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      <Form990PartVIISectionAGrp>
        <BusinessName>
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        <BusinessName>
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      <ContractorCompensationGrp>
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      <OtherRevenueMiscGrp>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
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      <LandBldgEquipCostOrOtherBssAmt>38978136</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>8027470</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>30950666</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>14655375</ReconcilationRevenueExpnssAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
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      <ContributorInformationGrp>
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        <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>
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        <BookValueAmt>2509738</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>26403862</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4179593</DepreciationAmt>
        <BookValueAmt>22224269</BookValueAmt>
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      <LeaseholdImprovementsGrp>
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        <DepreciationAmt>45550</DepreciationAmt>
        <BookValueAmt>43057</BookValueAmt>
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      <EquipmentGrp>
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        <DepreciationAmt>3802327</DepreciationAmt>
        <BookValueAmt>6173602</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>30950666</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>INTERCOMPANY RECEIVABLES</Desc>
        <BookValueAmt>90251356</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>90251356</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO MEDICARE AND MEDICAID COST REPORT</Desc>
        <Amt>1595008</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>INTERCOMPANY AP</Desc>
        <Amt>101450318</Amt>
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      <TotalLiabilityAmt>103045326</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SYSTEM APPLIES FASB ASC 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIALS STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740.</ExplanationTxt>
      </SupplementalInformationDetail>
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      <WrittenPolicyInd>true</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <FreeCareOthPercentageGrp>
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        <FreeCareOtherPct>300</FreeCareOtherPct>
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      <FPGReferenceDiscountedCareInd>true</FPGReferenceDiscountedCareInd>
      <Percent400Ind>X</Percent400Ind>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>true</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>false</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>false</AnnualCommunityBnftReportInd>
      <FinancialAssistanceAtCostTyp>
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        <DirectOffsettingRevenueAmt>0</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>243731</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0046</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>17764677</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>27571224</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
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      <UnreimbursedCostsGrp>
        <TotalCommunityBenefitExpnsAmt>0</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>0</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0</TotalExpensePct>
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      <TotalFinancialAssistanceTyp>
        <ActivitiesOrProgramsCnt>0</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>0</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>18008408</TotalCommunityBenefitExpnsAmt>
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        <TotalExpensePct>0.0046</TotalExpensePct>
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      <CommunityHealthServicesGrp>
        <ActivitiesOrProgramsCnt>41</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>536</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>1513</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0000</TotalExpensePct>
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      <HealthProfessionsEducationGrp>
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        <PersonsServedCnt>957</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>251422</TotalCommunityBenefitExpnsAmt>
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        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0</TotalExpensePct>
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      <ResearchGrp>
        <TotalCommunityBenefitExpnsAmt>0</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>0</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0</TotalExpensePct>
      </ResearchGrp>
      <CashAndInKindContributionsGrp>
        <ActivitiesOrProgramsCnt>224</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>243110</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>29281</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0006</TotalExpensePct>
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      <TotalOtherBenefitsGrp>
        <ActivitiesOrProgramsCnt>592</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>244603</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>282216</NetCommunityBenefitExpnsAmt>
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      <TotalCommunityBenefitsGrp>
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      <PhysicalImprvAndHousingGrp>
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        <TotalExpensePct>0.0</TotalExpensePct>
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      <EconomicDevelopmentGrp>
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      <CommunitySupportGrp>
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        <TotalExpensePct>0.0000</TotalExpensePct>
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      <EnvironmentalImprovementsGrp>
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        <TotalExpensePct>0.0</TotalExpensePct>
      </EnvironmentalImprovementsGrp>
      <LeadershipDevelopmentGrp>
        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0</TotalExpensePct>
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      <CoalitionBuildingGrp>
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        <TotalExpensePct>0.0</TotalExpensePct>
      </CoalitionBuildingGrp>
      <HealthImprovementAdvocacyGrp>
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      <HospitalFacilitiesGrp>
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        <BusinessName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>1201 PLEASANT VALLEY ROAD</AddressLine1Txt>
          <CityNm>OWENSBORO</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42303</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.OWENSBOROHEALTH.ORG</WebsiteAddressTxt>
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        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
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        <CHNAConductedInd>true</CHNAConductedInd>
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        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
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        <ConsultingProcessInd>X</ConsultingProcessInd>
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        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
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        <CHNAConductedWithNonFcltsInd>true</CHNAConductedWithNonFcltsInd>
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        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>https://www.owensborohealth.org/health-resources/health-needs-assessment</OwnWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <ImplementationStrategyAdoptInd>true</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>21</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>true</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>HTTPS://WWW.OWENSBOROHEALTH.ORG/HEALTH-RESOURCES/HEALTH-NEEDS-ASSESSMENT</StrategyWebsiteURLTxt>
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        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
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        <FPGFamilyIncmLmtDscntCarePct>400.0</FPGFamilyIncmLmtDscntCarePct>
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        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <ExplainedBasisInd>true</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>https://www.owensborohealth.org/patient-visitor/billing/financial-assistance</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>https://www.owensborohealth.org/patient-visitor/billing/financial-assistance</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>https://www.owensborohealth.org/patient-visitor/billing/financial-assistance</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPTranslatedInd>X</FAPTranslatedInd>
        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>false</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <LookBackMedicareInd>X</LookBackMedicareInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PRIORITY HEALTH AREAS FOR OHTLMC IN TAX YEARS 2021 - 2024 ARE: MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC HEALTH CONDITIONS, AND OBESITY/PHYSICAL INACTIVITY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 5 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER. IN ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER (OHTLMC) AND ITS POPULATION HEALTH COMMITTEE WITH THE COMMUNITY AND ECONOMIC INITIATIVE OF KENTUCKY (CEDIK) DEVELOPED A SURVEY TO GATHER HEALTH INFORMATION AND PERCEPTIONS OF GRAYSON COUNTY RESIDENTS 18 YEARS OF AGE AND OLDER. THE SURVEY WAS CONDUCTED IN JANUARY AND FEBRUARY OF 2022 USING AN ONLINE TOOL AND DISTRIBUTING PRINTED COPIES IN VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. THE ONLINE SURVEY WAS PROMOTED THROUGH LOCAL MEDIA, EMAILS, AND ITS FACEBOOK PAGE. EMAILS WITH A LINK TO THE SURVEY WERE SENT TO GRAYSON COUNTY CHAMBER OF COMMERCE MEMBERS, LOCAL INDUSTRIES, AND EMPLOYEES OF THE GRAYSON COUNTY SCHOOL SYSTEM AND THE HOSPITAL. PRINTED COPIES WERE DELIVERED TO AN ASSISTED LIVING FACILITY, THE GRAYSON COUNTY ALLIANCE FOOD BANK, THE GRAYSON COUNTY HEALTH DEPARTMENT, BIG CLIFTY MEDICAL COMPLEX, AND THE CANEYVILLE FAMILY PRACTICE. SURVEYS WERE ALSO CONDUCTED AT THE COMMUNITY COVID-19 VACCINE CLINIC. 1109 GRAYSON COUNTY RESIDENTS PARTICIPATED IN THE SURVEY. THE SURVEY QUESTIONS WERE IN THREE PRIMARY CATEGORIES: DEMOGRAPHICS, PERSONAL HEALTH INFORMATION, AND PERCEIVED HEALTH NEEDS OF THE COMMUNITY. CEDIK TABULATED THE RESULTS AND SUPPLEMENTED THEM WITH HEALTH STATISTICS AND DEMOGRAPHIC INFORMATION. OHTLMC THEN INVITED REPRESENTATIVES FROM VARIOUS BACKGROUNDS TO PARTICIPATE IN FOCUS GROUPS. THESE FOCUS GROUPS COMPRISED COMMUNITY CITIZENS, COMMUNITY LEADERS, AND HEALTHCARE GROUPS. ORGANIZATIONS REPRESENTED INCLUDED THE COUNTY EXTENSION OFFICE; GRAYSON COUNTY SCHOOLS; THE GRAYSON COUNTY HEALTH DEPARTMENT; OHTLMC EMPLOYEES; LOCAL INDUSTRY/MANUFACTURING; GRAYSON COUNTY HEALTHCARE FOUNDATION; CATHOLIC OUTREACH; TRI-COUNTY CASA; BANKS AND BUSINESSES; OHRH; UNITED WAY OF CENTRAL KENTUCKY; THE GRAYSON COUNTY ALLIANCE. LASTLY, FOUR KEY INFORMANT INTERVIEWS WERE DONE WITH INVOLVED COMMUNITY MEMBERS. AFTER CAREFULLY CONSIDERING THE RESULTS OF THE COMMUNITY HEALTH SURVEY, THE MOST RECENT HEALTH AND DEMOGRAPHIC INFORMATION AVAILABLE INPUT FROM THE COMMUNITY HEALTH COMMITTEE, AND THE KEY INFORMANT INTERVIEWS, THE FOLLOWING NEEDS WERE IDENTIFIED BY THE OHTLMC POPULATION HEALTH COMMITTEE AND APPROVED BY THE HOSPITAL LEADERSHIP AND THE BOARD OF DIRECTORS. THE PRIORITY HEALTH AREAS FOR OHTLMC IN TAX YEARS 2021 - 2024 ARE: MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC HEALTH CONDITIONS, AND OBESITY/PHYSICAL INACTIVITY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6b Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER. AS PREVIOUSLY NOTED, THE OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER (OHTLMC) CHNA WAS CONDUCTED WITH COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK). CEDIK ENGAGED MULTIPLE COMMUNITY PARTNERS, INDIVIDUAL CITIZENS, ELECTED OFFICIALS, COALITIONS AND SUBJECT MATTER EXPERTS IN CONDUCTING THE CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER. OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER CREATED A COMMUNITY HEALTH COMMITTEE. THE GROUP IS GUIDED BY THE IDENTIFIED PRIORITY HEALTH NEEDS NAMED IN ITS MOST RECENT CHNA IDENTIFYING AREAS OF FOCUS TO IMPROVE THE HEALTH OF OUR COMMUNITY AND THE HOSPITAL IMPLEMENTATION STRATEGY. THE COMMUNITY HEALTH COMMITTEE IS MADE UP OF INTERNAL TEAM MEMBERS AND EXTERNAL COMMUNITY MEMBERS. OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER CEO CHAIRS THE COMMITTEE. THE COMMUNITY HEALTH COMMITTEE MEETS MONTHLY TO DISCUSS IMPLEMENTATION OF THE IMPLEMENTATION STRATEGY TO IMPROVE THE COMMUNITY'S HEALTH. OHTLMC INTENDS THAT THE CONTENTS OF THIS REPORT BE USED TO CREATE AWARENESS BY INFORMING GRAYSON COUNTY RESIDENTS OF THE PRIORITIZED HEALTH ISSUES IDENTIFIED BY THE COMMUNITY. ALSO, AS A STRATEGY, OHTLMC USES THE CHNA REPORT AS A FOUNDATION TO BUILD LASTING RELATIONSHIPS BETWEEN OHTLMC, COMMUNITY PARTNERS, AND RESIDENTS OF GRAYSON COUNTY. OHTLMC HAS ENGAGED VITAL INTERNAL AND COMMUNITY PARTNERS TO ADDRESS THE PRIORITIZED NEEDS. THE STRATEGIES USED TO IMPACT THE PRIORITY HEALTH AREAS INCLUDE, BUT ARE NOT LIMITED TO, MODIFYING POLICIES, PUBLIC AND PRIVATE; PROVIDING SUPPORT, INFORMATION, AND INCENTIVES; IMPROVING ACCESS; ENHANCING SKILLS, AND CHANGING CONSEQUENCES. FOLLOW-UP SURVEYS WILL MEASURE EACH INITIATIVE'S SUCCESS AND GIVE THE HOSPITAL'S FOLLOWING AREAS OF FOCUS. PRIORITY NEEDS IN MOST RECENT CHNA: MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC HEALTH CONDITIONS, OBESITY/PHYSICAL INACTIVITY OHTLMC IS WORKING COLLABORATIVELY WITH COMMUNITY PARTNERS TO ADDRESS THE IDENTIFIED PRIORITY AREAS. NOW A PART OF THE OWENSBORO HEALTH SYSTEM, THE COMMUNITY HEALTH COMMITTEE IS ACCESSING SUPPLEMENTAL DATA, RESOURCE INFORMATION, AND ADDITIONAL PARTNERS TO BETTER UNDERSTAND THE PRIORITY HEALTH ISSUES AND POSSIBLE STRATEGIES. OHTLMC BEGAN SCREENING ALL PATIENTS ADMITTED AS AN INPATIENT FOR SOCIAL DETERMINANTS OF HEALTH ON JANUARY 23, 2023. THIS IS BEING UTILIZED SYSTEM-WIDE AND ALLOWS OUR CASE MANAGEMENT/QUALITY/COMMUNITY ENGAGEMENT AND POPULATION HEALTH TEAM MEMBERS TO IDENTIFY BETTER OPPORTUNITIES TO LINK PATIENTS WITH RESOURCES RELATED TO MENTAL HEALTH NEEDS TO PROVIDE A BETTER QUALITY OF LIFE. AS IDENTIFIED PRIORITY HEALTH ISSUES ARE CORRELATED TO SOCIAL DETERMINANTS OF HEALTH, NAMELY POVERTY, TRANSPORTATION, EDUCATION, AND HOUSING, OHTLMC WILL BE LOOKING TO EXPAND UPON INTERNAL AND EXTERNAL STRATEGIES NOW USED TO ADDRESS COMMUNITY HEALTH. MENTAL HEALTH: IN ADDITION TO PARTNERING WITH THE LOCAL MENTAL HEALTH CENTERS SERVING GRAYSON COUNTY AND OTHER PROVIDERS, OHTLMC CONTINUES TO OPERATE ITS NEW INPATIENT 12-BED GERIATRIC BEHAVIORAL HEALTH UNIT AVERAGING A DAILY CENSUS OF 6 PATIENTS. THE ADDITIONAL SERVICE INCREASED ACCESS TO MENTAL HEALTH SERVICES FOR THE AGING POPULATION IN AND AROUND GRAYSON COUNTY. IN ADDITION TO THE INPATIENT SERVICES, WE OFFER OUTPATIENT BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY AT LARGE UTILIZING THE OWENSBORO HEALTH REGIONAL HOSPITAL INPATIENT BEHAVIORAL HEALTH SERVICES, TELEHEALTH BEHAVIORAL HEALTH INTERVENTIONS, AND INTENSIVE OUTPATIENT PROGRAMS. WE HAVE ALSO HIRED A BEHAVIORAL HEALTH PHYSICIAN TO PROVIDE OUTPATIENT SERVICES TO OUR COMMUNITY. TO ENSURE OUR TEAM MEMBERS ARE EQUIPPED WITH THE TOOLS NEEDED TO PROVIDE A HIGH STANDARD OF CARE FOR PATIENTS SEEKING MENTAL HEALTH SERVICES, WE HAVE BEGUN TO OFFER MENTAL HEALTH FIRST AID TO OHTLMC TEAM MEMBERS. AS OF MAY 2024, WE HAVE 9 TEAM MEMBERS CERTIFIED IN MENTAL HEALTH FIRST AID; ADDITIONAL CLASSES ARE EXPECTED TO COME IN THE FOLLOWING YEAR. MENTAL HEALTH ISSUES AMONG YOUTH AND ADULTS ARE INCREASING AND WERE EXACERBATED BY THE WORLDWIDE PANDEMIC. WHILE THIS MADE COMMUNITY EDUCATION A CHALLENGE, OHTLMC CONTINUES TO WORK WITH THE COMMUNITY HEALTH COMMITTEE TO EXPLORE STRATEGIES TO DISCOVER INNOVATIVE SOLUTIONS FOR EDUCATIONAL OUTREACH. FROM JUNE 2023 TO MAY 2024, OHTLMC PROMOTED, THROUGH TRADITIONAL/SOCIAL MEDIA CHANNELS AND LOCAL COMMUNITY ORGANIZATIONS THE AVAILABILITY OF A POPULATION LEVEL MENTAL HEALTH INTERVENTION, A VETTED VIRTUAL RESOURCE, CREDIBLEMIND. IN ADDITION, THE HOSPITAL HOSTED ITS FOURTH ANNUAL MENTAL HEALTH AND ADDITION AWARENESS FAIR OPEN TO THE COMMUNITY. 100 COMMUNITY MEMBERS ATTENDED THIS COMMUNITY SERVICE WITH 56 MENTAL HEALTH VENDOR PROVIDING MENTAL HEALTH RESOURCES. OHTLMC PARTICIPATED IN THE 2ND ANNUAL GRAYSON COUNTY POVERTY COALITION SUMMER RESOURCE FAIR IN JUNE 2023. THE FAIR CONSISTED OF 60 VENDORS, 8 OF WHICH WERE OWENSBORO HEALTH SERVICES, TO PROVIDE COMMUNITY AND BASIC NEED RESOURCES TO 350 PARTICIPANTS TO LINK THE COMMUNITY TO AVAILABLE RESOURCES THEY MAY OTHERWISE BEEN UNAWARE OF. SUBSTANCE USE: SINCE APRIL 2019, OHTLMC HAS CONTINUED TO BE A MEMBER OF THE KENTUCKY OPIOID RESPONSE EFFORT'S KENTUCKY STATEWIDE OPIOID STEWARDSHIP PROGRAM (KY-SOS) TO ADDRESS INAPPROPRIATE OR EXCESS OPIOID PRESCRIBING. THE OPIOID STEWARDSHIP TEAM AT OHTLMC MEETS REGULARLY AND PARTICIPATES IN DATA COLLECTION AND REPORTING AS REQUIRED BY KY-SOS. IN ADDITION, OHTLMC HAS AN ESTABLISHED OPIOID STEWARDSHIP COMMITTEE WHOSE CHARGE IS TO ENSURE SAFE OPIOID PRESCRIBING AND DECREASE OPIOID ABUSE AND MISUSE BY PATIENTS IN OUR CARE. OUR PHARMACY TEAM IS RESPONSIBLE FOR TRAINING LOCAL POLICE DEPARTMENTS. TREATMENT: OHTLMC OFFERS MEDICAL DETOX FROM ALCOHOL, OPIOIDS, AND OTHER ADDICTIVE SUBSTANCES. AS THE BODY RIDS ITSELF OF TOXINS, WITHDRAWAL SYMPTOMS AND CRAVINGS ARE SAFELY MANAGED UNDER THE 24-HOUR SUPERVISION OF TRAINED PROFESSIONALS. NON-ADDICTIVE MEDICATIONS MAY BE PRESCRIBED TO LESSEN WITHDRAWAL SYMPTOMS, IN ADDITION TO NUTRITIONAL SUPPLEMENTS AND FLUIDS. PAIN WILL BE MANAGED THROUGH NON-NARCOTIC MEDICATIONS AND OTHER PROVEN THERAPIES. PATIENTS ARE USUALLY STABILIZED WITHIN A WEEK. MATERNAL OPIOID MEDICAL STABILIZATION (MOMS) -ANY EXPECTANT MOTHER SUFFERING FROM OPIOID USE DISORDER MAY BE CONSIDERED FOR THE OHTLMC MOMS PROGRAM. A NON-ADDICTIVE MEDICATION IS PRESCRIBED UNDER THE 24-HOUR SUPERVISION OF CARING AND SPECIALLY TRAINED MEDICAL PROFESSIONALS. STUDIES SHOW THAT, COMPARED TO UNTREATED PREGNANT WOMEN WITH OPIOID ADDICTION, EXPECTANT MOTHERS RECEIVING MEDICATION-ASSISTED TREATMENT GAVE BIRTH TO INFANTS WITH A LOWER RISK OF A CONDITION CALLED NEONATAL ABSTINENCE SYNDROME (NAS). OTHER BENEFITS OF MOMS INCLUDE SHORTER TREATMENT TIME FOR THE BABY, AN INCREASED LIKELIHOOD OF A FULL-TERM PREGNANCY, HEALTHIER BIRTH WEIGHT, AND A DESIRABLE HEAD CIRCUMFERENCE AT BIRTH. THE TYPICAL LENGTH OF STAY FOR THE MOMS PROGRAM IS TWO TO SEVEN DAYS, FOLLOWED BY AN INDIVIDUALIZED TREATMENT PLAN, INCLUDING CONTINUED OUTPATIENT TREATMENT AND COMMUNITY-SUPPORT SERVICES TO MEET THE NEEDS OF THE MOTHER AND HER UNBORN BABY. MEDICATION-ASSISTED TREATMENT: IN RESPONSE TO THE NATIONWIDE OPIOID CRISIS, OHTLMC OFFERS MEDICATION-ASSISTED TREATMENT OPTIONS FOR OPIOID ADDICTION. OHTLMC ADDICTION SERVICES USES FDA-APPROVED MEDICATIONS, SUCH AS SUBUTEX, SUBOXONE, SUBLOCADE, AND VIVITROL, TO RELIEVE OPIOID-WITHDRAWAL SYMPTOMS AND ALCOHOL CRAVINGS TO HELP THE PATIENT QUIT USING ADDICTIVE SUBSTANCES. OHTLMC COMMUNITY ENGAGEMENT COORDINATOR SERVES AS A COMMUNITY CONDUIT TO PROVIDE EDUCATION AND INFORMATION REGARDING THIS PREVALENCE OF SUBSTANCE USE DISORDER AND EDUCATION, WHEN POSSIBLE, TO THE COMMUNITY REGARDING SUBSTANCE USE PREVENTION. THIS PERSON SERVES ON THE GRAYSON COUNTY SUBSTANCE ABUSE FOCUSED EDUCATION (SAFE) COALITION, THE GHM ASAP COALITION, HOSTS A MONTHLY SUBSTANCE ABUSE PROVIDER'S MEETING, "TAKING BACK KENTUCKY, HOSTS AN ANNUAL MENTAL HEALTH AND ADDICTION RESOURCE AWARENESS FAIR WHICH WAS ATTENDED BY 100 COMMUNITY MEMBERS ATTENDING THE EVENT IN 2024 AND INCLUDED 56 SUBSTANCE USE /MENTAL HEALTH VENDORS HANDING OUT RESOURCES. THEY ALSO PLAYED A ROLE IN HOSTING AN ANNUAL SUMMER RESOURCE FAIR WHICH INCLUDED 350 COMMUNITY MEMBERS ATTENDING THE EVENT AND 60 VENDORS PROVIDING RESOURCES TO THE COMMUNITY. IN MARCH OF 2023 OHTLMC BEGAN HANDING OUT SELF-HELP RECOVERY WORKBOOKS TO PATIENTS ADMITTED FOR ANY OF OUR ADDICTION SERVICES PROGRAM. THESE BOOKS WILL BE UTILIZED BY PATIENTS OVER THE 3-5 DAY PERIOD THEY ARE HERE WITH US TO BEGIN TO WORK THROUGH ADDICTION RELATED TRAUMA, RELAPSE TRIGGERS, AND MANY OTHER KEY FACTORS IMPORTANT FOR THEIR RECOVERY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility , 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 2 - OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER. THE COMMUNITY ENGAGEMENT COORDINATOR AT OHTLMC ALSO ASSISTED IN THE DEVELOPMENT OF A OH SYSTEM WIDE SUBSTANCE ABUSE FOCUS TEAM THAT MEET FOR THE FIRST TIME IN APRIL 2023. THE VISION FOR THIS TEAM IS THAT OHI DEVELOPS AND SUPPORTS A COMPREHENSIVE PLAN TO CHANGE THE CULTURE OF CARE SURROUNDING SUBSTANCE ABUSE DISORDER THROUGH OUR COMMITMENT ACROSS THE SYSTEM PROVIDING EDUCATION, PREVENTION AND TREATMENT TO THE COMMUNITIES WE SERVE. SINCE THE DEVELOPMENT OF THIS TEAM, SEVERAL INITIATIVES HAVE COME TO LIGHT. THIS TEAM HAS CONNECTED PROVIDERS ACROSS THE SYSTEM TO BE AWARE OF ADDICTION SERVICES PROVIDED AT OHTLMC FOR REFERRAL OPPORTUNITIES, THEY HAVE STARTED THE WORK TO CREATE A RESOURCE WEBPAGE FOR PATIENTS, VISITORS AND THE COMMUNITY AT LARGE TO UTILIZE WHEN SEEKING SUBSTANCE USE RESOURCES, THEY HAVE WORKED WITH COMMUNITY PARTNERS TO IDENTIFY A NEED FOR NARCAN DISPENSING WITHIN THE COMMUNITIES AND THEY ARE WORKING ON PLANS TO HAVE NARCAN EASILY ACCESSIBLE FOR EVERYONE. OHTLMC WORKED WITH THE GRAYSON COUNTY SCHOOLS TO EXPLORE OPPORTUNITIES TO BRING EVIDENCE-BASED SUBSTANCE USE EDUCATION INTO THE SCHOOL SYSTEM. THIS IS STILL A WORK IN PROGRESS, BUT THEY WERE ABLE TO HOST A RED RIBBON WEEK CELEBRATION WITHIN THE COMMUNITY IN OCTOBER OF 2023. THIS CELEBRATION CONSISTED OF A SERIES OF ACTIVITIES TO INCLUDE, A BUSINESS DECORATING CONTEST AMONG LOCAL BUSINESSES, ENCOURAGING THE COMMUNITY AT LARGE TO WEAR RED RIBBONS, A CLASSROOM DOOR DECORATING CONTEST AMONG ALL LOCAL ELEMENTARY SCHOOLS, AND A SUBSTANCE USE SPEAKER FOR ALL GRADES AT THE GRAYSON COUNTY MIDDLE SCHOOL. WE IDENTIFIED THROUGH THE COMMUNITY HEALTH COMMITTEE THAT THERE ARE SOME GAPS IN SUBSTANCE USE EDUCATION SO WE ARE HOPING TO COLLABORATE TO ENSURE THAT GAP IS FILLED. OHTLMC WAS ABLE TO GET ONE TEAM MEMBER CERTIFIED AS A TOBACCO TREATMENT SPECIALIST IN AUGUST OF 2023. THIS TEAM MEMBER IS NOW DOING CONSULTS ON INPATIENT ADMISSIONS, CONNECTING THEM WITH NICOTINE REPLACEMENT THERAPY AND REFERRING THEM FOR FOLLOW UP CARE. OBESITY/PHYSICAL INACTIVITY. OHTLMC HAS BEGUN HAVING CONVERSATIONS WITH LOCAL OFFICIALS TO DEVELOP A PARTNERSHIP WITH PARKS AND RECREATION TO SPONSOR LOCAL WALKING TRAILS TO ENCOURAGE YOUTH AND YOUNG ADULTS TO GET OUTSIDE AND PHYSICALLY MOVE. PLANS ARE BEING MADE TO DISPLAY SIGNS ON LOCAL WALKING TRAILS EDUCATING COMMUNITY MEMBERS ON DIFFERENT HEALTH TOPICS ASSOCIATED WITH PHYSICAL ACTIVITY. WE PLAN TO EXPLORE PARTNERSHIPS WITH LOCAL AGENCIES TO OFFER MONTHLY RECIPES VIA SOCIAL MEDIA, OFFER HEALTH EDUCATION CLASSES, CREATE A GET ACTIVE WELLNESS CAMPAIGN, INCREASE ENGAGEMENT IN EXERCISE IN THE SCHOOL DISTRICT, AND PARTNER WITH THE LOCAL AQUATIC CENTER TO PROVIDE FREE OR LOW-COST WATER EXERCISE CLASSES. OHTLMC HAS ASSISTED AND PARTICIPATED IN AN OH SYSTEM FOCUS TEAM REGARDING OBESITY AND RELATED DISEASES, SINCE NOVEMBER 2022. THIS TEAM AIMS TO WORK TOGETHER WITHIN THE SYSTEM TO BRING AWARENESS TO SERVICES OFFERED AND IDENTIFY OPPORTUNITIES TO BE INNOVATIVE AS WE ADDRESS OBESITY AND PHYSICAL INACTIVITY WITHIN OUR COMMUNITIES. FROM JANUARY TO MAY OF 2023, THE OHTLMC COMMUNITY HEALTH COMMITTEE BEGAN THE FOUNDATIONAL WORK TO DEVELOP A COMMUNITY WALKING INITIATIVE TO RAISE AWARENESS OF GRAYSON COUNTY RESIDENTS' PERSONAL FITNESS AND ACTIVITY LEVELS. THE PLANNING WORK OUTLINED GOALS TO EDUCATE AND ENGAGE ALL AGES AND DEMOGRAPHICS OF GRAYSON COUNTY RESIDENTS BY PROVIDING AND PROMOTING LOCAL RESOURCES TO IMPROVE HEALTH AND FITNESS FOR INDIVIDUALS, PROMOTING AND EDUCATING THE BENEFITS OF MOVEMENT WITH HEALTH FACTS AND STATISTICS, AND DEVELOPING PARTNERSHIPS WITHIN THE COMMUNITY THAT WILL PROVIDE INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. FOR THIS PROJECT, THE COMMITTEE SECURED PARTNERSHIPS WITH THE CITY OF LEITCHFIELD, LEITCHFIELD PARKS AND REC, THE CITY OF CLARKSON, GRAYSON COUNTY PUBLIC TRAILS ASSOCIATION, AND GRAYSON COUNTY HIGH SCHOOL. THESE PARTNERSHIPS STARTED THE LOCAL RESOURCE LIST, AND A GRAYSON COUNTY SENIOR CREATED THE PROGRAM'S BRAND IMAGE BETWEEN MARCH AND MAY 2023. OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER AND THE COMMITTEE ARE CONTINUING TO DEVELOP THE PROGRAM'S COMMUNITY LAUNCH IN THE NEXT YEAR. FROM JUNE 2023- MAY 2024, OHTLMC LAUNCHED THEIR FITNESS INITIATIVE WITH GREAT SUCCESS. ATTENDING OVER 6 EVENTS AND TRACKING A TOTAL OF 374 MILES WALKED BY OVER 243 COMMUNITY MEMBERS THROUGH GIVE A WAYS AND INITIATIVES. WE ALSO PARTNERED WITH GRAYSON COUNTY SCHOOLS TO DO EDUCATION ON FITNESS AND NUTRITION IN ALL FOUR ELEMENTARY SCHOOLS. EACH STUDENT ALSO RECEIVED A WRIST PEDOMETER AND WAS ENCOURAGED TO TRACK THEIR STEPS IN EXCHANGE FOR PRIZES. CHRONIC DISEASES. OHTLMC PARTICIPATED IN THE SUMMER RESOURCE FAIR HOSTED BY THE GRAYSON COUNTY POVERTY COALITION, WHERE WE PROVIDED INFORMATION TO COMMUNITY MEMBERS ON PRIMARY CARE AND PREVENTATIVE SERVICES. OHTLMC WAS ABLE TO GET ONE TEAM MEMBER CERTIFIED AS A TOBACCO TREATMENT SPECIALIST IN AUGUST OF 2023. THIS TEAM MEMBER IS NOW DOING CONSULTS ON INPATIENT ADMISSIONS, CONNECTING THEM WITH NICOTINE REPLACEMENT THERAPY AND REFERRING THEM FOR FOLLOW UP CARE. OHTLMC PERFORMED SEVERAL PREVENTATIVE SERVICES WITHIN THE COMMUNITY AT A PROVIDER OPEN HOUSE AS WELL AS AT THE GRAYSON COUNTY THRIVE SUMMER RESOURCE FAIR, THE LOVE YOUR LUNG EVENT AND THE INCREDIBLE COLON EVENT. THESE PREVENTATIVE SERVICES INCLUDED: BLOOD PRESSURE CHECKS, BMI CHECKS, HEIGHT AND WEIGHT CHECKS, GLUCOSE MONITORING, ULTRASOUND SERVICES, EKG TESTS. OHTLMC HAS BEGUN UTILIZING COPD AND CHF PATIENT EDUCATION BOOKLETS AND HAS RECENTLY PERFORMED A GAP ANALYSIS TO IDENTIFY ADDITIONAL INTERVENTIONS NEEDED WHEN TREATING PATIENTS SUFFERING FROM COPD AND CHF. WE HAVE ALSO BEGAN UTILIZING THE MEDICAL CARE UNIT SECRETARY TO FOLLOW UP WITH PATIENTS ON DISCHARGE TO ENSURE PATIENTS ARE BEING SCHEDULED FOLLOW UP APPOINTMENTS WITH PRIMARY CARE PROVIDERS IN A TIMELY MANNER. OHTLMC CONTINUES TO WORK WITH SYSTEM TEAM MEMBERS TO SECURE GRANT FUNDING TO ASSIST IN PROVIDING WEIGHT SCALES, O2 MONITORS AND BLOOD PRESSURE MONITORS TO THE APPROPRIATE PATIENTS UPON DISCHARGE. 84% OF ALL NURSES HAVE RECEIVED DISEASE EDUCATION ON COPD/CHF. COPD/CHF BOOKS WERE RECEIVED FROM A GRANT AND DISTRIBUTED TO ALL INPATIENT, OUTPATIENT AND OUTPATIENT PROVIDER AREAS. ORDER SETS HAVE BEEN CREATED AND APPROVED FOR BOTH COPD AND CHF. A DASHBOARD HAS BEEN CREATED BY OUR CNO TO MONITOR PERCENTAGE OF DOCUMENTED PATIENT EDUCATION FOR COPD/CHF PATIENT, CARDIOPULMONARY OR PULMONARY APPOINTMENT REFERRAL RATES, ORDER SET USAGE FOR BOTH DISEASES, TOBACCO TREATMENT SPECIALIST'S CONSULTS AND PATIENTS WHO AGREE TO NICOTINE REPLACEMENT THERAPY, CARDIAC REHAB REFERRALS, COMMUNITY OUTREACH PROJECTS AND FOLLOW UP DISCHARGE APPOINTMENTS WITHIN 7 DAYS. WE ARE STILL WAITING ON UPDATE FOR SCALES, 02 MONITORS AND BLOOD PRESSURE MONITORS GRANT. WE ARE REQUESTING ASSISTANCE OF A PHYSICIAN CHAMPION FOR ORDER SET USAGE. WE HAVE RECENTLY DEVELOPED A PROCESS FOR PATIENTS TO RECEIVE NICOTINE REPLACEMENT THERAPY PRIOR TO BEING DISCHARGE SO THEY DO NOT HAVE A GAP IN RECEIVING THEIR SUPPLY FROM OH OUTPATIENT PHARMACY VIA MAIL. BROCHURE RACKS WITH STOPLIGHT AND DISEASE MANAGEMENT EDUCATION PAMPHLETS ARE NOW IN THE MAIN LOBBY, THE MEDICAL CARE WAITING AREA AND SOON TO BE IN THE ED WAITING AREA. OHTLMC PARTICIPATED IN THE SUMMER RESOURCE FAIR HOSTED BY GRAYSON COUNTY THRIVE. THIS EVENT REACHED 350 ATTENDEES PRESENT AND 60 VENDORS PROVIDING RESOURCES TO THE COMMUNITY. OH HAD SEVERAL VENDORS PRESENT TO EDUCATE ON CHRONIC DISEASE INCLUDING: PRIMARY CARE PROVIDERS, ADDICTION SERVICES, NUTRITION SERVICES, STROKE SCREENINGS AND EDUCATION, LUNG SCREENINGS, TOBACCO TREATMENT AND TRAUMA SERVICES.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>0</FacilityNum>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7b MEDICAID</FormAndLineReferenceDesc>
        <ExplanationTxt>OHTLMC RECEIVED AN ADDITIONAL MEDICAID SUPPLEMENTAL PAYMENT FROM THE HOSPITAL RATE IMPROVEMENT PROGRAM OR "UPL" WHICH WAS ENACTED IN JULY OF 2019. EFFECTIVE JULY 2020, KENTUCKY MEDICAID PAYS THE UPL TO THE AVERAGE COMMERCIAL INPATIENT PAYMENT LEVEL. IN ADDITION TO THE INPATIENT UPL, THE KENTUCKY MEDICAID OBTAINED APPROVAL TO EXPAND THE UPL PROGRAM TO INCLUDE OUTPATIENT MEDICAID MANAGED CARE ORGANIZATION (MCO) CLAIMS TO BE PAID AT THE AVERAGE OUTPATIENT COMMERCIAL RATE EFFECTIVE JANUARY 1, 2023. AS A RESULT, OHTLMC RECOGNIZED AN UPPER PAYMENT LIMIT (UPL) REIMBURSEMENT BEFORE TAXES AND ADMIN EXPENSES OF $14.990 MILLION AND $10.457 MILLION IN PREVIOUS YEAR. THE NET BENEFIT OF THE UPL FOR OHTLMC WAS $12.707 MILLION FOR FY 2024 AND $9.095 MILLION FOR FY 2023 (AFTER TAXES/ADMIN EXPENSES). THE PROGRAM HAS TO BE APPROVED ANNUALLY BY CMS AND THE STATEWIDE UPL NUMBERS WILL FLUCTUATE BASED UPON ACTUAL EXPERIENCE EACH YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT</FormAndLineReferenceDesc>
        <ExplanationTxt>KENTUCKY DOES NOT REQUIRE A COMMUNITY BENEFIT REPORT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation</FormAndLineReferenceDesc>
        <ExplanationTxt>5534172</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part II Community Building Activities</FormAndLineReferenceDesc>
        <ExplanationTxt>IN ORDER TO IMPROVE AND PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE, OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES SUPPORTING ECONOMIC DEVELOPMENT EFFORTS WHICH ARE NOT PART OF PART I CHARITY CARE OR OTHER COMMUNITY BENEFITS AND ARE NOT INCLUDED ELSEWHERE ON SCHEDULE H. AS ONE OF THE LARGEST EMPLOYER'S IN THE COUNTY OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER RECOGNIZES THE RESPONSIBILITY WE HAVE TO IMPROVE THE HEALTH OF OUR COMMUNITIES THROUGH ACTIVITIES SUCH AS IMPROVEMENT OF ECONOMIC DEVELOPMENT STRATEGIES AND WORKFORCE DEVELOPMENT IRRESPECTIVE OF THE IRS DEFINED COMMUNITY BENEFIT CLASSIFICATION. BY DOING SO, THE ECONOMIC VIABILITY OF THE COMMUNITY IN ADDITION TO ADDRESSING SEVERE HEALTHCARE WORKFORCE SHORTAGES, MADE WORSE BY THE COVID 19 PANDEMIC, CAN BE ADDRESSED AND COLLABORATIVE SOLUTIONS MAY BE DEVELOPED. OUR EFFORTS IN COMMUNITY BUILDING ADDRESS COMMUNITY ISSUES INCLUDING HEALTH IMPROVEMENT AND ADVOCACY, EDUCATION, POVERTY, WORKFORCE DEVELOPMENT AND ACCESS TO CARE. MORE SPECIFICALLY AND AS AN OUTGROWTH OF OUR SYSTEM GRANT PROGRAM NOW REFERRED TO AS THE OHRH COMMUNITY HEALTH INVESTMENT GRANT PROGRAM, OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER ENCOURAGES OUR EMPLOYEES TO VOLUNTEER FOR MANY DIFFERENT COMMUNITY AND SOCIAL SERVICE ORGANIZATIONS FROM AROUND THE REGION THAT ARE WORKING TO ADDRESS ROOT CAUSES OF HEALTH ISSUES AND/OR SOCIAL DETERMINANTS OF HEALTH THAT IMPACT THE HEALTH OF THE COMMUNITY AND ITS MEMBERS. OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER ENGAGES WITH OUR GRANT PARTNERS AND OTHER COMMUNITY PARTNERS TO ASSIST IDENTIFYING COLLABORATIVE WAYS THAT WE CAN ADVANCE SOCIAL IMPACT AND IMPROVE THE HEALTH OF OUR POPULATION COLLECTIVELY. MOREOVER, OUR TEAM MEMBERS SERVE ON A MYRIAD OF COMMUNITY CHAMBER OF COMMERCE, HEALTH, ARTS AND SOCIAL SERVICES BOARDS. TEAM MEMBERS ADVOCATE WHERE PERMISSIBLE ON KEY HEALTH ISSUES AND ADVOCACY PROGRAMS, LOCAL AND STATE POLICIES. OUR DUES, CONTRIBUTIONS, AND PARTICIPATION TO/WITH AREA CHAMBER AND ECONOMIC DEVELOPMENT AGENCIES WILL ALLOW THOSE ORGANIZATIONS TO INVEST IN ECONOMIC DEVELOPMENT ACTIVITIES CREATING NEW EMPLOYMENT OPPORTUNITIES, WORKER TRAINING, AFFORDABLE HOUSING, TRANSPORTATION, AND OTHER AREAS OF HEALTH PROMOTION. WHILE DOWNSTREAM TO SOME, ADDRESSING SOCIAL DETERMINANTS OF HEALTH WHICH MAY OR MAY NOT FALL UNDER A COMMUNITY BENEFIT CATEGORY, OR IN THE SHORT TERM BE CONSIDERED A PRIORITY HEALTH NEED, MUST AND DOES DESERVE ATTENTION AND RESOURCES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount</FormAndLineReferenceDesc>
        <ExplanationTxt>PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR BAD DEBTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES HISTORICAL COLLECTIONS AND WRITE-OFFS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR BAD DEBTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATION OF THE SUFFICIENCY OF THE ALLOWANCE FOR BAD DEBTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 3 Bad Debt Expense Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FAP OHTLMC DOES NOT HAVE A MECHANISM TO DETERMINE THE PORTION OF BAD DEBT ATTRIBUTABLE TO THOSE PATIENTS POTENTIALLY ELIGIBLE FOR THE FAP BUT DO NOT COMPLETE THE APPLICATION. THE AMOUNT ENTERED IS AN ESTIMATE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE IS NO FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF PART I OF SCHEDULE H OF THIS 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 8 Community benefit &amp; methodology for determining medicare costs</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF PART I OF SCHEDULE H OF THIS 990. THE CHARGES AND PAYMENTS ARE FROM THE MEDICARE PAID CLAIMS REPORTS. THE HOSPITAL IS DESIGNATED AS A CMS LOW-VOLUME HOSPITAL (LVH). THIS IS A DESIGNATION FOR HOSPITALS WITH FEWER THAN 3,800 PATIENT DISCHARGES IN THE PREVIOUS YEAR WHICH ARE MORE THAN 15 MILES FROM THE NEAREST IPPS ACUTE CARE HOSPITAL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>THE POLICIES OF THE SYSTEM ATTEMPT TO ENSURE ALL UNINSURED PATIENTS OF THE SYSTEM HAVE OPPORTUNITY TO APPLY AND QUALIFY FOR FINANCIAL ASSISTANCE PROGRAMS. THE HOSPITAL HAS FINANCIAL AID APPLICATIONS AVAILABLE AT REGISTRATION AREAS, VIA THE INTERNET, VIA PHONE, AND ARE SENT ROUTINELY VIA MAIL TO PATIENTS OF THE HOSPITAL. THE HOSPITAL PROVIDES FINANCIAL COUNSELORS AND CONTRACTS WITH AN OUTSIDE FIRM TO ENSURE PATIENTS ARE EVALUATED FOR ELIGIBILITY IN THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE. THE HOSPITAL DOES NOT CONTRACT PRIMARY COLLECTION AGENCIES. ALL SELF-PAY AND BALANCE AFTER INSURANCE ACCOUNTS ARE REVIEWED AND WORKED BY HOSPITAL REPRESENTATIVES TO ENSURE THAT THE PATIENT IS GIVEN EVERY OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. SELF-PAY DISCOUNTS ARE AVAILABLE TO ALL UNINSURED PATIENTS AS LONG AS THEY COMPLETE THE AID APPLICATION. DISCOUNTS GIVEN ARE EQUIVALENT TO THE AVERAGE INSURANCE DISCOUNTS THE HOSPITAL CONTRACTS ALLOW. ADDITIONALLY, PATIENTS WITH BALANCE ARE PERMITTED TO ESTABLISH PAYMENT PLANS. THE HOSPITAL DOES NOT CHARGE INTEREST TO ITS PATIENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FAP website</FormAndLineReferenceDesc>
        <ExplanationTxt>- OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER: Line 16a URL: https://www.owensborohealth.org/patient-visitor/billing/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FAP Application website</FormAndLineReferenceDesc>
        <ExplanationTxt>- OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER: Line 16b URL: https://www.owensborohealth.org/patient-visitor/billing/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FAP plain language summary website</FormAndLineReferenceDesc>
        <ExplanationTxt>- OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER: Line 16c URL: https://www.owensborohealth.org/patient-visitor/billing/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 2 Needs assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>MUCH HAS BEEN SHARED ABOUT ASSESSING THE HEALTH OF THE COMMUNITIES WE SERVE. OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER (OHTLMC) ADDITIONALLY UTILIZES ALL NEEDS ASSESSMENTS CONDUCTED WITHIN THE COMMUNITY, INFORMATION FROM THE REQUIRED SDOH SCREENINGS FOR PATIENTS, AND OTHER STATE LEVEL DATA AND REPORTS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 3 Patient education of eligibility for assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>OHTLMC REACHES OUT TO EDUCATE PATIENTS ABOUT THE PATIENT FINANCIAL ASSISTANCE PROGRAM. A BROCHURE IS AVAILABLE AT SEVERAL LOCATIONS THROUGHOUT THE HOSPITAL INCLUDING THE BUSINESS OFFICE AND REGISTRATION AREA. A VERSION OF THE BROCHURE AND ADDITIONAL INFORMATION IS ON THE HOSPITAL WEBSITE. INFORMATION CAN ALSO BE FOUND ON THE HOSPITAL'S FACEBOOK PAGE AND HAS BEEN PUBLISHED IN LOCAL NEWSPAPERS. WHEN SELF-PAY PATIENTS PRESENT THEMSELVES TO THE HOSPITAL FOR SERVICES, THE REGISTRAR DIRECTS THE PATIENTS TO THE FINANCIAL COUNSELOR FOR ASSISTANCE ON MEDICAID/COMMERCIAL PLANS AVAILABLE THROUGH THE ACA. ALSO AT THAT TIME, THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM IS APPLIED TO THE PATIENT'S PERSONAL SITUATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 4 Community information</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PRIMARY SERVICE FOR OHTLMC IS GRAYSON COUNTY, KY (POPULATION 26,000) LOCATED 75 MILES SOUTHWEST OF LOUISVILLE, KY. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES PARTS OF 6 SURROUNDING COUNTIES. THE ESTIMATED PERCENTAGE OF PEOPLE LIVING BELOW THE POVERTY LEVEL, AS DETERMINED BY THE US CENSUS BUREAU, IS 20.3% FOR THE PRIMARY SERVICE AREA. THE AREA IS MOSTLY RURAL WITH A HIGHER PERCENTAGE OF PERSONS OVER THE AGE OF 65 AND A SIGNIFICANTLY LOWER MEDIAN HOUSEHOLD INCOME COMPARED TO THE STATE OF KENTUCKY. THE UNEMPLOYMENT RATE FOR GRAYSON COUNTY IS 4.6%.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 5 Promotion of community health</FormAndLineReferenceDesc>
        <ExplanationTxt>IN ADDITION TO THE HEALTH PROMOTION STRATEGIES AND CONCEPTS PREVIOUSLY DESCRIBED, OHTLMC WORKS CLOSELY WITH ITS HEALTH FOUNDATION, LOCAL CHAMBERS OF COMMERCE, THE LOCAL DEPARTMENT OF PUBLIC HEALTH, LOCAL AND STATE ELECTED OFFICIALS, AND COMMUNITY LEADERS TO EDUCATE ON THE PRIORITY HEALTH ISSUES, DISCUSS OTHER EXISTING RELATED NEEDS AND WORK TOGETHER TO DEVELOP SOLUTIONS AND TACTICS TO ADDRESS THEM. OHTLMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH &amp; WELLNESS ISSUES, RECOGNIZING COMMUNITY NEEDS, AND WORKING TO FULFILL THOSE NEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 6 Affiliated health care system</FormAndLineReferenceDesc>
        <ExplanationTxt>AS AN AFFILIATE HOSPITAL AND IN SUPPORT OF OWENSBORO HEALTH INC., OHTLMC WILL BE ONE OF THREE NOT-FOR-PROFIT HOSPITALS IN THE SYSTEM WHOSE MISSION IS TO HEAL THE SICK AND IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. UTILIZING THE RICH ACCESS TO RESOURCES, PROGRAMS, AND SERVICES WILL BENEFIT THIS WESTERN KENTUCKY REGION AND EXPAND THE ABILITY TO ADDRESS THE PRIORITY HEALTH AREAS OF OUR COMMUNITIES AND DIRECTLY ADDRESS THE SOCIAL DETERMINANTS OF HEALTH, THE NATURAL BARRIERS TO POSITIVE HEALTH OUTCOMES THAT PLAGUE OUR COMMONWEALTH. REPLICATION OF EVIDENCE-BASED PROGRAMS WILL ALLOW GREATER SHARING OF KNOWLEDGE, EXPERTISE, AND PROGRAMMING FOR TARGETED IMPACT ON THE POPULATIONS WHICH NEED THEM THE MOST. WE WILL USE INVESTMENT DOLLARS IN A POPULATION HEALTH APPROACH TO ENGAGE IN INNOVATIVE STRATEGIES THE AFFILIATED HOSPITALS AND THEIR DIFFERENT ENTITIES MAY EMPLOY WITH A GUIDING POPULATION HEALTH STRATEGY AND APPROACH TO HAVE THE MOST SIGNIFICANT IMPACT ON THE HOSPITALS' INDIVIDUAL AND COLLECTIVE IDENTIFIED AND PRIORITIZED HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 7 State filing of community benefit report</FormAndLineReferenceDesc>
        <ExplanationTxt>KY</ExplanationTxt>
      </SupplementalInformationDetail>
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        <FormAndLineReferenceDesc>Schedule J, Part I, Line 1a Tax indemnification and gross-up payments</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION PROVIDES A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN FOR CERTAIN EXECUTIVE EMPLOYEES. BECAUSE BENEFITS UNDER THE SUPPLEMENTAL PLAN MUST BE INCLUDED IN TAXABLE INCOME WHEN THEY BECOME VESTED, AND AS REQUIRED BY THE SUPPLEMENTAL PLAN'S TERMS, THE ORGANIZATION PROVIDES AN ADDITIONAL BENEFIT THAT COVERS THE TAX LIABILITY WHEN IT IS INCURRED. THE TAX LIABILITY PAYMENTS ARE THEMSELVES INCLUDED IN W-2 INCOME IN THE YEAR MADE TO THE EXECUTIVES AND ARE INCLUDED IN THE FIGURES DISCLOSED ON SCHEDULE J, PART II.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 1a Health or social club dues or initiation fees</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING THE REPORTING PERIOD, THE ORGANIZATION PAID THE SYSTEM CEO MEMBERSHIP DUES IN A SOCIAL CLUB. THE CLUB MEMBERSHIP WAS USED FOR BUSINESS PURPOSES. ANY PERSONAL RELATED EXPENSES ARE TREATED AS TAXABLE WAGE INCOME AND FULLY INCLUDED ON THE RECIPIENT'S FORM W-2.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>OWENSBORO HEALTH TWIN LAKE MEDICAL CENTER, INC. RELIES ON THE COMPENSATION PRACTICES OF A RELATED ORGANIZATION OWENSBORO HEALTH, INC. TO DETERMINE THE COMPENSATION OF TOP MANAGEMENT OFFICIALS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>OWENSBORO HEALTH, INC ("OH") PROVIDES A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN FOR CERTAIN EXECUTIVE EMPLOYEES. PARTICIPATION IN THE PLAN IS SUBJECT TO THE RECOMMENDATION OF THE CHIEF EXECUTIVE OFFICER AND THE APPROVAL OF THE BOARD OF DIRECTORS. AS OF DECEMBER 31, OH SHALL CREDIT THE PARTICIPANT'S ACCOUNT WITH AN EMPLOYER CONTRIBUTION. THE PARTICIPANT MUST BE EMPLOYED BY OH AT THE END OF THE PLAN YEAR IN ORDER TO RECEIVE AN EMPLOYER CONTRIBUTION FOR THAT PLAN YEAR, AND PARTIAL YEAR CREDIT IS EARNED AFTER A PARTICIPANT REACHED NORMAL RETIREMENT AGE AS DEFINED BY THE PLAN. EMPLOYER CONTRIBUTIONS MADE FOR PLAN YEARS STARTING PRIOR TO 1/1/2022, THE EMPLOYER CONTRIBUTIONS FOR EACH CONTRIBUTION CLASS YEAR SHALL BE 100% VESTED AS OF THE END OF THE PLAN YEAR WHICH IS FIVE YEARS AFTER THE DATE ON WHICH THE EMPLOYER CONTRIBUTION WAS MADE FOR SUCH CONTRIBUTION CLASS YEAR. EMPLOYER CONTRIBUTIONS MADE FOR PLAN YEARS STARTING ON OR AFTER 1/1/2022, THE EMPLOYER CONTRIBUTIONS FOR EACH CONTRIBUTION CLASS YEAR SHALL BE 100% VESTED AS OF THE LATER OF THE JANUARY 1 THAT IS THREE YEARS FROM THE START OF THE CONTRIBUTION CLASS YEAR FOR WHICH THE CONTRIBUTION WAS MADE, OR THE JANUARY 1 COINCIDENT WITH OR FOLLOWING THE FIFTH ANNIVERSARY OF THE PARTICIPANT'S PARTICIPATION DATE. THE TAX LIABILITY PAYMENTS ARE THEMSELVES INCLUDED IN W-2 INCOME IN THE YEAR MADE TO THE EXECUTIVES AND ARE INCLUDED IN THE FIGURES DISCLOSED ON SCHEDULE J, PART II. 457F PLAN TO EXECUTIVES: RUSS RANALLO ($32,980)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 7 Non-fixed payments</FormAndLineReferenceDesc>
        <ExplanationTxt>SUCCESS SHARING PLAN THE SUCCESS SHARING PLAN IS A PROGRAM DESIGNED TO FOCUS ON THE ACCOUNTABILITY OF ALL EMPLOYEES TO INFLUENCE THE FINANCIAL, QUALITY, PATIENT SATISFACTION AND EMPLOYEE DEVELOPMENT GOALS, AND TO REINFORCE THE OH CORE COMMITMENTS (RESPECT, INTEGRITY, INNOVATION, SERVICE, EXCELLENCE AND TEAMWORK) WHILE WORKING TO ACHIEVE THESE GOALS. THE PLAN ACHIEVES THIS BY PROVIDING A DIRECT LINK BETWEEN ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES AND THE TOTAL COMPENSATION OF THOSE WHO'S DECISIONS AND ACTIONS ARE ACCOUNTABLE FOR THE OUTCOMES WHICH DRIVE THE ORGANIZATION'S SUCCESS. ELIGIBILITY IS BASED ON HOURS WORKED IN THE YEAR; STAFF EMPLOYEES ARE PAID A PRO-RATED AMOUNT OF A DOLLAR MAXIMUM AND MANAGEMENT IS PAID A FIXED PERCENTAGE OF ANNUAL SALARY BASED ON LEVEL OF MANAGEMENT. PAYMENT IS PREDICATED ON BOARD APPROVAL.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part I, Line 6 Volunteers</FormAndLineReferenceDesc>
        <ExplanationTxt>VOLUNTEERS SUPPORT THE MISSION AND GOALS OF OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER ("OHTLMC"). VOLUNTEERS STAFF THE VISITOR INFORMATION DESK, PROVIDE DIRECTION TO VISITORS, AND OPERATE THE HOSPITAL GIFT SHOP. VOLUNTEERS ARE AN ESSENTIAL PART OF THE CARE AND COMFORT OHTLMC PROVIDES. OHTLMC HAD 40 VOLUNTEERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER IS OWENSBORO HEALTH, INC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER OWENSBORO HEALTH, INC. APPOINTS THE MEMBERS OF THE BOARD. THE BOARD IS COMPOSED OF 9 MEMBERS DIVIDED INTO THREE CLASSES SERVING THREE YEAR TERMS (OTHER THAN THE INITIAL BOARD MEMBERS WHO HAVE TERMS EXPIRING IN OCTOBER 2021, 2022 AND 2023 RESPECTIVELY FOR EACH CLASS OF THREE DIRECTORS SO THAT THE TERMS ARE STAGGERED). TERM LIMIT OF THREE FULL THREE YEAR CONSECUTIVE TERMS WITH AT LEAST ONE YEAR OFF BEFORE ELIGIBLE TO SERVE AGAIN. AT LEAST FOUR OF THE BOARD MEMBERS MUST BE RESIDENTS OF GRAYSON COUNTY, KENTUCKY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOLLOWING MATTERS SHALL REQUIRE THE APPROVAL OF THE SOLE MEMBER OF THE CORPORATION, OWENSBORO HEALTH, INC.: (A) ANY CHANGE IN THE MISSION OR PURPOSE OF THE CORPORATION; (B) ANY AMENDMENT TO THE ARTICLES OR BYLAWS OF THE CORPORATION; (C) ANY ADDITION OF NEW MEMBERS; (D) APPOINTMENT OR REMOVAL OF DIRECTORS OF THE CORPORATION IN ACCORDANCE WITH THE BOARD OF DIRECTORS; (E) ANY PURCHASE OR ACQUISITION, SALE, GIFT, LEASE, DISPOSITION OF, MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED BY THE CORPORATION, EXCLUDING ROUTINE OR BUDGETED EXPENDITURES, THE VALUE OF WHICH IN THE AGGREGATE EXCEEDS $200,000; (F) SELLING, EXCHANGING, OR OTHERWISE DISPOSING OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (G) ANY UNBUDGETED INCURRENCE OR GUARANTEE OF INDEBTEDNESS BY THE CORPORATION THAT IN THE AGGREGATE EXCEEDS $200,000; (H) ANY MERGER, ACQUISITION, OR CONSOLIDATION OF THE CORPORATION OR ENTERING INTO ANY JOINT BUSINESS VENTURE WITH ANY OTHER PERSON, CORPORATION OR OTHER LEGAL ENTITY; (I) ANY DISSOLUTION OF THE CORPORATION; (J) CREATION, ACQUISITION, OR DISPOSITION OF ANY SUBSIDIARY OR AFFILIATED ENTITY OF THE CORPORATION; AND (K) APPROVAL OF THE ANNUAL CAPITAL AND OPERATING BUDGETS FOR THE CORPORATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS REVIEWED BY THE INTERNAL FINANCE TEAM AND FORWARDED TO THE CFO FOR FINAL REVIEW AND APPROVAL BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY UNDER OUR CONFLICT OF INTEREST POLICY (#100-214), EACH BOARD DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWER, AND KEY EMPLOYEE IS REQUIRED ANNUALLY TO COMPLETE THE FOLLOWING: (1) CONFIDENTIALITY STATEMENT, (2) DISCLOSURE CERTIFICATE, AND (3) INDEPENDENCE AND RELATED PARTY QUESTIONNAIRE. THESE DISCLOSURES ARE REVIEWED AND RETAINED BY THE CHIEF LEGAL OFFICER, WHO IS ALSO IN THE APPROVAL CHAIN FOR ALL OH CONTRACTS. ALL COMPLETED CONTRACTS ARE MAINTAINED BY THE LEGAL OFFICE IN A SEARCHABLE DATABASE (THROUGH ICONTRACT). THESE WILL BE REVIEWED AND MAINTAINED BY THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER ALSO HAS ACCESS TO THE CONTRACT'S DATABASE AND COMPLETES AN OIG SANCTION CHECK FOR NEW CONTRACTS. ONCE THE CONFLICT OF INTEREST DATA HAS BEEN COLLECTED, NEW CONTRACTS WILL BE SCREENED FOR POTENTIAL CONFLICTS OF INTEREST. IN ADDITION, OH MAINTAINS A COMPLIANCE HOTLINE THROUGH WHICH ANYONE WITH KNOWLEDGE OF A CONFLICT OF INTEREST OR IMPROPER VENDOR RELATIONSHIP CAN ANONYMOUSLY REPORT SUSPECTED VIOLATIONS OF THE OH POLICY. OF THOSE INDIVIDUALS FOUND TO HAVE A CONFLICT OF INTEREST, EMPHASIS IS MADE THAT THEY MAINTAIN IN CONFIDENCE ANY INFORMATION, KNOWLEDGE, OR DOCUMENTS ACQUIRED AS THE RESULT OF THEIR POSITION OR ATTENDANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>OHTLMC FOLLOWS OH'S COMPENSATION PROCESS THAT COMPLIES WITH THE REBUTTABLE PRESUMPTION OF REASONABLENESS. OH'S COMPENSATION PROCESS IS AS FOLLOWS: - TOTAL COMPENSATION IS THE SUM OF EACH EXECUTIVE'S BASE SALARY, INCENTIVE OPPORTUNITY, BENEFITS, AND PERQUISITES. - OUR TOTAL COMPENSATION PHILOSOPHY WILL APPLY TO ALL EXECUTIVES OF THE ORGANIZATION. - CASH COMPENSATION AND BENEFITS PLANS PROVISIONS WILL BE, ON AVERAGE, COMPETITIVE WITH THOSE HEALTHCARE ORGANIZATIONS WITHIN WHICH WE COMPETE FOR EXECUTIVE TALENT. OUR LABOR MARKET IS DEFINED AS SUCCESSFUL AND COMPARABLY SIZED HEALTHCARE ORGANIZATIONS ON A NATIONAL LEVEL. SUCCESS IS MEASURED IN TERMS OF FINANCIAL AND OPERATIONAL PERFORMANCE AND MARKET LEADERSHIP. - COMPETITIVE POSITIONING OF BASE SALARIES, AS REFLECTED BY THE SALARY RANGE MIDPOINTS, WILL BE AT THE 50TH PERCENTILE. EXECUTIVES MAY BE PLACED ABOVE OR BELOW THE SALARY RANGE BASED ON THE: EXECUTIVE'S KNOWLEDGE, COMPETENCIES, AND EXPERIENCE; PERFORMANCE OF THE EXECUTIVE'S AREA OF RESPONSIBILITY; THE EXECUTIVE'S CONTRIBUTION TO THE ORGANIZATION'S OVERALL PERFORMANCE; INTERNAL EQUITY CONSIDERATIONS; THE FINANCIAL RESOURCES AVAILABLE; AND, EXECUTIVE BASE SALARY INCREASES PROVIDED IN THE COMPETITIVE MARKET. - ANNUAL INCENTIVE OPPORTUNITIES WILL BE POSITIONED BETWEEN THE 50TH AND 75TH PERCENTILE DEPENDING ON THE DEGREE TO WHICH PERFORMANCE GOALS ARE MET OR EXCEEDED. TOTAL CASH COMPENSATION, AS REFLECTED BY BASE SALARIES AND ANNUAL INCENTIVES, WILL ALSO BE POSITIONED BETWEEN THE 50TH AND 75TH PERCENTILES AND WILL BE INFLUENCED BY PERFORMANCE RESULTS AS MEASURED AGAINST ESTABLISHED GOALS. - THE ORGANIZATION WILL PROVIDE APPROPRIATE AND COMPETITIVE SUPPLEMENTAL BENEFITS AND PERQUISITES DELIVERED IN A FLEXIBLE STRUCTURE TO ALLOW FOR INDIVIDUAL CHOICE AND BASED ON THE ORGANIZATION'S MISSION AND BUSINESS NEEDS. - OUR EXECUTIVE COMPENSATION PLAN WILL BE DESIGNED, MANAGED AND MAINTAINED IN A MANNER THAT WILL: SUPPORT AND COMPLEMENT OUR MISSION, MANAGEMENT PHILOSOPHY, SHORT- AND LONG-TERM BUSINESS STRATEGIES, AND EMPLOYEE RELATION'S GOALS; ATTRACT AND RETAIN EXECUTIVES WITH THE RIGHT SKILLS, ABILITIES AND MOTIVATION TO ACHIEVE OUR BUSINESS OBJECTIVE; AND ENSURE THE EXECUTIVE TOTAL COMPENSATION IS REASONABLE AND COMPETITIVE. OUR CASH COMPENSATION AND BENEFITS PLANS WILL BE REVIEWED AND ADJUSTED PERIODICALLY TO MEET THE CHANGING BUSINESS AND ORGANIZATIONAL CHARACTERISTICS OF OUR ORGANIZATION AND ITS EXECUTIVE STAFF. THE COMPENSATION OF EACH INDIVIDUAL EXECUTIVE WILL BE REVIEWED AND APPROVED IN A MANNER CONSISTENT WITH THE INTERMEDIATE SANCTION TAX REGULATIONS. THE LAST COMPENSATION REVIEW PROCESS WAS COMPLETED IN 2024 BY SULLIVAN COTTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b Process to establish compensation of other employees</FormAndLineReferenceDesc>
        <ExplanationTxt>OHTLMC FOLLOWS OH'S COMPENSATION PROCESS THAT COMPLIES WITH THE REBUTTABLE PRESUMPTION OF REASONABLENESS. OH'S COMPENSATION PROCESS IS AS FOLLOWS: - TOTAL COMPENSATION IS THE SUM OF EACH EXECUTIVE'S BASE SALARY, INCENTIVE OPPORTUNITY, BENEFITS, AND PERQUISITES. - OUR TOTAL COMPENSATION PHILOSOPHY WILL APPLY TO ALL EXECUTIVES OF THE ORGANIZATION. - CASH COMPENSATION AND BENEFITS PLANS PROVISIONS WILL BE, ON AVERAGE, COMPETITIVE WITH THOSE HEALTHCARE ORGANIZATIONS WITHIN WHICH WE COMPETE FOR EXECUTIVE TALENT. OUR LABOR MARKET IS DEFINED AS SUCCESSFUL AND COMPARABLY SIZED HEALTHCARE ORGANIZATIONS ON A NATIONAL LEVEL. SUCCESS IS MEASURED IN TERMS OF FINANCIAL AND OPERATIONAL PERFORMANCE AND MARKET LEADERSHIP. - COMPETITIVE POSITIONING OF BASE SALARIES, AS REFLECTED BY THE SALARY RANGE MIDPOINTS, WILL BE AT THE 50TH PERCENTILE. EXECUTIVES MAY BE PLACED ABOVE OR BELOW THE SALARY RANGE BASED ON THE: EXECUTIVE'S KNOWLEDGE, COMPETENCIES, AND EXPERIENCE; PERFORMANCE OF THE EXECUTIVE'S AREA OF RESPONSIBILITY; THE EXECUTIVE'S CONTRIBUTION TO THE ORGANIZATION'S OVERALL PERFORMANCE; INTERNAL EQUITY CONSIDERATIONS; THE FINANCIAL RESOURCES AVAILABLE; AND, EXECUTIVE BASE SALARY INCREASES PROVIDED IN THE COMPETITIVE MARKET. - ANNUAL INCENTIVE OPPORTUNITIES WILL BE POSITIONED BETWEEN THE 50TH AND 75TH PERCENTILE DEPENDING ON THE DEGREE TO WHICH PERFORMANCE GOALS ARE MET OR EXCEEDED. TOTAL CASH COMPENSATION, AS REFLECTED BY BASE SALARIES AND ANNUAL INCENTIVES, WILL ALSO BE POSITIONED BETWEEN THE 50TH AND 75TH PERCENTILES AND WILL BE INFLUENCED BY PERFORMANCE RESULTS AS MEASURED AGAINST ESTABLISHED GOALS. - THE ORGANIZATION WILL PROVIDE APPROPRIATE AND COMPETITIVE SUPPLEMENTAL BENEFITS AND PERQUISITES DELIVERED IN A FLEXIBLE STRUCTURE TO ALLOW FOR INDIVIDUAL CHOICE AND BASED ON THE ORGANIZATION'S MISSION AND BUSINESS NEEDS. - OUR EXECUTIVE COMPENSATION PLAN WILL BE DESIGNED, MANAGED AND MAINTAINED IN A MANNER THAT WILL: SUPPORT AND COMPLEMENT OUR MISSION, MANAGEMENT PHILOSOPHY, SHORT- AND LONG-TERM BUSINESS STRATEGIES, AND EMPLOYEE RELATION'S GOALS; ATTRACT AND RETAIN EXECUTIVES WITH THE RIGHT SKILLS, ABILITIES AND MOTIVATION TO ACHIEVE OUR BUSINESS OBJECTIVE; AND ENSURE THE EXECUTIVE TOTAL COMPENSATION IS REASONABLE AND COMPETITIVE. OUR CASH COMPENSATION AND BENEFITS PLANS WILL BE REVIEWED AND ADJUSTED PERIODICALLY TO MEET THE CHANGING BUSINESS AND ORGANIZATIONAL CHARACTERISTICS OF OUR ORGANIZATION AND ITS EXECUTIVE STAFF. THE COMPENSATION OF EACH INDIVIDUAL EXECUTIVE WILL BE REVIEWED AND APPROVED IN A MANNER CONSISTENT WITH THE INTERMEDIATE SANCTION TAX REGULATIONS. THE LAST COMPENSATION REVIEW PROCESS WAS COMPLETED IN 2024 BY SULLIVAN COTTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S FORM 1023 AND FORM 990 ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE ON GUIDESTAR'S DATABASE AVAILABLE AT WWW.GUIDESTAR.ORG. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE KENTUCKY SECRETARY OF STATE'S WEBSITE AT HTTPS://APP.SOS.KY.GOV/FTSEARCH/. OTHERWISE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. A COPY OF THE ORGANIZATION'S FINANCIAL STATEMENTS IS ATTACHED TO ITS 990 IN COMPLIANCE WITH THE REQUIREMENTS OF THE AFFORDABLE CARE ACT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VIII, Line 11d Other Miscellaneous Revenue</FormAndLineReferenceDesc>
        <ExplanationTxt>- Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; - Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g Other Fees</FormAndLineReferenceDesc>
        <ExplanationTxt>COLLECTION SERVICES - Total Expense: 29861, Program Service Expense: 0, Management and General Expenses: 29861, Fundraising Expenses: 0; CONTRACT LABOR - Total Expense: 4492663, Program Service Expense: 2805864, Management and General Expenses: 1686799, Fundraising Expenses: 0; CONSULTING AND MISC PROFESSIONAL FEES - Total Expense: 31214, Program Service Expense: 31045, Management and General Expenses: 169, Fundraising Expenses: 0; PHYSICIAN FEES - Total Expense: 3925231, Program Service Expense: 3925231, Management and General Expenses: 0, Fundraising Expenses: 0; PURCHASED SERVICES - Total Expense: 746865, Program Service Expense: 671882, Management and General Expenses: 74983, Fundraising Expenses: 0; R&amp;M SERVICE CONTRACTS - Total Expense: 744885, Program Service Expense: 678918, Management and General Expenses: 65967, Fundraising Expenses: 0;</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1201 PLEASANT VALLEY ROAD</AddressLine1Txt>
          <CityNm>OWENSBORO</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42303</ZIPCd>
        </USAddress>
        <EIN>611286361</EIN>
        <PrimaryActivitiesTxt>HEALTHCARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH FOUNDATION INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1201 PLEASANT VALLEY ROAD</AddressLine1Txt>
          <CityNm>OWENSBORO</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42303</ZIPCd>
        </USAddress>
        <EIN>611251763</EIN>
        <PrimaryActivitiesTxt>HEALTHCARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>OH</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>true</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH MEDICAL GROUP</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1201 PLEASANT VALLEY ROAD</AddressLine1Txt>
          <CityNm>OWENSBORO</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42303</ZIPCd>
        </USAddress>
        <EIN>611197638</EIN>
        <PrimaryActivitiesTxt>HEALTHCARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>OH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
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        <RelatedOrganizationName>
          <BusinessNameLine1Txt>OWENSBORO AM SR FAC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>1000 BRKRG</AddressLine1Txt>
          <CityNm>OWENSBORO</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42303</ZIPCd>
        </USAddress>
        <EIN>752184992</EIN>
        <PrimaryActivitiesTxt>SURGERY CENTER</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>Unrelated</PredominantIncomeTypeTxt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
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      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>TWIN LAKES REGIONAL PAIN MANAGEMENT</BusinessNameLine1Txt>
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          <AddressLine1Txt>910 WALLACE AVE</AddressLine1Txt>
          <CityNm>LEITCHFIELD</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42754</ZIPCd>
        </USAddress>
        <EIN>472329929</EIN>
        <PrimaryActivitiesTxt>PAIN MANAGEMENT</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>Related</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>116364</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>99983</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
      </IdRelatedOrgTxblPartnershipGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>true</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>true</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>true</TransferFromOtherOrgInd>
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        <OtherOrganizationName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH MEDICAL GROUP INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>J</TransactionTypeTxt>
        <InvolvedAmt>204736</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>OWENSBORO HEALTH MEDICAL GROUP INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>P</TransactionTypeTxt>
        <InvolvedAmt>2336807</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>