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      <GovernmentGrantsAmt>122986</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>13920</AllOtherContributionsAmt>
      <TotalContributionsAmt>136906</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Service Revenue, Net</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>60609188</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>60609188</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy Sales - Patients</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>5845446</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>5845446</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Care Quality Incentives</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>179776</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>179776</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>66435499</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>233968</TotalRevenueColumnAmt>
        <ExclusionAmt>233968</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>153305</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>42213</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>111092</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>111092</TotalRevenueColumnAmt>
        <ExclusionAmt>111092</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>830</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <OtherAmt>-830</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-830</TotalRevenueColumnAmt>
        <ExclusionAmt>-830</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>5560</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>5038</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>522</TotalRevenueColumnAmt>
        <ExclusionAmt>522</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>Cafeteria Income</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>96107</TotalRevenueColumnAmt>
        <ExclusionAmt>96107</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Intercompany Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>53546</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>53546</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>179405</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>172921</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>6484</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>329058</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>67246215</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>66661966</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>447343</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>2650</TotalAmt>
        <ProgramServicesAmt>2650</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>948272</TotalAmt>
        <ProgramServicesAmt>414779</ProgramServicesAmt>
        <ManagementAndGeneralAmt>533493</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>26330721</TotalAmt>
        <ProgramServicesAmt>24674751</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1655970</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>868476</TotalAmt>
        <ProgramServicesAmt>829665</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38811</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>5622715</TotalAmt>
        <ProgramServicesAmt>5304262</ProgramServicesAmt>
        <ManagementAndGeneralAmt>318453</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>2044288</TotalAmt>
        <ProgramServicesAmt>1915720</ProgramServicesAmt>
        <ManagementAndGeneralAmt>128568</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>31077</TotalAmt>
        <ManagementAndGeneralAmt>31077</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>7212</TotalAmt>
        <ProgramServicesAmt>7212</ProgramServicesAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising></FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>7122506</TotalAmt>
        <ProgramServicesAmt>6512969</ProgramServicesAmt>
        <ManagementAndGeneralAmt>609537</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>144443</TotalAmt>
        <ProgramServicesAmt>8878</ProgramServicesAmt>
        <ManagementAndGeneralAmt>135565</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1688415</TotalAmt>
        <ProgramServicesAmt>1128446</ProgramServicesAmt>
        <ManagementAndGeneralAmt>559969</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>27662</TotalAmt>
        <ProgramServicesAmt>24983</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2679</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>848573</TotalAmt>
        <ProgramServicesAmt>754211</ProgramServicesAmt>
        <ManagementAndGeneralAmt>94362</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>176025</TotalAmt>
        <ProgramServicesAmt>139439</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36586</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>0</TotalAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>606932</TotalAmt>
        <ProgramServicesAmt>513877</ProgramServicesAmt>
        <ManagementAndGeneralAmt>93055</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>6731081</TotalAmt>
        <ProgramServicesAmt>374596</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6356485</ManagementAndGeneralAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1467167</TotalAmt>
        <ProgramServicesAmt>1242222</ProgramServicesAmt>
        <ManagementAndGeneralAmt>224945</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>919855</TotalAmt>
        <ProgramServicesAmt>916017</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3838</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>11204586</TotalAmt>
        <ProgramServicesAmt>11204586</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Provision for Doubtful Accounts</Desc>
        <TotalAmt>3045374</TotalAmt>
        <ProgramServicesAmt>3045374</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Taxes, Licenses Fees</Desc>
        <TotalAmt>1451861</TotalAmt>
        <ProgramServicesAmt>1142125</ProgramServicesAmt>
        <ManagementAndGeneralAmt>309736</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Recruiting</Desc>
        <TotalAmt>194063</TotalAmt>
        <ProgramServicesAmt>192136</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1927</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>170509</TotalAmt>
        <ProgramServicesAmt>52208</ProgramServicesAmt>
        <ManagementAndGeneralAmt>118301</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>71654463</TotalAmt>
        <ProgramServicesAmt>60401106</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11253357</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>2125</BOYAmt>
        <EOYAmt>3591</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>22318023</BOYAmt>
        <EOYAmt>13025802</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>8216611</BOYAmt>
        <EOYAmt>8577958</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>1962785</BOYAmt>
        <EOYAmt>1577054</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>688340</BOYAmt>
        <EOYAmt>1166747</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>16579188</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>3789534</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>10705528</BOYAmt>
        <EOYAmt>12789654</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>1073543</BOYAmt>
        <EOYAmt>1075287</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>1080043</BOYAmt>
        <EOYAmt>945038</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>396388</BOYAmt>
        <EOYAmt>1333246</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>46443386</BOYAmt>
        <EOYAmt>40494377</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>12671075</BOYAmt>
        <EOYAmt>13620795</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>10624391</BOYAmt>
        <EOYAmt>9553968</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>1511988</BOYAmt>
        <EOYAmt>1511344</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>24807454</BOYAmt>
        <EOYAmt>24686107</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>21635932</BOYAmt>
        <EOYAmt>15808270</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>21635932</BOYAmt>
        <EOYAmt>15808270</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>46443386</BOYAmt>
        <EOYAmt>40494377</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-4408248</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>-1419414</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="990A" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="990B" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <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>
    <IRS990ScheduleC documentId="990C" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>true</OtherActivitiesInd>
      <OtherActivitiesAmt>7212</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>7212</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>II-B 1i</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization pays membership fees to the American Hospital Association and WV Hospital Association, which participates in lobbying activities. The amount reported above represents the portion of the dues allocated for lobbying activities. The West Virginia Healthcare Cooperative Inc. does not participate in or intervene in including publishing or distributing of statements any political campaign on behalf of or in opposition to any candidate for public office.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="990D" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>188298</OtherCostOrOtherBasisAmt>
        <BookValueAmt>188298</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>6996612</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1045649</DepreciationAmt>
        <BookValueAmt>5950963</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>1258479</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>295219</DepreciationAmt>
        <BookValueAmt>963260</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>5785850</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2059602</DepreciationAmt>
        <BookValueAmt>3726248</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>2349949</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>389064</DepreciationAmt>
        <BookValueAmt>1960885</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>12789654</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Financial derivatives and other financial products</Desc>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>Closely-held equity interests</Desc>
      </OtherSecuritiesGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Federal income taxes</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Long Term Lease Liability</Desc>
        <Amt>210408</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Self Insurance Liabilities</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Leases Payable - Current</Desc>
        <Amt>316220</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Capitalized Leases Payable - Non - Current</Desc>
        <Amt>984716</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>1511344</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>64248091</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>-3045374</OtherRevenueAmt>
      <RevenueNotReportedAmt>-3045374</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>67293465</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-47251</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-47251</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>67246214</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>68651302</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>42213</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>42213</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>68609089</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>3045374</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>3045374</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>71654463</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>X 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS, BCHS, PHIC, HPN, and TMHS are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2023 and 2022.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XI 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount includes 3,045,374 Provision for Doubtful Accounts - Patient Accounts that was reported as an offset to revenue on the audited financial statements but is reported as an expense on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XI 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount consists of 5,038 special events expense that is recorded as an offset to revenue on the Form 990 as well as 42,213 is rental expenses that is an offset to revenue on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XII 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount of 42,213 is rental expenses that is an offset to revenue on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>XII 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>This amount includes Provision for Doubtful Accounts - Patient Accounts of 3,045,374 that was reported as an offset to revenue on the audited financial statements but are reported as an expense on the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <FundraisingEventInformationGrp>
        <Event1Nm>Spud Run</Event1Nm>
        <GrossReceiptsEvent1Amt>5560</GrossReceiptsEvent1Amt>
        <GrossRevenueEvent1Amt>5560</GrossRevenueEvent1Amt>
        <OtherDirectExpensesEvent1Amt>5038</OtherDirectExpensesEvent1Amt>
        <GrossReceiptsTotalAmt>5560</GrossReceiptsTotalAmt>
        <GrossRevenueTotalEventsAmt>5560</GrossRevenueTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>5038</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>5038</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>522</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
    </IRS990ScheduleG>
    <IRS990ScheduleH documentId="990H" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <FinancialAssistancePolicyInd>true</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>true</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>false</FPGReferenceDiscountedCareInd>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>false</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>true</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>true</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>554244</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>554244</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00810</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>17818690</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>17818690</DirectOffsettingRevenueAmt>
      </UnreimbursedMedicaidGrp>
      <UnreimbursedCostsGrp>
        <TotalCommunityBenefitExpnsAmt>228178</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>228178</DirectOffsettingRevenueAmt>
      </UnreimbursedCostsGrp>
      <TotalFinancialAssistanceTyp>
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        <DirectOffsettingRevenueAmt>18046868</DirectOffsettingRevenueAmt>
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        <FAPAppAvailableOnWebsiteURLTxt>https//wvumedicine.org/wp-content/uploads/2022/10/WVUHFAP-Financial-Application1020202.pdf</FAPAppAvailableOnWebsiteURLTxt>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The 2021 CHNA process began with a thorough review of the previous cycles needs assessment reports, and included review of publicly available secondary data related to counties within the combined service area. These data included census data and County Health Rankings Data. Using these reports as a springboard, the leadership team started the initial discussion around critical health needs, changes in the community demographics over the previous few years, and lessons learned from the last CHNA cycles health topic prioritization and development of implementation activities. Primary data collection was comprised of surveying community members to gather perceptions of health issues, quality of life, and other related topics. Survey data was analyzed and presented back to the BCMH/SRMC CHNA leadership team for prioritization of topics to be addressed through implementation planning.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The primary source of data utilized to inform the CHNA was a public input survey. This survey was developed by WVU OHA with the BCMH/SRMC CHNA leadership team following an iterative process. Survey topics included questions about specific health issues, thoughts on overall health of the community, quality of life, access to health care and medical needs including specialist care, risky behaviors and personal choices, and demographic information including geographic location and income. Data was collected anonymously from residents age 18 and older. The survey was disseminated via a web-based platform. Collection efforts included hospital social media pages, staff list e-mail invitation, postcards with QR code for survey were placed at hospital registration points, postcards were placed at the Summersville Arena Convention Center and were distributed during community events. A total of 202 surveys were completed by community members from the area. Noteworthy limitations included disproportionately low representation from males, from the lower-income population of these counties, from non-white community members, from households with children, and low or no response from a few of the counties in the PSA. The CHNA can be found online here https//wvumedicine.org/wp-content/uploads/2022/08/BCMH-SRMC-2021-Community-Health-Needs-Assessment.pdf.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>For the first time, Braxton County Memorial Hospital BCMH and Summersville Regional Medical Center SRMC have chosen to complete the 2021 CHNA portion of this process in tandem. Adjacent service areas and shared hospital administration informed the decision to complete the needs assessment portion of this requirement as a single joint effort. Each hospitals Board of Directors conducted independent reviews of the CHNA. In addition to the requirement to conduct a CHNA, leadership of both hospitals continually expressed the desire to go beyond regulatory requirements in serving patients and the community at large. To facilitate this goal, the pair partnered with West Virginia Universitys Office of Health Affairs WVU OHA to complete this CHNA using a robust community based process designed to engage a broad representation of community members. The WVU team was led by Dr. Tom Bias. A CHNA leadership team including hospital and community representation was convened by BCMH SRMC to inform and guide to process.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The 2021 CHNA and Implementation Plan adopted in 2022 identified Health Living Obesity, Chronic Disease, Physical Activity, and Nutrition as the greatest need. SRMC participated in the following during 2022 in an effort to continue addressing these issues. Chronic Disease SRMC participated in several nation campaigns that bring awareness to health issues such as National Wear Red Day bringing awareness to heart health, Donate Life WV Hospital Challenge - achieving a level of Titanium and hosting a Flag Raising Ceremony in honor of National Donate Life Month, and to raise awareness about organ donation, as well as, a Pink it Out event to raise awareness about Breast Cancer and encourage regular screenings. Obesity, Physical Activity, and Nutrition SRMC participated in the Nicholas County Science Fair, encouraging knowledge about health and wellness. Sponsored the Spud Run at the Nicholas County Potato Festival, participated in a food drive, donating the items to Mountaineer Food Bank to combat hunger and improve nutrition. Movie in the Park events promoting physical activity among families. Monthly ads are circulating in each local newspaper in each county, often featuring current wellness related dates Breast Cancer Awareness, Diabetes Awareness etc.. SRMC also includes a slide in our weekly communication, that is displayed on screens throughout the hospital facilities, dedicated to health and wellness information. The Implementation Plan can be found here https//wvumedicine.org/wp-content/uploads/2022/08/BCMH-SRMC-Community-Health-Implementation-Plan2022.pdf.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 13b</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC offers discounted care only to individuals who qualify for free care. SRMC offers Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/ guarantor must meet certain requirements.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group Summersville Regional Medical Center Line Part V, Section B, Line 24</FormAndLineReferenceDesc>
        <ExplanationTxt>All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amount are moved to Charity Care and no longer charged to the patient.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>2</FacilityNum>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Summersville Fairview Health Clinic</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>350 Fairview Heights Road</AddressLine1Txt>
            <CityNm>Summersville</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>26651</ZIPCd>
          </USAddress>
          <FacilityTxt>Family Practice Clinic</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Summersville Specialty Clinic</BusinessNameLine1Txt>
          </BusinessName>
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            <AddressLine1Txt>702 Professional Park Drive</AddressLine1Txt>
            <CityNm>Summersville</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>26651</ZIPCd>
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          <FacilityTxt>Physician Practice</FacilityTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 3c</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC uses 200 Federal Poverty Guideline FPG to determine free care eligibility. However, WVUH does not offer discounted care to individuals who fail the 200 FPG test.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>SRMCs community benefit numbers are reported in total with the other hospitals within West Virginia United Health System. The most recent amounts can be found at the following web address https//wvumedicine.org/about/community-benefit/.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>Net community benefit expense for 2023 is 586,211 and is 0.86 of total net expenses. To calculate net expense, Provisions for Doubtful Accounts - Patients of 3,045,374 was deducted from total expenses of 71,654,463 as shown in Part IX line 25 of the core Form 990, for a net expense of 68,609,089.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-Charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad Debt Expense at cost was calculated by multiplying Provisions for Doubtful Accounts - Patients of 3,045,374 by our cost to charge ratio of 43.21 derived from Worksheet 2 in the IRS Schedule H instructions for a total of 1,315,906.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 5,000. The total of that report was 323,126 which we then multiplied by our cost to charge ratio of 43.21 for a total of 139,623.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The estimated bad debt attributable to patients eligible for charity care of 139,623 should be considered community benefit due to the fact that anyone with outstanding balances of 5,000 or greater usually qualifies as catastrophic if the patient completes the application process.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>In our charity care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year. Regardless, that bad debt should be considered community benefit as we provide services to those in need regardless of their ability to pay.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>Patient accounts receivables are primarily paid by federal and state governmental authorities under the Medicare and Medicaid programs, managed health plans, commercial insurance companies, workers compensation programs, employers and patients. Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. The System does not believe there are any significant concentrations of revenues from any particular payor that would subject the System to any significant credit risks in the collection of patient accounts receivable. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters. Changes in general economic conditions, patient accounting service center operations, payor mix, payor claim processing could affect collections of accounts receivable, cash flows and results of operations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>The System performs periodic assessments to determine if an allowance for expected credit losses is necessary. The System considers its incurred loss experience and adjusts for known and expected events and other circumstances. In estimating its expected credit losses, the System may consider changes in the length of time its receivables have been outstanding, changes in credit ratings for payors, requests from payors to alter payment terms due to financial difficulty, and notices of payor bankruptcies or payors entering receivership. Because the Systems accounts receivable is typically paid for by highly solvent, creditworthy payors, such as Medicare, Medicaid, other governmental programs, and highly regulated commercial insurers on behalf of the patient, the Systems credit losses are immaterial to the consolidated financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>The mix of accounts receivable at December 31, 2023 and 2022, from patients and third-party payors is as follows For the year-end December 31, 2023 Medicare - 25, Medicaid - 13, Blue Cross - 21, Commercial, managed care and other - 39, Patients - 2, totaling 100. For the year-end December 31, 2022 Medicare - 27, Medicaid - 16, Blue Cross - 19, Commercial, managed care and other - 35, Patients - 3, totaling 100.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 8</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount reported in Part III Line 6 9,811,285 was calculated using the total Medicare allowable cost from the Medicare cost report, less Medicare reimbursement of direct GME.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 9b</FormAndLineReferenceDesc>
        <ExplanationTxt>SRMC does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center considers several components in assessing how the organization determines the need of the communities it serves. Through outside consultants to collaborating with various departments, a needs assessment takes into account several factors including physicians to population ratios, physician availability in the entire service area, and general health risks for our community. The Primary Service Area for Summersville Regional Medical Center is Nicholas County, WV. This data is then analyzed to provide general estimates to where SRMC could better care for residents of Nicholas County.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Population and demographic data is provided by WVU Medicines population health and enterprise analytics department.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center employs one financial counselor to meet with patients to discuss financial eligibility for our charity care program. Summersville Regional Medical Center has the qualification requirements, as well as, applications for charity care available at all registration areas. Patients that do not qualify for state or federally funded programs can apply for the charity care program at Summersville Regional Medical Center.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center SRMC is a non-profit hospital located in Nicholas County, WV in the city of Summersville. SRMC currently provides acute, orthopedic, emergency, outpatient, clinic, long-term and primary care to primarily Nicholas County residents as well as to individuals residing in central West Virginia. In 2023, Nicholas County had a population of 24,169, a median household income of 48,826, an employment rate of 48.2, approximately 18.7 of residents living in poverty, and 7.9 living without healthcare coverage. Population and demographic information was obtained from the United States Census Bureau https//data.census.gov/cedsci/.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The Summersville Regional Medical Center board of directors is a community board, with four members living in or around Nicholas County, WV.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>Summersville Regional Medical Center extends privileges to all qualified medical staff in Nicholas County and surrounding communities to meet its healthcare needs.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The West Virginia Health Care Cooperative is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its service areas, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, Potomac Valley Hospital in Keyser, WV, St. Josephs Hospital of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Hospital, in Glen Dale, WV, Braxton County Memorial Hospital in Gassaway, WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, Wetzel County Hospital, Inc. in New Martinsville, WV, Barnesville Hospital Association in Barnesville, OH, Uniontown Hospital in Uniontown, PA, Wheeling Hospital, Inc. in Wheeling, WV, Harrison Community Hospital, Inc. in Cadiz, OH, GRMC, Inc. in Oakland, MD, Princeton Community Hospital Association, Inc. in Princeton, WV, Thomas Health System, Inc. in South Charleston, WV, and Grant Memorial Hospital, Inc. in Petersburg, WV.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc., Camden-Clark Physician Corp, and Fayette Physician Network dba WVUHS Medical Group that operate in conjunction with the System hospitals along with United Summit Center, Inc. a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc. and Camden-Clark Health Services, Inc. which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc. in Bridgeport, WV, Camden-Clark Foundation, Inc. in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Foundation, Inc. in Glen Dale, WV, Barnesville Hospital Foundation in Barnesville, OH, and Harrison Community Hospital Foundation in Cadiz, OH which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. Wheeling Hospital Ambulatory Surgical Center, LLC a surgical center located in Bridgeport, OH was acquired in 2021.</ExplanationTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Robin Eckhart</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>John Tim Lewis</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Michael Taylor MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>David Meriwether MD</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <BonusFilingOrganizationAmount>1500</BonusFilingOrganizationAmount>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Benjamin Hensley DO</PersonNm>
        <TitleTxt>Surgeon</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>96071</CompensationBasedOnRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Bandy Mullins MD</PersonNm>
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        <PersonNm>John Epling</PersonNm>
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        <PersonNm>Brandon Williams</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Bradley Willis</PersonNm>
        <TitleTxt>Director, Chair</TitleTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>CEO compensation is determined by the WV United Health System compensation committee. The System engages an independent group to perform an executive compensation review and compensation survey annually. This information is provided to the committee, which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package offered does not exceed fair market value.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>Per the WVUHS Incentive Plan incentives are contingent on meeting a net earning target.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="990O" softwareId="23017659" softwareVersionNum="23.1.0.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4d</FormAndLineReferenceDesc>
        <ExplanationTxt>Program Service Expenses 26,892,663, Grants and allocations 0, Revenue 29,621,244 Overall the Hospital provided 9,475 inpatient days of care acute 5,009, ICU 1,661, SNF/NF 1,822, and Observation 983. Outpatient services include 1,476 surgery cases, 1,273 endo cases, 2,132 MRI, 9,731 CT scans, 3,358 infusion therapy procedures, 21,794 diagnostic radiology, 178,175 laboratory, and 5,376 rehab therapy services. Orthopedic services included 4,067 visits in 2023. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges foregone for charity during the year amounted to 1,282,676 for hospital services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part I, Line 1</FormAndLineReferenceDesc>
        <ExplanationTxt>care services to the residents. Summersville Regional Medical Center operates an emergency room taking all patients regardless of insurance in conjunction with a regional medical center approach, connecting patients to tertiary care facilities as necessary for services. Ancillary diagnostic services are also provided including lab, X-ray, CT, MRI, ultrasound, PT/OT, nuclear medicine, surgery, and emergency room. Physician clinics include rural health clinics, surgery practice, womens health practice and orthopedics practice.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The board reviews and approves the Form 990 before it is filed with the IRS. If this cannot be accomplished at a regularly scheduled meeting, a special meeting will be held to uphold this board action.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Conflict of interest statements require a board member with a conflict to excuse themselves from the discussion and boardroom if a matter of discussion and voting would be a conflict of interest with them. Indvidual statements completed by other board members are reviewed by the chairman. The vice-chairman reviews the chairmans conflict of interest statement.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents, conflict of interest policy, and financial statements are available upon request by persons. They are not posted on the website at the present time. This has been discussed in public session of the board meetings.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Other changes in net assets include 1,313,773 related organization capitalization, 110,679 JOA contribution to the School of Medicine, and 5,038 special events expense.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Service Expense includes Consulting Professional fees of 64,528 which 5,712 is considered program service expense and 58,816 is considered management and general expenseContracted Labor fees of 3,143,994 which 2,593,273 is considered program service expense and 550,721 is considered management and general Patient Care Contract Labor fees of 9,228 of which all is considered program service expense and Contracted Physician Expense of 3,904,756 of which all is considered program service expense.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation of the CEO is determined by the WV United Health System Compensation Committee based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This information is provided to the compensation committee which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package does not exceed fair market value based on the data from the consultant group. The minutes of the compensation committee are contemporaneously documented and retained. A full compensation survey was completed in 2022 for 2023 compensation amounts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation of all officers at the Vice President level and below is determined based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This data is then interpreted and provided to an independent compensation committee. The independent compensation committee then uses this data to determine a fair and reasonable compensation package. All relevant data as well as minutes from each meeting are retained.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>In 2023, West Virginia United Health System WVUHS, EIN 55-0754713, transitioned to a centralized accounts payable process in which WVUHS made the majority of vendor payments and then issued the required 1099s. WVUHS is reimbursed by the entities for their portion of payments made, vendor payments that meet the Top 5 Independent Contractor reporting requirements are reported in Part VII, Section B of the reporting entity.</ExplanationTxt>
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          <BusinessNameLine1Txt>Camden-Clark Foundation</BusinessNameLine1Txt>
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          <AddressLine1Txt>800 Garfield Ave</AddressLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Jefferson Memorial Hospital</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>300 S Preston St</AddressLine1Txt>
          <CityNm>Ranson</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25438</ZIPCd>
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        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1Txt>United Hospital Center Inc</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>327 Medical Park Drive</AddressLine1Txt>
          <CityNm>Bridgeport</CityNm>
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          <ZIPCd>26330</ZIPCd>
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          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1Txt>Camden-Clark Memorial Hospital</BusinessNameLine1Txt>
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          <AddressLine1Txt>800 Garfield Ave</AddressLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Potomac Valley Hospital of W Va Inc</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>100 Pin Oak Lane</AddressLine1Txt>
          <CityNm>Keyser</CityNm>
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          <ZIPCd>26726</ZIPCd>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Joseph's Hospital of Buckhannon Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1 Amalia Drive</AddressLine1Txt>
          <CityNm>Buckhannon</CityNm>
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          <ZIPCd>26201</ZIPCd>
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        <EIN>550356996</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Joseph's Foundation of Buckhannon Inc</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1 Amalia Drive</AddressLine1Txt>
          <CityNm>Buckhannon</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
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        <EIN>550727650</EIN>
        <PrimaryActivitiesTxt>Hospital Support</PrimaryActivitiesTxt>
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        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
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          <BusinessNameLine1Txt>St Joseph's Hospital of Buckhannon Inc</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Reynolds Memorial Hospital Inc</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>800 Wheeling Ave</AddressLine1Txt>
          <CityNm>Glen Dale</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26038</ZIPCd>
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        <EIN>550357045</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1Txt>Reynolds Memorial Foundation</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Braxton County Memorial Hospital</BusinessNameLine1Txt>
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          <AddressLine1Txt>100 Hoylman Drive</AddressLine1Txt>
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          <ZIPCd>26624</ZIPCd>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1Txt>Community Health Association</BusinessNameLine1Txt>
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          <AddressLine1Txt>122 Pinnell Street</AddressLine1Txt>
          <CityNm>Ripley</CityNm>
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          <ZIPCd>25271</ZIPCd>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1Txt>Wetzel County Hospital Inc</BusinessNameLine1Txt>
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          <ZIPCd>26155</ZIPCd>
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        <PrimaryActivitiesTxt>Home Health and Hospice</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>Medical Park Foundation</BusinessNameLine1Txt>
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          <AddressLine1Txt>1 Medical Park</AddressLine1Txt>
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          <BusinessNameLine1Txt>Self Insurance Trust Agreement of Wheeling Hospital Inc</BusinessNameLine1Txt>
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          <ZIPCd>21550</ZIPCd>
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          <BusinessNameLine1Txt>Grant Memorial Hospital Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>117 Hospital Drive</AddressLine1Txt>
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          <BusinessNameLine1Txt>Herbert J Thomas Memorial Hospital Association</BusinessNameLine1Txt>
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          <AddressLine1Txt>4605 MacCorkle Ave SW</AddressLine1Txt>
          <CityNm>South Charleston</CityNm>
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          <BusinessNameLine1Txt>Charleston Hospital Inc</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>333 Laidley St</AddressLine1Txt>
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          <ZIPCd>25301</ZIPCd>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <BusinessNameLine1Txt>Princeton Community Hospital Association</BusinessNameLine1Txt>
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          <AddressLine1Txt>122 Twelfth Street</AddressLine1Txt>
          <CityNm>Princeton</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>24740</ZIPCd>
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          <BusinessNameLine1Txt>Princeton Community Hospital Foundation Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>PO Box 1369</AddressLine1Txt>
          <CityNm>Princeton</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
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        <EIN>550694209</EIN>
        <PrimaryActivitiesTxt>Support</PrimaryActivitiesTxt>
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        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>12 A Type I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Princeton Community Hospital Association</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Thomas Health System Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4605 MacCorkle Ave SW</AddressLine1Txt>
          <CityNm>South Charleston</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25309</ZIPCd>
        </USAddress>
        <EIN>260440674</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>THS Physician Partners Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4605 MacCorkle Ave SW</AddressLine1Txt>
          <CityNm>South Charleston</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25309</ZIPCd>
        </USAddress>
        <EIN>454395947</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Thomas Health System Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Welch Medical Center Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO Box 8034</AddressLine1Txt>
          <CityNm>Morgantown</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26506</ZIPCd>
        </USAddress>
        <EIN>921990757</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>WVUHS Specialty Pharmacy Services Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO Box 8034</AddressLine1Txt>
          <CityNm>Morgantown</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26506</ZIPCd>
        </USAddress>
        <EIN>872740836</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>WV United Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Ohio Valley Health Corporation</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>222 Nicolette Rd</AddressLine1Txt>
          <CityNm>Parkersburg</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26104</ZIPCd>
        </USAddress>
        <EIN>922553803</EIN>
        <PrimaryActivitiesTxt>Patient Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501c3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Camden-Clark Health Services</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Allied Health Services Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>PO Box 782</AddressLine1Txt>
          <CityNm>Morgantown</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>26507</ZIPCd>
        </USAddress>
        <EIN>550652017</EIN>
        <PrimaryActivitiesTxt>Linen Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C Corp</EntityTypeTxt>
        <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>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>