenson - $534,223 paid in the fiscal year ended 9/30/2014. Part I, Line 4b: Under the plan, Tuality Healthcare is obligated to contribute vested accrued benefits to the participant's plan account. Contributions to the participant's plan account are made on a monthly basis at an amount equal to two thousand dollars per month.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Gregory Rosenblatt</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Highly Compensated Employee Family Member of Director</RelationshipDescriptionTxt>
        <TransactionAmt>471236</TransactionAmt>
        <TransactionDesc>Compensation for Physician Services.</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Gregory Rosenblatt snd Charles Rosenblatt have a family relationship.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>A copy of the 990 is reviewed by Tuality Healthcare's Chief Financial Officer. It is then presented to the Tuality Healthcare Board of Directors for review, prior to being filed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by making it part of the employee's annual review. Board members are also required to review the policy annually. All afore said parties are required to certify that they have read the conflict of interest policy, have disclosed any potential conflicts of interest, and agree to immediately notify the Compliance Officer if a conflict should arise. Corrective actions are to be taken immediately to address any conflicts of interest.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive group's compensation is periodically reviewed every 3-5 yrs by an independent party, at the direction of the board of directors. The Tuality Healthcare HR department annually reviews compensation for all others.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's tax returns are made available for public inspection on the following website: Guidestar.org. Governing documents are made available upon written request to the Chief Financial Officer of Tuality Healthcare.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN INTEREST IN NET ASSETS UNDER FAS 136 25,600. DIRECT WRITE OFF METHOD IN EXCESS OF GAAP METHOD OF BAD DEBT EXPENSE 3,829,527. ROUNDING -58. EQUITY INCOME NET OF DISTRIBUTIONS OF JT VENTURES 1,649,844. CHANGE IN MINIMUM PENSION LIABILITY UNDER FAS 158 -1,696,073.</ExplanationTxt>
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    </IRS990ScheduleO>
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      <IdRelatedTaxExemptOrgGrp>
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          <State>OR</State>
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        <MethodOfAmountDeterminationTxt>Cash</MethodOfAmountDeterminationTxt>
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    </IRS990ScheduleR>
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</Return>