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      <MissionDesc>WE ARE INSPIRED BY THE LOVE OF CHRIST TO PROVIDE QUALITY HEALTH CARE IN WAYS WHICH RESPECT THE GOD-GIVEN DIGNITY OF EACH PERSON AND THE SACREDNESS OF HUMAN LIFE.</MissionDesc>
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      <Desc>St. Mary's Medical Center was established in 1924 and, based on the core values of compassion, hospitality, reverence, trust, interdependence, and stewardship, continues to provide high quality healthcare services to residents of Huntington, West Virginia and the surrounding area. Services are provided without regard to the patient's race, creed, sex, national origin, age, or handicap. Furthermore, while reimbursement for care provided is crucial to the continued operation of St. Mary's Medical Center, it is recognized that circumstances exist which render certain parties unable to pay for needed services, and no patient is denied services due to the lack of ability to pay. During the fiscal year which ended September 30, 2019, St. Mary's Medical Center provided 98,470 days of inpatient days of care and treated an additional 280,947 patients in the emergency and outpatient settings. Approximately 78% of the inpatients served were covered by governmental programs, such as Medicare and Medicaid. A similar percentage is applicable to outpatient services. Since care provided to Medicare and Medicaid beneficiaries is subject to contractual reimbursement restrictions, payment received for services provided is often significantly below the actual cost of the services. St. Mary's Medical Center has established charity care policies and guidelines, used to help identify those patients who genuinely do not have the resources to pay for services received. During the fiscal year ended September 30, 2019, the hospital provided approximately $3.2 million dollars in charity care services, representing care provided at reduced prices or completely free of charge. These services include inpatient services, an adult outpatient clinic, a handicapped children's clinic, and a specialty pregnancy clinic. Also, St. Mary's Medical Center exceeds the guidelines established for the West Virginia ad valorem statute.</Desc>
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        <Desc>In addition to those patients without the wherewithal to pay for services rendered, we assist in the relief of burden of government for several programs. A strong auxiliary (operated as a department of the hospital) exists, which contributes heavily to the activities of SMMC. During the fiscal year ended September 30, 2019, the auxiliary contributed approximately $400,000 to SMMC and SMMC awarded grants to various organizations in the amount of $226,280. In addition, volunteers provided over 26,132 hours of service valuable to promoting the mission and activities of the hospital.</Desc>
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        <Desc>St. Marys Medical Center (SMMC) has participated in a number of community-building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows: American Cancer Society Relay for Life St. Marys Regional Cancer Center participates each year in the local Cabell County American Cancer Society Relay for Life. The 2019 event combined Cabell and Wayne counties in West Virginia with Lawrence County, Ohio, to form Relay for Life of the Tri-Counties. The event was May 17, 2019, at Ritter Park in Huntington, W.Va., and raised funds and awareness for the American Cancer Society. American Heart Association Events: Go Red for Women Celebration &amp; Huntington Heart Walk St. Marys Regional Heart Institute partners with the American Heart Association, the largest voluntary health organization working to prevent, treat and defeat heart disease, stroke and other cardiovascular diseases, for two major events each year. Cardiovascular disease is the No. 1 killer of men and women in the Tri-State. The annual Go Red for Women Celebration was Friday, Feb. 1, or National Go Red for Women Day. The celebration combined heart disease education and free health screenings with entertainment and a heart healthy lunch. The celebration raised funds for and awareness of the work of the American Heart Association. More than 250 people attended the event. The 2019 Huntington Heart Walk was Saturday, April 13 at Ritter Park in Huntington, W.Va. The walk raised funds and awareness for the American Heart Association. Nearly 800 people attended the event. Cabell Huntington Hospital SeniorFest Several SMMC services participated in the 6th Annual SeniorFest at Cabell Huntington Hospital Saturday, Sept. 29. The day-long event offers screenings, such as blood pressure, blood sugar and prostate screenings. Seniors can also receive a free flu shot, talk with physicians and staff, participate in health activities and attend educational sessions. The day also offers games, entertainment, food and prizes. Community Health Screenings SMMC participated in numerous health fairs throughout its service area during the year. These events provide free screenings for health issues, such as cholesterol, blood sugar, HDL, and osteoporosis. Education about stroke, joint replacement surgery, and risk factors for diabetes and other health issues is also provided. More than 1,000 people are screened each year through these free health screenings. Concert for a Cure The St. Marys Foundation teamed with the Cabell Huntington Hospital Foundation and St. Marys Regional Cancer Center for this event, which raised funds to help cancer patients, spotlighted the importance of early detection, and honored cancer survivors through a special concert. The event was Saturday, Aug. 17 at Barboursville Park Amphitheater in Barboursville, W.Va., and featured two popular classic rock cover bands. Girls On The Run of Cabell and Wayne Counties Girls on the Run is a nonprofit organization dedicated to creating a world where every girl knows and activates her limitless potential and is free to boldly pursue her dreams. Trained coaches lead small teams through research-based curricula, which include dynamic discussions, activities and running games. Over the course of the 10-week program, girls in 3rd-8th grade develop essential skills to help them navigate their worlds and establish a lifetime appreciation for health and fitness. SMMCs financial support of the local Girls On The Run of Cabell and Wayne Counties covers the program expenses, as well as a part-time coordinator for the area. GoNoodle GoNoodle is a website-based program that provides hundreds of dance-alongs, mindfulness videos and other ways to get kids moving. These activities help engage childrens minds and bodies and help them perform their best in the classroom. SMMC partnered with area businesses to offer the premium version, GoNoodle Plus, to area schools in counties throughout West Virginia and Southern Ohio. Greater Huntington Walks Greater Huntington Walks (GHW) was formed in 2018 to improve the perception of Huntington, W.Va., as an unhealthy community. The group consists of individuals and organizations, including SMMC, Cabell Huntington Hospital, the City of Huntington, Marshall University and the Huntington Regional Chamber of Commerce. The mission of GHW is for the Greater Huntington area to be viewed as a healthy and active community for people to live, work and visit. It aims to promote and enhance health by encouraging walking and other activities while working together to achieve a publicly-stated goal. Huntington Area Chapter AARP SMMC is the founding sponsor of the Huntington Area Chapter AARP, which meets monthly. SMMC provides leadership support and funding to help distribute useful lifestyle and health information to seniors in our community. AARP is the nations largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. PROACT (Provider Response Organization for Addiction Care and Treatment) PROACTs goal is to offer individuals and their families a viable system that provides positive outcomes. Partner institutions within PROACT include SMMC, Cabell Huntington Hospital, Marshall Health, Valley Health and Thomas Health. The non-profit organization relies on funding from its founding institutions, grant awards, business operations and private donations to sustain its efforts. The PROACT center, which opened in 2018, was created to address the clinical, behavioral, spiritual and professional issues of those affected by substance use. It functions as the centralized hub for treatment, recovery, therapy, education, research, workforce opportunities and support for those affected by addiction. Regional Health Summit SMMC partners each year with Cabell Huntington Hospital to present the Regional Health Summit, an opportunity to learn about new or existing health programs and initiatives. The knowledge gained during this event supports better communication among health and social service providers to create opportunities for collaboration and enhances collective impact to address needs. The free conference focuses on bringing together healthcare organizations, healthcare providers, community partners, researchers, and policymakers to continue to build regional efforts in Kentucky, Ohio and West Virginia to improve health, wellness, and prevention efforts across the Region. The 2019 event was Wednesday, May 8 and Thursday May 9 and focused on "Shaping Stronger Communities." St. Marys Veterans Memorial Day 5K SMMC partnered with community leaders in Ironton, Ohio, to offer the St. Marys Veterans Memorial Day 5K Monday, May 27. In addition to encouraging community members to stay physically active, the event also raised funds for scholarships and other community initiatives. St. Marys The Total Woman The Total Woman is a membership program by SMMC to help empower women to make good healthcare decisions and take action that will result in better health for themselves and their families. The program has more than 5,000 members who participate in health education programs throughout the year. Volunteer Service on Community Boards SMMC managers volunteered their time to their communities through service on a number of non-profit boards including: Lawrence County (Ohio) Economic Development Corporation, Lawrence County (Ohio) Chamber of Commerce, Huntington Regional Chamber of Commerce, United Way of the River Cities, Big Brothers/Big Sisters, Huntington Museum of Art, Foundation for the Tri-State Community, Society of Yeager Scholars at Marshall University, Huntington YMCA, and Facing Hunger Foodbank.</Desc>
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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JEFF LEABERRY</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>VICKIE SMITH</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MATT MILLER</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL G SELLARDS</PersonNm>
        <TitleTxt>FORMER PRESIDENT/CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>896503</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33735</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ANGELA D SWEARINGEN</PersonNm>
        <TitleTxt>VICE PRESIDENT/CFO</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>401120</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>37150</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>TODD CAMPBELL</PersonNm>
        <TitleTxt>CURRENT PRESIDENT/CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
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        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>503995</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>37377</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JOSEPH TRADER</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromOrgAmt>123517</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27505</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DOUG KORSTANJE</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>148342</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>28303</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>VERA ROSE MD</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>301832</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN BETH ROBINSON</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>32405</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>TIMOTHY PARNELL</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25501</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ERNEST TAYLOR MD</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>17591</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ELIZABETH BOSLEY DNP RN</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>25639</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID SHEILS</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>NEPAL CHOWDHURY MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromOrgAmt>2348642</ReportableCompFromOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MATTHEW WERTHAMMER MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>30434</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DWIGHT SAULLE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ESAM BARYUN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>RICHARD HEUER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <ReportableCompFromOrgAmt>603487</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29700</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>10439883</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
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      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>UNIVERSITY PHYSICIANS AND SURGEONS</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1600 MEDICAL CENTER DRIVE SUITE B5</AddressLine1Txt>
            <CityNm>HUNTINGTON</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>NORTHSTAR ANESTHESIA OF WV PLLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>6225 N STATE HIGHWAY 161 SUITE 20</AddressLine1Txt>
            <CityNm>IRVING</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75038</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL</ServicesDesc>
        <CompensationAmt>3989077</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>CERNER HEALTH SERVICES INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 959168</AddressLine1Txt>
            <CityNm>ST LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63195</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>INFO TECHNOLOGY</ServicesDesc>
        <CompensationAmt>3641124</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ULTIMATE HEALTH SERVICES</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5170 US ROUTE 60 EAST</AddressLine1Txt>
            <CityNm>HUNTINGTON</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25705</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL</ServicesDesc>
        <CompensationAmt>3424668</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>AMERICAN RED CROSS</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4 CHASE METROTECH CENTER 7TH FLOOR</AddressLine1Txt>
            <CityNm>BROOKLYN</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>11245</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL</ServicesDesc>
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      <CntrctRcvdGreaterThan100KCnt>37</CntrctRcvdGreaterThan100KCnt>
      <AllOtherContributionsAmt>90760</AllOtherContributionsAmt>
      <NoncashContributionsAmt>90760</NoncashContributionsAmt>
      <TotalContributionsAmt>90760</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>443019194</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>443019194</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>SCHOOL OF NURSING</Desc>
        <BusinessCd>611600</BusinessCd>
        <TotalRevenueColumnAmt>1859815</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1859815</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PURCHASE REBATES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>3229694</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3229694</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY REVENUE</Desc>
        <BusinessCd>446110</BusinessCd>
        <TotalRevenueColumnAmt>1245199</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1245199</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER PROGRAM SERVICE REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>304547</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>304547</RelatedOrExemptFuncIncomeAmt>
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      <TotalProgramServiceRevenueAmt>449658449</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>2867685</TotalRevenueColumnAmt>
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      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
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      <GrossRentsGrp>
        <RealAmt>1307142</RealAmt>
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        <RealAmt>239840</RealAmt>
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        <PersonalAmt>0</PersonalAmt>
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      <NetRentalIncomeOrLossGrp>
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        <RelatedOrExemptFuncIncomeAmt>1067302</RelatedOrExemptFuncIncomeAmt>
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      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>32489872</SecuritiesAmt>
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        <SecuritiesAmt>30536543</SecuritiesAmt>
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        <TotalRevenueColumnAmt>1957167</TotalRevenueColumnAmt>
        <ExclusionAmt>1957167</ExclusionAmt>
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        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
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      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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        <TotalRevenueColumnAmt>514322</TotalRevenueColumnAmt>
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        <Desc>CAFETERIA SALES</Desc>
        <BusinessCd>722100</BusinessCd>
        <TotalRevenueColumnAmt>3393172</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3393172</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueMiscGrp>
        <Desc>OTHER AFFILIATED ENTITIES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>-10631049</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>-10631049</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueMiscGrp>
        <Desc>ALL OTHER REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1528356</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1528356</RelatedOrExemptFuncIncomeAmt>
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      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>1528356</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1528356</RelatedOrExemptFuncIncomeAmt>
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        <TotalRevenueColumnAmt>450446164</TotalRevenueColumnAmt>
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        <ExclusionAmt>4809474</ExclusionAmt>
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      <GrantsToDomesticOrgsGrp>
        <TotalAmt>476519</TotalAmt>
        <ProgramServicesAmt>476519</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>4878383</TotalAmt>
        <ProgramServicesAmt>3317300</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1561083</ManagementAndGeneralAmt>
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      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>141605030</TotalAmt>
        <ProgramServicesAmt>96291420</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45313610</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>4877622</TotalAmt>
        <ProgramServicesAmt>3316783</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1560839</ManagementAndGeneralAmt>
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        <TotalAmt>49515694</TotalAmt>
        <ProgramServicesAmt>33670672</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15845022</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>10883425</TotalAmt>
        <ProgramServicesAmt>7400729</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3482696</ManagementAndGeneralAmt>
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      <FeesForServicesManagementGrp>
        <TotalAmt>569836</TotalAmt>
        <ManagementAndGeneralAmt>569836</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>887957</TotalAmt>
        <ManagementAndGeneralAmt>887957</ManagementAndGeneralAmt>
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      <FeesForServicesAccountingGrp>
        <TotalAmt>360000</TotalAmt>
        <ManagementAndGeneralAmt>360000</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
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      <FeesForSrvcInvstMgmntFeesGrp>
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        <ProgramServicesAmt>13356263</ProgramServicesAmt>
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        <ProgramServicesAmt>2510357</ProgramServicesAmt>
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      <RoyaltiesGrp>
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      <OccupancyGrp>
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        <ProgramServicesAmt>4487592</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2111808</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>106349</ProgramServicesAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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      <ConferencesMeetingsGrp>
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      <InterestGrp>
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        <ManagementAndGeneralAmt>872808</ManagementAndGeneralAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>3192833</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1502509</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>87031690</TotalAmt>
        <ProgramServicesAmt>87031690</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBTS</Desc>
        <TotalAmt>19941714</TotalAmt>
        <ProgramServicesAmt>19941714</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>REPAIRS &amp; MAINTENANCE</Desc>
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        <ManagementAndGeneralAmt>3828601</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>PROVIDER TAX</Desc>
        <TotalAmt>11213808</TotalAmt>
        <ProgramServicesAmt>11213808</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1646390</TotalAmt>
        <ProgramServicesAmt>1119545</ProgramServicesAmt>
        <ManagementAndGeneralAmt>526845</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>442890055</TotalAmt>
        <ProgramServicesAmt>344370987</ProgramServicesAmt>
        <ManagementAndGeneralAmt>98519068</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1023025</BOYAmt>
        <EOYAmt>631127</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>13017363</BOYAmt>
        <EOYAmt>15713829</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>0</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>88670339</EOYAmt>
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      <ReceivablesFromOfficersEtcGrp>
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        <EOYAmt>0</EOYAmt>
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      <RcvblFromDisqualifiedPrsnGrp>
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        <EOYAmt>0</EOYAmt>
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      <OthNotesLoansReceivableNetGrp>
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        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>11192881</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>2970960</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>212304309</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>19350980</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>192953329</EOYAmt>
      </LandBldgEquipBasisNetGrp>
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        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
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        <BOYAmt>4325236</BOYAmt>
        <EOYAmt>5030802</EOYAmt>
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      <IntangibleAssetsGrp>
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        <EOYAmt>0</EOYAmt>
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        <EOYAmt>7313760</EOYAmt>
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      <TotalAssetsGrp>
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      <GrantsPayableGrp>
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        <EOYAmt>0</EOYAmt>
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      <DeferredRevenueGrp>
        <BOYAmt>968806</BOYAmt>
        <EOYAmt>1219048</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
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      <EscrowAccountLiabilityGrp>
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        <EOYAmt>0</EOYAmt>
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      <LoansFromOfficersDirectorsGrp>
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        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>17824</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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        <EOYAmt>222028698</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>249656758</BOYAmt>
        <EOYAmt>291031820</EOYAmt>
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      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
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        <EOYAmt>120239545</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>120297937</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>411329757</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>7556109</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-2166000</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>-33164989</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
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    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <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>
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    </IRS990ScheduleB>
    <IRS990ScheduleC documentId="IRS990ScheduleC">
      <TotalGrassrootsLobbyingGrp />
      <TotalDirectLobbyingGrp />
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      <OtherExemptPurposeExpendGrp />
      <TotalExemptPurposeExpendGrp />
      <LobbyingNontaxableAmountGrp />
      <GrassrootsNontaxableGrp />
      <TotLbbyngGrassrootMnsNonTxGrp />
      <TotLbbyExpendMnsLbbyngNonTxGrp />
      <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>
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      <TotalLobbyingExpendituresAmt>83516</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IIB, Line 1, Lobbying Activities:</FormAndLineReferenceDesc>
        <ExplanationTxt>PART II-B, LINE 1, LOBBYING ACTIVITIES: The Hospital is a member of the West Virginia Hospital Association (WVHA), The Catholic Health Association of the United States (CHA), and the American Hospital Association (AHA), which engage in lobbying on behalf of its members. A portion of the dues paid to WVHA, CHA, and AHA have been allocated to lobbying activities which totaled $83,516. Specific information regarding the advocacy agendas of the associations can be viewed on their websites, WVHA.org, CHAUSA.org, and AHA.org.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
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      <CYMinus4YrEndwmtFundGrp />
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        <Desc>ACCRUED PENSION COSTS</Desc>
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      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DEFERRED SALARIES AND WAGES</Desc>
        <Amt>4296687</Amt>
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      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO AFFILIATE HOSPITAL</Desc>
        <Amt>67795242</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>222028698</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>MANAGEMENT ANNUALLY REVIEWS ITS TAX PROVISIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS AT SEPTEMBER 30, 2019 AND 2018.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="IRS990ScheduleH">
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      <WrittenPolicyInd>true</WrittenPolicyInd>
      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
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      <FPGReferenceDiscountedCareInd>true</FPGReferenceDiscountedCareInd>
      <Percent200DInd>X</Percent200DInd>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>false</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>true</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>false</ReportPublicallyAvailableInd>
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        </EntityName>
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      <HospitalFacilitiesGrp>
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        <BusinessName>
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          <CityNm>HUNTINGTON</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25702</ZIPCd>
        </USAddress>
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        <ResearchFacilityInd>X</ResearchFacilityInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>URGENT CARE</OtherDesc>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
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        </HospitalFacilityName>
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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>
        <PriorCHNAImpactInd>X</PriorCHNAImpactInd>
        <CHNAConductedYr>18</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>true</CHNAConductedWithOtherFcltsInd>
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        <CHNAReportWidelyAvailableInd>true</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>See Part VI Supplemental Information</OwnWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <ImplementationStrategyAdoptInd>true</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>18</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>true</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>See Part VI Supplemental Information</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>false</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
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        <FPGFamilyIncmLmtDscntCarePct>200.</FPGFamilyIncmLmtDscntCarePct>
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        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
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        <ResidencyCriteriaInd>X</ResidencyCriteriaInd>
        <ExplainedBasisInd>true</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>SEE PART V, PAGE 8</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>SEE PART V, PAGE 8</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>SEE PART V, PAGE 8</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>false</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>PART V</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section A: This facility includes a school of nursing, school of respiratory therapy, a school of medical imaging and a clinical pastoral education program. Interns and residents from Marshall University School of Medicine are also assigned at the hospital for their clinical rotations as are students in community based Practical nursing programs. St. Mary's Medical Center: Part V, Section B, Line 5: In conducting the Community Health Needs Assessment for St. Mary's Medical Ctr., the medical center took into account input from representatives of the community served by the medical center, including those with special knowledge of or expertise in public health. The CHNA was done in collaboration with Cabell Huntington Hospital and the local health department of the service areas identified. A third party specialist, the Center for Entrepreneurial Studies and Development,Inc. located in Morgantown, WV was engaged to assist in the planning and development process. SMMC established a core planning team consisting of representative members of the medical center management: Director of Provider Relations, VP of Mission Integration, Sr. VP &amp; COO, VP of Support Services, Planning &amp; Development, and the VP of Finance &amp; CFO. Part V, Section B, Line 6a: The hospital facility's CHNA was conducted with Cabell Huntington Hospital, Inc. St. Mary's Medical Center: Part V, Section B, Line 11: The SMMC action plan focused upon three overarching goals: building a network of collaboration, enhancing education and awareness activities, and tailoring interventions for specific demographic groups with an emphasis on senior awareness. Each priority was evaluated to determine if SMMC currently was addressing that need, able to adapt current programs or develop new programs to meet the need, provide an agency that is currently addressing the needed financial support, or if there were insufficient resources (financial or personal) to address the need without collaboration with other agencies. Priorities that were deemed to be outside the scope of SMMC and addressed by other resources in the community were not included in the action plan. St. Mary's Medical Center Part V, line 16a, FAP website: https://www.st-maryscdn.net/pdfs/FAP_Policy_FY2019.pdf St. Mary's Medical Center Part V, line 16b, FAP Application website: https:/www.st-maryscdn.net/pdfs/financial_assistance_application.pdf ST. Mary's Medical Center Part V, line 16c, FAP Plain Language Summary Website: http://www.st-marys.org/patients-and-visitors/billing/</ExplanationTxt>
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      <FacilityNum>4</FacilityNum>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>ST MARY'S FAMILY CARE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>147 WILLOW TREE WAY</AddressLine1Txt>
            <CityNm>HURRICANE</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25526</ZIPCd>
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          <FacilityTxt>OUTPATIENT CLINIC</FacilityTxt>
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          <USAddress>
            <AddressLine1Txt>6475 FARMDALE ROAD</AddressLine1Txt>
            <CityNm>BARBOURSVILLE</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25504</ZIPCd>
          </USAddress>
          <FacilityTxt>OUTPATIENT CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
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            <BusinessNameLine1Txt>ST MARY'S PAIN RELIEF SPECIALISTS</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>2900 1ST AVENUE SUITE 210</AddressLine1Txt>
            <CityNm>HUNTINGTON</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25702</ZIPCd>
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          <FacilityTxt>OUTPATIENT CLINIC</FacilityTxt>
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          <BusinessName>
            <BusinessNameLine1Txt>OCCUPATIONAL MEDICINE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>2833 FIFTH AVENUE</AddressLine1Txt>
            <CityNm>HUNTINGTON</CityNm>
            <StateAbbreviationCd>WV</StateAbbreviationCd>
            <ZIPCd>25702</ZIPCd>
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          <FacilityTxt>OUTPATIENT CLINIC</FacilityTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H PART VI</FormAndLineReferenceDesc>
        <ExplanationTxt>Part I, Line 3c: Eligibility is determined by comparing household family income against the income poverty guidelines for financial indigence, a ratio of total medical expenses to annual disposable income for medical indigence. Income is defined as the total annual cash receipts before taxes from all sources. Financially indigent. Uncompensated care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on the medical center's eligibility system which may include: (a) income levels and means testing or other criteria for determining a patient's inability to pay; or b) other criteria for determining a patient's inability to pay that are consistent with the medical center's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at St. Mary's Medical Center are deemed financially indigent. Financially indigent services include noncovered services for patients eligible for the Medicaid program, services provided under county indigent care contracts, and other state or federal assistance programs for low income groups. Medically indigent. Uncompensated care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whos medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with the Medical Center's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay. While financial indigence is based strictly on an income level, medical indigence considers both income and the financial obligation for healthcare services to calculate the patient's ability to pay without liquidating assets critical to living or earning a living, such as a home, car, personal belongings, etc. Therefore, patients are considered for medically indigent status on a case by case basis. The patient would be required to provide documentation of income to determine if he/she is to be considered medically indigent. All patients are eligible to be considered for medically indigent status with the exception of patients with income below 200% of the federal poverty level as these patients are considered for some level of uncompensated care under the financially indigent category. Part I, Line 6a: SMMC prepares an annual written report that describes programs and services that promote the health of our community. The Community Benefit Report provides valuable information on programs and services provided by the Medical Center. The report is distributed to Hospital board members, but it has not been distributed to the general public. The report is compiled using the program "A Guide for Planning and Reporting Community Benefit." Part I, Line 7: The cost to charge ratio as calculated from worksheet 2 of the Schedule H instructions was used to determine community benefit expenses for financial assistance at cost and Medicaid. The amount of cash and in-kind contributions for community groups was obtained from the hospital's accounting records. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25(b), but subtracted for purposes of calculating the percentage in this column is $19,941,714. Part II, Community Building Activities: St. Marys Medical Center (SMMC) has participated in a number of community-building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows: American Cancer Society Relay for Life St. Marys Regional Cancer Center participates each year in the local Cabell County American Cancer Society Relay for Life. The 2019 event combined Cabell and Wayne counties in West Virginia with Lawrence County, Ohio, to form Relay for Life of the Tri-Counties. The event was May 17, 2019, at Ritter Park in Huntington, W.Va., and raised funds and awareness for the American Cancer Society. American Heart Association Events: Go Red for Women Celebration &amp; Huntington Heart Walk St. Marys Regional Heart Institute partners with the American Heart Association, the largest voluntary health organization working to prevent, treat and defeat heart disease, stroke and other cardiovascular diseases, for two major events each year. Cardiovascular disease is the No. 1 killer of men and women in the Tri-State. The annual Go Red for Women Celebration was Friday, Feb. 1, or National Go Red for Women Day. The celebration combined heart disease education and free health screenings with entertainment and a heart healthy lunch. The celebration raised funds for and awareness of the work of the American Heart Association. More than 250 people attended the event. The 2019 Huntington Heart Walk was Saturday, April 13 at Ritter Park in Huntington, W.Va. The walk raised funds and awareness for the American Heart Association. Nearly 800 people attended the event. Cabell Huntington Hospital SeniorFest Several SMMC services participated in the 6th Annual SeniorFest at Cabell Huntington Hospital Saturday, Sept. 29. The day-long event offers screenings, such as blood pressure, blood sugar and prostate screenings. Seniors can also receive a free flu shot, talk with physicians and staff, participate in health activities and attend educational sessions. The day also offers games, entertainment, food and prizes. Community Health Screenings SMMC participated in numerous health fairs throughout its service area during the year. These events provide free screenings for health issues, such as cholesterol, blood sugar, HDL, and osteoporosis. Education about stroke, joint replacement surgery, and risk factors for diabetes and other health issues is also provided. More than 1,000 people are screened each year through these free health screenings. Concert for a Cure The St. Marys Foundation teamed with the Cabell Huntington Hospital Foundation and St. Marys Regional Cancer Center for this event, which raised funds to help cancer patients, spotlighted the importance of early detection, and honored cancer survivors through a special concert. The event was Saturday, Aug. 17 at Barboursville Park Amphitheater in Barboursville, W.Va., and featured two popular classic rock cover bands. Girls On The Run of Cabell and Wayne Counties Girls on the Run is a nonprofit organization dedicated to creating a world where every girl knows and activates her limitless potential and is free to boldly pursue her dreams. Trained coaches lead small teams through research-based curricula, which include dynamic discussions, activities and running games. Over the course of the 10-week program, girls in 3rd-8th grade develop essential skills to help them navigate their worlds and establish a lifetime appreciation for health and fitness. SMMCs financial support of the local Girls On The Run of Cabell and Wayne Counties covers the program expenses, as well as a part-time coordinator for the area. GoNoodle GoNoodle is a website-based program that provides hundreds of dance-alongs, mindfulness videos and other ways to get kids moving. These activities help engage childrens minds and bodies and help them perform their best in the classroom. SMMC partnered with area businesses to offer the premium version, GoNoodle Plus, to area schools in counties throughout West Virginia and Southern Ohio. Greater Huntington Walks Greater Huntington Walks (GHW) was formed in 2018 to improve the perception of Huntington, W.Va., as an unhealthy community. The group consists of individuals and organizations, including SMMC, Cabell Huntington Hospital, the City of Huntington, Marshall University and the Huntington Regional Chamber of Commerce. The mission of GHW is for the Greater Huntington area to be viewed as a healthy and active community for people to live, work and visit. It aims to promote and enhance health by encouraging walking and other activities while working together to achieve a publicly-stated goal. Huntington Area Chapter AARP SMMC is the founding sponsor of the Huntington Area Chapter AARP, which meets monthly. SMMC provides leadership support and funding to help distribute useful lifestyle and health information to seniors in our community. AARP is the nations largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. PROACT (Provider Response Organization for Addiction Care and Treatment) PROACTs goal is to offer individuals and their families a viable system that provides positive outcomes. Partner institutions within PROACT include SMMC, Cabell H</ExplanationTxt>
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          <AddressLine1Txt>1448 TENTH AVE SUITE 100</AddressLine1Txt>
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          <AddressLine1Txt>ONE JOHN MARSHALL DRIVE</AddressLine1Txt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANGELA D SWEARINGEN</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TODD CAMPBELL</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DOUG KORSTANJE</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>VERA ROSE MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SUSAN BETH ROBINSON</PersonNm>
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        <DeferredCompensationFlngOrgAmt>8250</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>24155</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>317875</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY PARNELL</PersonNm>
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        <BonusFilingOrganizationAmount>31163</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>8134</DeferredCompensationFlngOrgAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERNEST TAYLOR MD</PersonNm>
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        <NontaxableBenefitsFilingOrgAmt>9341</NontaxableBenefitsFilingOrgAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ELIZABETH BOSLEY DNP RN</PersonNm>
        <TitleTxt>VICE-PRESIDENT</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID SHEILS</PersonNm>
        <TitleTxt>PRESIDENT FOUNDATION</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <PersonNm>MATTHEW WERTHAMMER MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DWIGHT SAULLE MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ESAM BARYUN</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RICHARD HEUER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>ON A REGULAR BASIS, THE ORGANIZATION PROVIDES DOCUMENTATION TO THE COMPENSATION COMMITTEE OF THE ST. MARY'S MEDICAL CENTER, INC. BOARD WITH RESPECT TO THE COMPENSATION OF THE ORGANIZATION'S CEO FOR REVIEW AND APPROVAL. SUCH INFORMATION INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX-EXEMPT ORGANIZATIONS IN THE HUNTINGTON, WEST VIRGINIA COMMUNITY AS WELL AS COMPENSATION FOR THE CEO POSITION WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS, AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE OFFICERS/EXECUTIVE COMMITTEE IS DOCUMENTED.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
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        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>90760</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>FMV</MethodOfDeterminingRevenuesTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>IN MAY 2018, CABELL HUNTINGTON HOSPITAL, INC. BECAME THE SOLE MEMBER OF ST. MARY'S MEDICAL CENTER, A FULL SERVICE ACUTE CARE HOSPITAL LOCATED IN HUNTINGTON, WEST VIRGINIA. AT THAT TIME, MOUNTAIN HEALTH NETWORK, INC. (MHN) BEGAN PROVIDING MANAGEMENT SERVICES TO CABELL HUNTINGTON HOSPITAL, INC. AS WELL AS ST. MARY'S MEDICAL CENTER. MHN IS COMPRISED OF EXPERIENCED HEALTH CARE PROFESSIONALS, PERSONS WITH EXTENSIVE FINANCIAL AND BUSINESS EXPERTISE, CLINICIANS WITH EXTENSIVE MEDICAL EXPERIENCE AND EXPERIENCED HOSPITAL BOARD MEMBERS. MHN WILL BE RETAINED TO FORMULATE AND IMPLEMENT APPROPRIATE MEASURES FOR THE INTEGRATION OF CERTAIN PROGRAMS AND SERVICES AT BOTH HOSPITALS AS WELL AS PROVIDED CONTINUED MANAGEMENT, STRATEGIC PLANNING AND OPERATIONAL SUPERVISION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization is a membership (not a stock) corporation under West Virginia state law. Effective May 1, 2018, under agreement, the organization's sole corporate member was transferred to Cabell Huntington Hospital, Inc., a related not-for-profit organization from the previous sole corporate member, Pallottine Health Services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>Effective May 1, 2018, in accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the Cabell Huntington Hospital, Inc. board of directors.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>As a result of the ownership change effective May 1, 2018 Cabell Huntington Hospital, Inc., as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. The CFO will review the 990 with the finance/audit committee and the board of directors at the next scheduled board meeting in August.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C:</FormAndLineReferenceDesc>
        <ExplanationTxt>Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15:</FormAndLineReferenceDesc>
        <ExplanationTxt>On an annual basis, the organization provides documentation to the executive compensation committee of the St. Mary's Medical Center, Inc. board of directors for evaluation of compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 16B</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisers does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a Section 501(c)(3) charitable organization-hospital. 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are any concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS</FormAndLineReferenceDesc>
        <ExplanationTxt>Transfers to/from Affiliates, net $ (346,915) Changes in pension fund status (27,593,774) Released from restrictions (4,675,879) 457b Plan adjustment (548,421) Total $(33,164,989)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FINANCE/AUDIT COMMITTEE SHALL REVIEW THE RESULTS OF THE ANNUAL AUDIT AND ALL OTHER REPORTS FROM INDEPENDENT EXTERNAL AUDITORS AND SHALL ARRANGE FOR THOSE REPORTS, TOGETHER WITH ANY RECOMMENDATIONS FROM THE FINANCE/AUDIT COMMITTEE, TO BE PRESENTED TO THE BOARD OF DIRECTORS AT SUCH A TIME AS THE BOARD OF DIRECTORS MAY SCHEDULE FOR THAT PURPOSE.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:COLLECTION SERVICES TOTAL FEES:1409390</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:MEDICAL SERVICES TOTAL FEES:4333394</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:1010502</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:22571939</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:15601540</ExplanationTxt>
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          <BusinessNameLine1Txt>CLAIRE FRANCES</BusinessNameLine1Txt>
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          <AddressLine1Txt>200 MALL RD</AddressLine1Txt>
          <CityNm>ASHLAND</CityNm>
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        <EIN>311517507</EIN>
        <PrimaryActivitiesTxt>MEDICAL SERVI</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>-169928</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>432193</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.25000</OwnershipPct>
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      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>HUNTINGTON AREA MRI</BusinessNameLine1Txt>
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          <AddressLine1Txt>2900 FIRST AVE</AddressLine1Txt>
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          <StateAbbreviationCd>WV</StateAbbreviationCd>
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        </USAddress>
        <EIN>261877332</EIN>
        <PrimaryActivitiesTxt>MEDICAL SERVI</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>106918</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>139368</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>true</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.49000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
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        <RelatedOrganizationName>
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          <AddressLine1Txt>1408 CAMPBELL DR</AddressLine1Txt>
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          <StateAbbreviationCd>OH</StateAbbreviationCd>
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        </USAddress>
        <EIN>471141289</EIN>
        <PrimaryActivitiesTxt>REAL ESTATE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>OH</LegalDomicileStateCd>
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        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>166853</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>7894520</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.65000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>IRONTON MED CAMPUS</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1408 CAMPBELL DR</AddressLine1Txt>
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        </USAddress>
        <EIN>471637912</EIN>
        <PrimaryActivitiesTxt>REAL ESTATE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>OH</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>211640</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>1963421</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.65000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>THREE GABLES SURGERY</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>5897 ST RTE 7</AddressLine1Txt>
          <CityNm>PROCTORVILLE</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>45669</ZIPCd>
        </USAddress>
        <EIN>870648900</EIN>
        <PrimaryActivitiesTxt>OUTPATIENT CA</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>OH</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>-84358</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>6029981</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>true</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.52340</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>TRI-STATE MPSLLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>2900 FIRST AVE</AddressLine1Txt>
          <CityNm>HTGN</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25702</ZIPCd>
        </USAddress>
        <EIN>824513003</EIN>
        <PrimaryActivitiesTxt>BILLINGS/COLL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>-27599</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>81387</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>false</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.60000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>VANGUARD FINANCIAL SERVICES</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>2900 FIRST AVENUE</AddressLine1Txt>
          <CityNm>HUNTINGTON</CityNm>
          <StateAbbreviationCd>WV</StateAbbreviationCd>
          <ZIPCd>25702</ZIPCd>
        </USAddress>
        <EIN>450496141</EIN>
        <PrimaryActivitiesTxt>COLLECTION AG</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WV</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ST MARYS MED</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C CORP</EntityTypeTxt>
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        <ShareOfEOYAssetsAmt>942337</ShareOfEOYAssetsAmt>
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        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>true</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>true</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>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>true</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>HUNTINGTON AREA MRI SERVICES</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>O</TransactionTypeTxt>
        <InvolvedAmt>211874</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ST MARY'S MEDICAL CENTER FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>b</TransactionTypeTxt>
        <InvolvedAmt>58380</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ST MARY'S MEDICAL CENTER FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>c</TransactionTypeTxt>
        <InvolvedAmt>90760</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ST MARY'S MEDICAL CENTER FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>O</TransactionTypeTxt>
        <InvolvedAmt>242010</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>THREE GABLES SURGERY CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>F</TransactionTypeTxt>
        <InvolvedAmt>187882</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>THREE GABLES SURGERY CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>O</TransactionTypeTxt>
        <InvolvedAmt>192620</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>THREE GABLES SURGERY CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>Q</TransactionTypeTxt>
        <InvolvedAmt>27640</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>THREE GABLES SURGERY CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>S</TransactionTypeTxt>
        <InvolvedAmt>358449</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>CABELL HUNTINGTON HOSPITAL</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>P</TransactionTypeTxt>
        <InvolvedAmt>3524252</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>CABELL HUNTINGTON HOSPITAL</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>Q</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>INTERNAL ACCTG</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>