﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2013v3.1" xsi:schemaLocation="http://www.irs.gov/efile">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2014-11-07T08:31:14-08:00</ReturnTs>
    <TaxPeriodEndDt>2013-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmName>
        <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1>220 CAMPUS BLVD STE 310</AddressLine1>
        <City>WINCHESTER</City>
        <State>VA</State>
        <ZIPCode>226012889</ZIPCode>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2013-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>521357729</EIN>
      <BusinessName>
        <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
      </BusinessName>
      <BusinessNameControlTxt>VALL</BusinessNameControlTxt>
      <PhoneNum>5405364300</PhoneNum>
      <USAddress>
        <AddressLine1>220 CAMPUS BLVD SUITE 310</AddressLine1>
        <City>WINCHESTER</City>
        <State>VA</State>
        <ZIPCode>22601</ZIPCode>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>PETER F GALLAGHER</PersonNm>
      <PersonTitleTxt>CFO</PersonTitleTxt>
      <SignatureDt>2014-11-07</SignatureDt>
      <DiscussWithPaidPreparerInd>false</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PhoneNum>5405364300</PhoneNum>
    </PreparerPersonGrp>
    <TaxYr>2013</TaxYr>
    <BuildTS>2015-11-30 17:44:51Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCount="12">
    <IRS990 documentId="IRS990" referenceDocumentId="IRS990ScheduleO 990BinaryAttachments.1 990BinaryAttachments.2 990BinaryAttachments.3" softwareId="13000170" softwareVersion="2013v3.1">
      <GrossReceiptsAmt>90864228</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <AllAffiliatesIncludedInd>false</AllAffiliatesIncludedInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.VALLEYHEALTHLINK.COM</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1983</FormationYr>
      <LegalDomicileStateCd>VA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>SERVING OUR REGIONAL COMMUNITY BY IMPROVING HEALTH. PROVISION OF HEALTHCARE AND MEDICAL SERVICES.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>14</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>13</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>6555</TotalEmployeeCnt>
      <TotalGrossUBIAmt>59594</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>557923</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>725720</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>78150861</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>82209075</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>7768787</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>7483458</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>-62081</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>-86784</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>86415490</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>90331469</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>371329</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>620754</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>53342053</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>57071092</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>515003</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>508760</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>1679822</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>31609072</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>33464079</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>85837457</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>91664685</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>578033</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-1333216</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>42411103</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>48214156</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>45630720</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>51993352</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>-3219617</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>-3779196</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>SERVING OUR REGIONAL COMMUNITY BY IMPROVING HEALTH. PROVISION OF HEALTHCARE AND MEDICAL SERVICES.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>89984863</ExpenseAmt>
      <GrantAmt>397559</GrantAmt>
      <Desc>ORGANIZATION PROVIDED MANAGEMENT AND/OR SUPPORT SERVICES TO 9 SUBSIDIARIES AND 6 OUTSIDE HEALTHCARE ORGANIZATIONS DURING 2013.</Desc>
      <TotalProgramServiceExpensesAmt>89984863</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="IRS990ScheduleB">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="IRS990ScheduleD">false</CreditCounselingInd>
      <TempOrPermanentEndowmentsInd referenceDocumentId="IRS990ScheduleD">false</TempOrPermanentEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">false</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">true</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd referenceDocumentId="IRS990ScheduleG">true</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentId="IRS990ScheduleG">false</FundraisingActivitiesInd>
      <GamingActivitiesInd referenceDocumentId="IRS990ScheduleG">false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd referenceDocumentId="IRS990ScheduleI">true</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentId="IRS990ScheduleI">false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd referenceDocumentId="IRS990ScheduleK.1 IRS990ScheduleK.2">true</TaxExemptBondsInd>
      <InvestTaxExemptBondsInd>false</InvestTaxExemptBondsInd>
      <EscrowAccountInd>false</EscrowAccountInd>
      <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      <EngagedInExcessBenefitTransInd referenceDocumentId="IRS990ScheduleL">false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd referenceDocumentId="IRS990ScheduleL">false</PYExcessBenefitTransInd>
      <LoanOutstandingInd referenceDocumentId="IRS990ScheduleL">false</LoanOutstandingInd>
      <GrantToRelatedPersonInd referenceDocumentId="IRS990ScheduleL">false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd referenceDocumentId="IRS990ScheduleL">false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd referenceDocumentId="IRS990ScheduleL">true</BusinessRlnWithFamMemInd>
      <BusinessRlnWithOfficerEntInd referenceDocumentId="IRS990ScheduleL">true</BusinessRlnWithOfficerEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="IRS990ScheduleR">true</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="IRS990ScheduleR">true</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="IRS990ScheduleR">false</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="IRS990ScheduleR">false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="IRS990ScheduleR">false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>504</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>false</BackupWthldComplianceInd>
      <EmployeeCnt>6555</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>true</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>true</ForeignFinancialAccountInd>
      <ForeignCountryCd>OC</ForeignCountryCd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <Form8282FiledCnt>0</Form8282FiledCnt>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>false</Form8899Filedind>
      <Form1098CFiledInd>false</Form1098CFiledInd>
      <ExcessBusinessHoldingsInd>false</ExcessBusinessHoldingsInd>
      <TaxableDistributionsInd>false</TaxableDistributionsInd>
      <DistributionToDonorInd>false</DistributionToDonorInd>
      <OrgFiledInLieuOfForm1041Ind>false</OrgFiledInLieuOfForm1041Ind>
      <LicensedMoreThanOneStateInd>false</LicensedMoreThanOneStateInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>14</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>13</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>true</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>true</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>true</InvestmentInJointVentureInd>
      <WrittenPolicyOrProcedureInd>true</WrittenPolicyOrProcedureInd>
      <OtherWebsiteInd>X</OtherWebsiteInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>KATHRYN THOMAS</PersonNm>
        <PhoneNum>5405364300</PhoneNum>
        <USAddress>
          <AddressLine1>220 CAMPUS BLVD SUITE 310</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS T GILPIN</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>1500</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK H MERRILL</PersonNm>
        <TitleTxt>President &amp; CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>652885</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>186144</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CLIFTON L RUTHERFORD</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>1600</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEVEN CLUSS</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOSEPH F SILEK JR</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>900</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JIM LONG</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>HARRY F BYRD III</PersonNm>
        <TitleTxt>Secretary</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DOUGLAS B KEIM MD</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM B MAJOR MD</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY BETH PRICE</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>600</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATRICK D IRELAND MD</PersonNm>
        <TitleTxt>TRUSTEE/PHYS</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>81600</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FAITH B POWER</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>2500</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>HARRY S SMITH</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>700</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEFFREY A SKILES</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUANNE THURMAN-GERSDORF</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>199895</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>46773</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>J CRAIG LEWIS</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>374157</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>89146</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM HAIRE</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NEIL MCLAUGHLIN</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>164936</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>42508</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOAN ROSCOE</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>250164</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>41112</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WES WILLIAMS</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>197631</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26122</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARVIN T WAY</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>334908</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>73237</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ELIZABETH SAVAGE-TRACY</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>233504</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>51524</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT AMOS</PersonNm>
        <TitleTxt>CFO-WMC</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>227760</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25377</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTOPHER B RUMPF MD</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>382509</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>92861</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NELSON T CLARK</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>178222</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>30846</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FLOYD R HEATER</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>220484</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>54436</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATRICK B NOLAN</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>225029</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>50214</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRIS RUCKER</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>153663</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>38790</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TONYA SMITH</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>207360</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>48518</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FRANCIS X DENNEHY</PersonNm>
        <TitleTxt>DIR RESIDENCY</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>237449</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29242</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NEAL MCKNIGHT</PersonNm>
        <TitleTxt>COR DIR PAT ACT</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>209081</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25351</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RICHARD BRUCE CARLSON</PersonNm>
        <TitleTxt>COR DIR MAT MGM</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>198919</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>24574</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTOPHER GOODITIS</PersonNm>
        <TitleTxt>DIR IS TECH SERV</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>191115</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27364</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NADINE POLASKO</PersonNm>
        <TitleTxt>EPIC SYS ANALYST</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>198522</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18113</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>3693504</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>1434089</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>1022252</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>13</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>WINCHESTER EMERGENCY PHYSICIANS</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>80 PEACHTREE ROAD STE 200</AddressLine1>
            <City>ASHEVILLE</City>
            <State>NC</State>
            <ZIPCode>28803</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIAN SERVICES</ServicesDesc>
        <CompensationAmt>10525199</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>HMP OF FRONT ROYAL LLC</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>4535 DRESSLER ROAD NW</AddressLine1>
            <City>CANTON</City>
            <State>OH</State>
            <ZIPCode>44718</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIAN SERVICES</ServicesDesc>
        <CompensationAmt>3486763</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>FRONT ROYAL EMERGENCY PHYSICIANS</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>80 PEACHTREE ROAD STE 200</AddressLine1>
            <City>ASHEVILLE</City>
            <State>NC</State>
            <ZIPCode>28803</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIAN SERVICES</ServicesDesc>
        <CompensationAmt>2934803</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>BARTON MALOW COMPANY</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>26500 AMERICAN DRIVE</AddressLine1>
            <City>SOUTHFIELD</City>
            <State>MI</State>
            <ZIPCode>48034</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION DESIGN</ServicesDesc>
        <CompensationAmt>16963354</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1>SHENANDOAH EMERGENCY PHYSICIANS</BusinessNameLine1>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1>80 PEACHTREE ROAD STE 200</AddressLine1>
            <City>ASHEVILLE</City>
            <State>NC</State>
            <ZIPCode>28803</ZIPCode>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIAN SERVICES</ServicesDesc>
        <CompensationAmt>2370350</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>66</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>33653</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>692067</GovernmentGrantsAmt>
      <TotalContributionsAmt>725720</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>CLINICAL RESEARCH REVENUE</Desc>
        <TotalRevenueColumnAmt>498688</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>498688</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CORPORATE MANAGEMENT FEES</Desc>
        <TotalRevenueColumnAmt>78097983</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>78097983</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>WELLNESS FEE REVENUE</Desc>
        <TotalRevenueColumnAmt>3612404</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3612404</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>82209075</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>7483458</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>62100</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>7421358</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>445975</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>532759</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-86784</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>-2506</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-84278</ExclusionAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>90331469</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>82209075</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>59594</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>7337080</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>620754</TotalAmt>
        <ProgramServicesAmt>620754</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>3340837</TotalAmt>
        <ProgramServicesAmt>3340837</ProgramServicesAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>39851561</TotalAmt>
        <ProgramServicesAmt>39234095</ProgramServicesAmt>
        <FundraisingAmt>617466</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>4114476</TotalAmt>
        <ProgramServicesAmt>4050725</ProgramServicesAmt>
        <FundraisingAmt>63751</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>6371998</TotalAmt>
        <ProgramServicesAmt>6273269</ProgramServicesAmt>
        <FundraisingAmt>98729</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>3392220</TotalAmt>
        <ProgramServicesAmt>3341149</ProgramServicesAmt>
        <FundraisingAmt>51071</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>888983</TotalAmt>
        <ProgramServicesAmt>888983</ProgramServicesAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>3593</TotalAmt>
        <ProgramServicesAmt>3593</ProgramServicesAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>508760</TotalAmt>
        <FundraisingAmt>508760</FundraisingAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1048248</TotalAmt>
        <ProgramServicesAmt>1048248</ProgramServicesAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>1317674</TotalAmt>
        <ProgramServicesAmt>1308839</ProgramServicesAmt>
        <FundraisingAmt>8835</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>2574312</TotalAmt>
        <ProgramServicesAmt>2529493</ProgramServicesAmt>
        <FundraisingAmt>44819</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>4977134</TotalAmt>
        <ProgramServicesAmt>4968225</ProgramServicesAmt>
        <FundraisingAmt>8909</FundraisingAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>1564120</TotalAmt>
        <ProgramServicesAmt>1563421</ProgramServicesAmt>
        <FundraisingAmt>699</FundraisingAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>759307</TotalAmt>
        <ProgramServicesAmt>716179</ProgramServicesAmt>
        <FundraisingAmt>43128</FundraisingAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>242080</TotalAmt>
        <ProgramServicesAmt>90603</ProgramServicesAmt>
        <FundraisingAmt>151477</FundraisingAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>0</TotalAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>17203</TotalAmt>
        <ProgramServicesAmt>17203</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>264032</TotalAmt>
        <ProgramServicesAmt>264032</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>PURCHASED SERVICES</Desc>
        <TotalAmt>13805432</TotalAmt>
        <ProgramServicesAmt>13805432</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EQUIP RENTAL &amp; MAINT</Desc>
        <TotalAmt>6089897</TotalAmt>
        <ProgramServicesAmt>6089897</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>3824317</TotalAmt>
        <ProgramServicesAmt>3810420</ProgramServicesAmt>
        <FundraisingAmt>13897</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EMPLOYEE RELATIONS</Desc>
        <TotalAmt>1337903</TotalAmt>
        <ProgramServicesAmt>1308297</ProgramServicesAmt>
        <FundraisingAmt>29606</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>-5250156</TotalAmt>
        <ProgramServicesAmt>-5288831</ProgramServicesAmt>
        <FundraisingAmt>38675</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>91664685</TotalAmt>
        <ProgramServicesAmt>89984863</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>1679822</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>3938257</BOYAmt>
        <EOYAmt>5140824</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <EOYAmt>0</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <EOYAmt>0</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>16459129</BOYAmt>
        <EOYAmt>19615645</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>1397900</BOYAmt>
        <EOYAmt>1390533</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>5781800</BOYAmt>
        <EOYAmt>5893504</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>231243</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>155041</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>69200</BOYAmt>
        <EOYAmt>76202</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>14764817</BOYAmt>
        <EOYAmt>16097448</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>42411103</BOYAmt>
        <EOYAmt>48214156</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>44114603</BOYAmt>
        <EOYAmt>49910823</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>152570</BOYAmt>
        <EOYAmt>169258</EOYAmt>
      </DeferredRevenueGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>1363547</BOYAmt>
        <EOYAmt>1913271</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>45630720</BOYAmt>
        <EOYAmt>51993352</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>-3219617</BOYAmt>
        <EOYAmt>-3779196</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>-3219617</BOYAmt>
        <EOYAmt>-3779196</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>42411103</BOYAmt>
        <EOYAmt>48214156</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-1333216</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>773637</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>true</AccountantCompileOrReviewInd>
      <AcctCompileOrReviewBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </AcctCompileOrReviewBasisGrp>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA" softwareId="13000170" softwareVersion="2013v3.1">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB" softwareId="13000170" softwareVersion="2013v3.1">
      <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="IRS990ScheduleD" softwareId="13000170" softwareVersion="2013v3.1">
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>231243</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>155041</DepreciationAmt>
        <BookValueAmt>76202</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>76202</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>COLONIAL HEALTH ALLIANCE INVEST</Desc>
        <BookValueAmt>30000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>EXECUTIVE BENEFITS</Desc>
        <BookValueAmt>2993236</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INVESTMENT - VALLEY REGIONAL ENTERPRISES</Desc>
        <BookValueAmt>86250</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>MEDICAL CIRCLE, LLC JOINT VENTURE</Desc>
        <BookValueAmt>695194</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>OTHER RECEIVABLES</Desc>
        <BookValueAmt>1476153</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>VA SOLUTIONS SERVICES INVESTMENT</Desc>
        <BookValueAmt>8982668</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>WINCHESTER ENDOSCOPY, LLC JOINT VENTURE</Desc>
        <BookValueAmt>769297</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>WINCHESTER OPEN MRI - JOINT VENTURE</Desc>
        <BookValueAmt>1064650</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>16097448</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>EXEC DEF COMP LIABILITY</Desc>
        <Amt>1913269</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Rounding</Desc>
        <Amt>2</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>1913271</TotalLiabilityAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="IRS990ScheduleG" softwareId="13000170" softwareVersion="2013v3.1">
      <MailSolicitationsInd>X</MailSolicitationsInd>
      <InPersonSolicitationsInd>X</InPersonSolicitationsInd>
      <SolicitationOfNonGovtGrantsInd>X</SolicitationOfNonGovtGrantsInd>
      <SolicitationOfGovtGrantsInd>X</SolicitationOfGovtGrantsInd>
      <SpecialFundraisingEventsInd>X</SpecialFundraisingEventsInd>
      <AgrmtProfFundraisingActyInd>false</AgrmtProfFundraisingActyInd>
      <FundraiserActivityInfoGrp>
        <OrganizationBusinessName>
          <BusinessNameLine1>GSI</BusinessNameLine1>
        </OrganizationBusinessName>
        <USAddress>
          <AddressLine1>255 MADISON AVE</AddressLine1>
          <City>WYCKOFF</City>
          <State>NJ</State>
          <ZIPCode>07481</ZIPCode>
        </USAddress>
        <ActivityTxt>FUNDRAISING C</ActivityTxt>
        <FundraiserControlOfFundsInd>false</FundraiserControlOfFundsInd>
        <RetainedByContractorAmt>344000</RetainedByContractorAmt>
      </FundraiserActivityInfoGrp>
      <FundraiserActivityInfoGrp>
        <OrganizationBusinessName>
          <BusinessNameLine1>GOVT IMPACT</BusinessNameLine1>
        </OrganizationBusinessName>
        <USAddress>
          <AddressLine1>PO BOX 1438</AddressLine1>
          <City>SIMI VALLE</City>
          <State>CA</State>
          <ZIPCode>93062</ZIPCode>
        </USAddress>
        <ActivityTxt>FUNDRAISING C</ActivityTxt>
        <FundraiserControlOfFundsInd>false</FundraiserControlOfFundsInd>
        <RetainedByContractorAmt>123000</RetainedByContractorAmt>
      </FundraiserActivityInfoGrp>
      <FundraiserActivityInfoGrp>
        <OrganizationBusinessName>
          <BusinessNameLine1>M2S</BusinessNameLine1>
        </OrganizationBusinessName>
        <USAddress>
          <AddressLine1>12 COMMERENCE A</AddressLine1>
          <City>W LEBANON</City>
          <State>NH</State>
          <ZIPCode>03784</ZIPCode>
        </USAddress>
        <ActivityTxt>FUNDRAISING C</ActivityTxt>
        <FundraiserControlOfFundsInd>false</FundraiserControlOfFundsInd>
        <RetainedByContractorAmt>32750</RetainedByContractorAmt>
      </FundraiserActivityInfoGrp>
      <TotalRetainedByContractorsAmt>499750</TotalRetainedByContractorsAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 2b - Fundraiser Additional Information</FormAndLineReferenceDesc>
        <ExplanationTxt>Provided Fundraising Counsel for Capital Campaign</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleG>
    <IRS990ScheduleI documentId="IRS990ScheduleI" softwareId="13000170" softwareVersion="2013v3.1">
      <GrantRecordsMaintainedInd>true</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>GOOD SAMARITAN FREE CLINIC</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>121 QUEEN STREET</AddressLine1>
          <City>MARTINSBURG</City>
          <State>WV</State>
          <ZIPCode>25402</ZIPCode>
        </USAddress>
        <RecipientEIN>050602031</RecipientEIN>
        <CashGrantAmt>21250</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>CHARITY CARE</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>NEW LIFE CENTER EDGEHILL</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>315 E CORK STREET</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <CashGrantAmt>7496</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>MORTAGE ASSISTANCE</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>OUR HEALTH</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>329 N CAMERON STREET</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <RecipientEIN>541972659</RecipientEIN>
        <CashGrantAmt>275513</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>COVER OUR HEALTH EXPENSES</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>SHENANDOAH COUNTY FREE CLINIC</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>781 SPRING PKWY</AddressLine1>
          <City>WOODSTOCK</City>
          <State>VA</State>
          <ZIPCode>22664</ZIPCode>
        </USAddress>
        <RecipientEIN>541008875</RecipientEIN>
        <CashGrantAmt>37500</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>WELL TRAN SERVICE SUPPORT</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>ST LUKE COMMUNITY CLINIC</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>316 N ROYAL AVENUE</AddressLine1>
          <City>FRONT ROYAL</City>
          <State>VA</State>
          <ZIPCode>22630</ZIPCode>
        </USAddress>
        <RecipientEIN>541801220</RecipientEIN>
        <CashGrantAmt>55800</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>CHARITY CARE</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>4</Total501c3OrgCnt>
      <TotalOtherOrgCnt>1</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Grantmaker's Description of How Grants are Used</FormAndLineReferenceDesc>
        <ExplanationTxt>VIRTUALLY ALL OF THE ORGANIZATIONS PROVIDED WITH GRANT FUNDS ARE LOCAL, AND CLOSELY MONITORED BY VALLEY HEALTH'S MANAGEMENT AND BOARD. PERIODIC REPORTS ARE OBTAINED AS WELL FROM THESE GRANTEES WHICH DISCUSS OPERATIONS AND BENEFITS RENDERED TO THE COMMUNITIES SERVED. BEFORE FUNDING IS GRANTED, CONSISTENCY OF MISSION IS EVALUATED IN ORDER TO ASSURE LIKE DIRECTION WITH VALLEY HEALTH INITIATIVES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ" softwareId="13000170" softwareVersion="2013v3.1">
      <IdemnificationGrossUpPmtsInd>X</IdemnificationGrossUpPmtsInd>
      <DiscretionarySpendingAcctInd>X</DiscretionarySpendingAcctInd>
      <HousingAllowanceOrResidenceInd>X</HousingAllowanceOrResidenceInd>
      <WrittenPolicyRefTAndEExpnssInd>true</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>true</SubstantiationRequiredInd>
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>true</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>true</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>true</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>true</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>true</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>true</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>true</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RebuttablePresumptionProcInd>false</RebuttablePresumptionProcInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRIS RUCKER</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>153474</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>189</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>13842</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>24948</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>192453</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRISTOPHER B RUMPF MD</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>356732</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>23401</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>2376</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>58902</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>33959</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>475370</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRISTOPHER GOODITIS</PersonNm>
        <TitleTxt>DIR IS TECH SERV</TitleTxt>
        <BaseCompensationFilingOrgAmt>190869</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>246</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>27364</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>218479</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ELIZABETH SAVAGE-TRACY</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>232651</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>853</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>22508</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>29016</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>285028</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>FLOYD R HEATER</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>220016</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>468</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>25876</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>28560</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>274920</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>FRANCIS X DENNEHY</PersonNm>
        <TitleTxt>DIR RESIDENCY</TitleTxt>
        <BaseCompensationFilingOrgAmt>236933</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>516</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>29242</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>266691</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>J CRAIG LEWIS</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>372678</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>1479</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>55213</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>33933</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>463303</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOAN ROSCOE</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>249048</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>1116</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>24269</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>16843</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>291276</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK H MERRILL</PersonNm>
        <TitleTxt>President &amp; CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>633464</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>19421</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>143411</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>42733</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>839029</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARVIN T WAY</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>333480</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>1428</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>49546</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>23691</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>408145</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NADINE POLASKO</PersonNm>
        <TitleTxt>EPIC SYS ANALYST</TitleTxt>
        <BaseCompensationFilingOrgAmt>189571</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>8699</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>252</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>18113</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>216635</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NEAL MCKNIGHT</PersonNm>
        <TitleTxt>COR DIR PAT ACT</TitleTxt>
        <BaseCompensationFilingOrgAmt>205688</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>3000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>393</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25351</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>234432</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NEIL MCLAUGHLIN</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>164200</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>736</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>16210</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>26298</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>207444</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NELSON T CLARK</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>178092</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>130</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>16850</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>13996</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>209068</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PATRICK B NOLAN</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>224284</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>745</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>21526</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>28688</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>275243</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RICHARD BRUCE CARLSON</PersonNm>
        <TitleTxt>COR DIR MAT MGM</TitleTxt>
        <BaseCompensationFilingOrgAmt>186708</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>11161</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>1050</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>24574</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>223493</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ROBERT AMOS</PersonNm>
        <TitleTxt>CFO-WMC</TitleTxt>
        <BaseCompensationFilingOrgAmt>227449</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>311</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25377</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>253137</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SUANNE THURMAN-GERSDORF</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>199128</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>767</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>21592</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>25181</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>246668</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TONYA SMITH</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>207060</CompensationBasedOnRltdOrgsAmt>
        <OtherCompensationRltdOrgsAmt>300</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>20484</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>28034</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>255878</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>WES WILLIAMS</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>197631</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>19600</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>6522</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>223753</TotalCompensationFilingOrgAmt>
        <CompReportPrior990FilingOrgAmt>125198</CompReportPrior990FilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 1a: Relevant information in regards to selections on 1a.</FormAndLineReferenceDesc>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 4: Participated or recieved pay from an equity based compensation arrangement</FormAndLineReferenceDesc>
        <ExplanationTxt>Al Pilong received $311,363 in severance pay in 2013. His last date of employment was October 31, 2012 and received severance for 12 months ending October 31, 2013.Wes Williams received $125,198 in severance pay in 2013. His last date of employment was November 23, 2013 and received severance for 6 months ending May 23, 2014.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 5b: Explanation of organization compensation based on revenues of related organization</FormAndLineReferenceDesc>
        <ExplanationTxt>A portion of management's bonuses are based on the financial results of any given year with a residual on quality, patient satisfaction, patient safety, and project completion.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or</FormAndLineReferenceDesc>
        <ExplanationTxt>A portion of management's bonuses are based on the financial results of any given year with a residual on quality, patient satisfaction, patient safety, and project completion.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="IRS990ScheduleK.1" softwareId="13000170" softwareVersion="2013v3.1">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>IDA OF CITY OF WINCHESTERVA</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>521232253</BondIssuerEIN>
        <CUSIPNum>973129DW6</CUSIPNum>
        <BondIssuedDt>2007-01-31</BondIssuedDt>
        <IssuePriceAmt>91415663</IssuePriceAmt>
        <PurposeDesc>SEE STATEMENT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>IDA OF CITY OF WINCHESTER VA</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>521232253</BondIssuerEIN>
        <CUSIPNum>973129EQ8</CUSIPNum>
        <BondIssuedDt>2009-12-17</BondIssuedDt>
        <IssuePriceAmt>74256930</IssuePriceAmt>
        <PurposeDesc>SEE STATEMENT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>WEST VIRGINIA HOSPITAL FINANCE AUTHORITY</BusinessNameLine1>
        </IssuerName>
        <CUSIPNum>956622c28</CUSIPNum>
        <BondIssuedDt>2009-12-17</BondIssuedDt>
        <IssuePriceAmt>24811955</IssuePriceAmt>
        <PurposeDesc>SEE STATEMENT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>IDA OF CITY OF WINCHESTER</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>521232253</BondIssuerEIN>
        <BondIssuedDt>2009-11-17</BondIssuedDt>
        <IssuePriceAmt>100000000</IssuePriceAmt>
        <PurposeDesc>SEE STATEMENT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <TotalProceedsAmt>91415663</TotalProceedsAmt>
        <RefundingEscrowAmt>14508990</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>3128218</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>73778455</CapitalExpendituresAmt>
        <CurrentRefundingInd>false</CurrentRefundingInd>
        <AdvanceRefundingInd>true</AdvanceRefundingInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <TotalProceedsAmt>74256930</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>1301587</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>72955344</CapitalExpendituresAmt>
        <CurrentRefundingInd>false</CurrentRefundingInd>
        <AdvanceRefundingInd>false</AdvanceRefundingInd>
        <FinalAllocationMadeInd>false</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <TotalProceedsAmt>24811955</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>469612</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>24342343</CapitalExpendituresAmt>
        <CurrentRefundingInd>false</CurrentRefundingInd>
        <AdvanceRefundingInd>false</AdvanceRefundingInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <TotalProceedsAmt>100000000</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>700935</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>99299065</CapitalExpendituresAmt>
        <SubstantialCompletionYr>2012</SubstantialCompletionYr>
        <CurrentRefundingInd>false</CurrentRefundingInd>
        <AdvanceRefundingInd>false</AdvanceRefundingInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <BondIssMeetPrvtSecPymtTestInd>true</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <BondIssMeetPrvtSecPymtTestInd>true</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <BondIssMeetPrvtSecPymtTestInd>true</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <BondIssMeetPrvtSecPymtTestInd>true</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>true</Form8038TFiledInd>
        <HedgeIdentifiedInBksAndRecInd>true</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1>MERRILL LYNCH</BusinessNameLine1>
        </HedgeProviderName>
        <TermOfHedgePct>33.0000</TermOfHedgePct>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </GICProviderName>
        <RegulatorySafeHarborStsfdInd>true</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>true</Form8038TFiledInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </GICProviderName>
        <RegulatorySafeHarborStsfdInd>true</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <Form8038TFiledInd>true</Form8038TFiledInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </GICProviderName>
        <RegulatorySafeHarborStsfdInd>true</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <Form8038TFiledInd>true</Form8038TFiledInd>
        <HedgeIdentifiedInBksAndRecInd>true</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1>Wells Fargo</BusinessNameLine1>
        </HedgeProviderName>
        <TermOfHedgePct>33.0000</TermOfHedgePct>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </GICProviderName>
        <RegulatorySafeHarborStsfdInd>false</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI</FormAndLineReferenceDesc>
        <ExplanationTxt>PART I LINE A Funds used to refinance 2003 of Warren Memorial Hospital and Shenandoah Memorial Hospital; purchase of equipment;construction of ambulatory care center at Warren;renovations and upgrades at Warren, Shenandoah, and Winchester Medical Center.PART I LINE B Funds used for WMC Campus expansion, East Parking Garage and reimbursement for Diagnostic Center and CE infrastructure.PART I LINE C Funds used to build new Hampshire Memorial Hospital.PART 1 LINE E $70 million used to refinance 2000 Winchester Medical Center Bonds and $35 million used to build a new hospital for Page Memorial Hospital</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleK documentId="IRS990ScheduleK.2" softwareId="13000170" softwareVersion="2013v3.1">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>IDA OF CITY OF WINCHESTER</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>521232253</BondIssuerEIN>
        <BondIssuedDt>2013-12-04</BondIssuedDt>
        <IssuePriceAmt>105665</IssuePriceAmt>
        <PurposeDesc>SEE STATEMENT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <TotalProceedsAmt>105665000</TotalProceedsAmt>
        <RefundingEscrowAmt>70000000</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>665000</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>21068281</CapitalExpendituresAmt>
        <UnspentAmt>13931719</UnspentAmt>
        <SubstantialCompletionYr>2013</SubstantialCompletionYr>
        <CurrentRefundingInd>true</CurrentRefundingInd>
        <AdvanceRefundingInd>true</AdvanceRefundingInd>
        <FinalAllocationMadeInd>false</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>true</EngageBondCounselContractsInd>
        <BondIssMeetPrvtSecPymtTestInd>true</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>true</Form8038TFiledInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </GICProviderName>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="IRS990ScheduleL" softwareId="13000170" softwareVersion="2013v3.1">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1>Shenandoah Oncology PC</BusinessNameLine1>
          </BusinessName>
        </NameOfInterested>
        <RelationshipDescriptionTxt>See Below</RelationshipDescriptionTxt>
        <TransactionAmt>312722</TransactionAmt>
        <TransactionDesc>Medical Office Lease</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>John Kent</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>See Below</RelationshipDescriptionTxt>
        <TransactionAmt>11435</TransactionAmt>
        <TransactionDesc>Employment Arrange</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Winchester Cardio V</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>See Below</RelationshipDescriptionTxt>
        <TransactionAmt>847848</TransactionAmt>
        <TransactionDesc>Employment Arrange</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule L, Part V Supplemental Information</FormAndLineReferenceDesc>
        <ExplanationTxt>1.Shenandoah Oncology, PC - Professional corporation with more than 5% ownership interests held by William Major, MD, a current Trustee, and Nicholas Gemma, MD, a former trustee$312,722 Medical Office Lease2.John Kent - Current employee and family member of Dena Kent, a former officer.3. Winchester Cardiology &amp; Vascular Medicine - Professional corporation with more than 5% ownership interests held by Jeffrey Skiles, a current trustee.$847,848 Professional Services Agreements</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="13000170" softwareVersion="2013v3.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Client Note 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Client Note 1 - SCHEDULE K PART I LINE AFunds used to refinance 2003 of Warren Memorial Hospital and Shenandoah Memorial Hospital;purchase of equipment; construction of ambulatory care center at Warren; renovations and upgrades at Warren, Shenandoah, and Winchester Medical Center.PART I LINE BFunds used for WMC Campus Expansion, East Parking Garage and reimbursement for Diagnostic Center and CE Infrastructure.PART I LINE CFunds used to build new Hampshire Hospital.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder</FormAndLineReferenceDesc>
        <ExplanationTxt>The corporation shall have two classes of members: regular and honorary. The number of regular members shall not exceed 100. In addition, there may be an unlimited number of honorary members. Qualifications for both classes of membership shall be established in the Bylaws of the Corporation. Honorary members have no voting or any other rights whatsoever. Regular members shall have voting rights soley with respect to the election of regular members, honorary members and trustees, as established in the Bylaws of the Corporation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b: Form 990 Review Process</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is prepared by internal staff and undergoes several levels of review including the CFO and CEO. Further, the board reviews the 990 during one of its recurring monthly meetings where any issues of concern or question are addressed by Senior Management.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts</FormAndLineReferenceDesc>
        <ExplanationTxt>All employees that are managers, have purchasing rights with defined limits, or may enter into a contract on behalf of the organization are required to sign a conflict of interest attestation upon employment and annually. All employees can report breaches in VH policy. VH has an employee integrity hotline and a compliance officer. The audit committee is advised of compliance activity on a quarterly basis in addition to monthly follow up by the CEO on any immediate issues. Any infractions can result in disciplinary action or dismissal.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Trustees is responsible for the compensation review. They use compensation literature and outside consultants to determine the appropriate compensation for the CEO,Officers,and Senior Management. As new individuals are hired into management positions, recruiting firms use FMV information to establish salary and general compensation levels.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization makes all records available as required by law.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other Changes In Net Assets Or Fund Balances - Other Increases</FormAndLineReferenceDesc>
        <ExplanationTxt>TRANSFER FROM AFFILIATE = $773637</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR" softwareId="13000170" softwareVersion="2013v3.1">
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>EAST MOUNTAIN HEALTH LLC</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>68 HERITAGE CIRCLE</AddressLine1>
          <City>ROMNEY</City>
          <State>WV</State>
          <ZIPCode>26757</ZIPCode>
        </USAddress>
        <EIN>262586527</EIN>
        <PrimaryActivitiesTxt>WELLNESS CENTER</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>SHENANDOAH MEMORIAL HOSPITAL</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>759 SOUTH MAIN STREET</AddressLine1>
          <City>WOODSTOCK</City>
          <State>VA</State>
          <ZIPCode>22664</ZIPCode>
        </USAddress>
        <EIN>540490687</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>SURGI CENTER OF WINCHESTER INC</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1860 AMHERST STREET</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>541279131</EIN>
        <PrimaryActivitiesTxt>ASC</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>WARREN MEMORIAL HOSPITAL</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1000 SHENANDOAH DRIVE</AddressLine1>
          <City>FRONT ROYAL</City>
          <State>VA</State>
          <ZIPCode>22630</ZIPCode>
        </USAddress>
        <EIN>540488103</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>WINCHESTER MEDICAL CENTER</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1840 AMHERST ST</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>540505979</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>HAMPSHIRE MEMORIAL HOSPITAL INC</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>363 SUNRISE BLVD</AddressLine1>
          <City>ROMNEY</City>
          <State>WV</State>
          <ZIPCode>26757</ZIPCode>
        </USAddress>
        <EIN>208241398</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>SHENADOAH MEMORIAL HOSPITAL FOUNDATION</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>759 S MAIN STREET</AddressLine1>
          <City>WOODSTOCK</City>
          <State>VA</State>
          <ZIPCode>22664</ZIPCode>
        </USAddress>
        <EIN>521535978</EIN>
        <PrimaryActivitiesTxt>FUNDRAISING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501 (c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>11a</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>WINCHESTER MEDICAL CENTER FOUNDATION</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1840 AMHERST STREET</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>542013319</EIN>
        <PrimaryActivitiesTxt>FUNDRAISING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>11a</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>WARREN MEMORIAL HOSPITAL FOUNDATION</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1000 SHENANDOAH DRIVE</AddressLine1>
          <City>FRONT ROYAL</City>
          <State>VA</State>
          <ZIPCode>22630</ZIPCode>
        </USAddress>
        <EIN>541601942</EIN>
        <PrimaryActivitiesTxt>FUNDRAISING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501 (c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>11a</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>PAGE MEMORIAL HOSPITAL</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>200 MEMORIAL DRIVE</AddressLine1>
          <City>LURAY</City>
          <State>VA</State>
          <ZIPCode>22835</ZIPCode>
        </USAddress>
        <EIN>540551200</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501 (c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>VALLEY PHYSICIAN ENTERPRISE INC</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>220 CAMPUS BLVD</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>262767279</EIN>
        <PrimaryActivitiesTxt>PHYSICIAN PRACTICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501 (c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>WAR MEMORIAL HOSPITAL INC</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>1 HEALTHY WAY</AddressLine1>
          <City>BERKELEY SPRINGS</City>
          <State>WV</State>
          <ZIPCode>25411</ZIPCode>
        </USAddress>
        <EIN>800407200</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501 (c) (3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>VALLEY HEALTH SYSTEM</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>WINCHESTER OPEN MRI LLC</BusinessNameLine1>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1>160 EXETER DRIVE</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22603</ZIPCode>
        </USAddress>
        <EIN>542041643</EIN>
        <PrimaryActivitiesTxt>MRI SERVICE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ShareOfTotalIncomeAmt>4175642</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>1064650</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.50000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>WINCHESTER ENDOSCOPY SERVICES LLC</BusinessNameLine1>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1>190 CAMPUS BLVD STE 150</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>263886651</EIN>
        <PrimaryActivitiesTxt>Endoscopy Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ShareOfTotalIncomeAmt>886515</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>343407</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.51000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>MEDICAL CIRCLE LLC ta VALLEY OPEN MRI</BusinessNameLine1>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1>125-A MEDICAL CIRCLE</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>203390908</EIN>
        <PrimaryActivitiesTxt>MRI SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ShareOfTotalIncomeAmt>829220</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>695194</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.51000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>VALLEY REGIONAL ENTERPRISES INC</BusinessNameLine1>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1>220 CAMPUS BLVD SUITE 420</AddressLine1>
          <City>WINCHESTER</City>
          <State>VA</State>
          <ZIPCode>22601</ZIPCode>
        </USAddress>
        <EIN>541456064</EIN>
        <PrimaryActivitiesTxt>MED EQUIP/AMBULANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VA</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </DirectControllingEntityName>
        <EntityTypeTxt>C CORP</EntityTypeTxt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <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>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>SHENANDOAH MEMORIAL HOSPITAL</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>7499585</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>SURGI CENTER OF WINCHESTER INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>518346</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>WARREN MEMORIAL HOSPITAL</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>7958132</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>WINCHESTER MEDICAL CENTER</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>q</TransactionTypeTxt>
        <InvolvedAmt>21398913</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>HAMPSHIRE MEMORIAL HOSPITAL INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>1861333</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>PAGE MEMORIAL HOSPITAL</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>1877522</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>VALLEY PHYSICIAN ENTERPRISE INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>q</TransactionTypeTxt>
        <InvolvedAmt>1430516</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>WAR MEMORIAL HOSPITAL INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>1410277</InvolvedAmt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>