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        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LAURIE MACDONALD</PersonNm>
        <TitleTxt>CFO/VP FINANCE</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>193740</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>36003</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY ELLEN SMITH</PersonNm>
        <TitleTxt>CHIEF NURSING OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11304</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DR PAVEL GATYNYA</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29593</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DR DHARAMVEER NANDAL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DR JULIA WONDERLING</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>19056</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DR NAVEEN SINGANAMALA</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27093</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DR SCOTT MCKIMM</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>3753</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GREG BAUER</PersonNm>
        <TitleTxt>FORMER CEO/PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>0.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.0</AverageHoursPerWeekRltdOrgRt>
        <FormerOfcrDirectorTrusteeInd>X</FormerOfcrDirectorTrusteeInd>
        <ReportableCompFromOrgAmt>324579</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>66551</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2687680</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>246929</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>16</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>SODEXO</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>6500 BROOKTREE RD</AddressLine1Txt>
            <CityNm>WEXFORD</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15090</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>NUTRITION/HSKPG SERV</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>APOGEE</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>MEDICAL MANAGEMENT</AddressLine1Txt>
            <CityNm>SCOTTSDALE</CityNm>
            <StateAbbreviationCd>AZ</StateAbbreviationCd>
            <ZIPCd>85254</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HOSPITALISTS SERVICE</ServicesDesc>
        <CompensationAmt>1200971</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ASSOCIATED</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>CLINICAL LABORATORIES</AddressLine1Txt>
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            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>16501</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LAB SERVICES</ServicesDesc>
        <CompensationAmt>668301</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>AHSA</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>TRAVERSE</AddressLine1Txt>
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          </USAddress>
        </ContractorAddress>
        <ServicesDesc>NURSE STAFFING SVC</ServicesDesc>
        <CompensationAmt>467096</CompensationAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>SMP</PersonNm>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>HOME MEDICAL</AddressLine1Txt>
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            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15857</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHARMACY SERVICES</ServicesDesc>
        <CompensationAmt>357524</CompensationAmt>
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      <CntrctRcvdGreaterThan100KCnt>12</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>1000</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>28200</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>367097</AllOtherContributionsAmt>
      <TotalContributionsAmt>396297</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>59453942</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>59453942</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER SERVICE REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>632433</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>632433</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>EHR INCENTIVE REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>346347</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>346347</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CAFETERIA INCOME</Desc>
        <BusinessCd>722514</BusinessCd>
        <TotalRevenueColumnAmt>303821</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>303821</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>AUXILIARY INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>141870</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>141870</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>60878413</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>266406</TotalRevenueColumnAmt>
        <ExclusionAmt>266406</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>623190</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>210673</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>412517</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>412517</TotalRevenueColumnAmt>
        <ExclusionAmt>412517</ExclusionAmt>
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      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>19140002</SecuritiesAmt>
        <OtherAmt>3011</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
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        <OtherAmt>2833</OtherAmt>
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      <GainOrLossGrp>
        <SecuritiesAmt>242937</SecuritiesAmt>
        <OtherAmt>178</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>243115</TotalRevenueColumnAmt>
        <ExclusionAmt>243115</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>GAIN ON INVESTMENT IN EQUITY INVESTEE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>663230</TotalRevenueColumnAmt>
        <ExclusionAmt>663230</ExclusionAmt>
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      <OtherRevenueMiscGrp>
        <Desc>MOB HOUSEKEEPING</Desc>
        <BusinessCd>812900</BusinessCd>
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      <OtherRevenueTotalAmt>717028</OtherRevenueTotalAmt>
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        <TotalRevenueColumnAmt>62913776</TotalRevenueColumnAmt>
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        <UnrelatedBusinessRevenueAmt>53798</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1585268</ExclusionAmt>
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      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
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      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
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      <CompCurrentOfcrDirectorsGrp>
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        <ProgramServicesAmt>171921</ProgramServicesAmt>
        <ManagementAndGeneralAmt>518212</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>133582</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>19608937</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2045187</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>308167</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4138</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>2885557</ProgramServicesAmt>
        <ManagementAndGeneralAmt>319356</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>1742794</ProgramServicesAmt>
        <ManagementAndGeneralAmt>214653</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>44579</TotalAmt>
        <ManagementAndGeneralAmt>44579</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>80543</TotalAmt>
        <ManagementAndGeneralAmt>80543</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
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        <ManagementAndGeneralAmt>29926</ManagementAndGeneralAmt>
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        <TotalAmt>10145418</TotalAmt>
        <ProgramServicesAmt>6755846</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3389572</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
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      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>6670254</TotalAmt>
        <ProgramServicesAmt>6030828</ProgramServicesAmt>
        <ManagementAndGeneralAmt>639426</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
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        <ManagementAndGeneralAmt>424197</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
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        <ProgramServicesAmt>880373</ProgramServicesAmt>
        <ManagementAndGeneralAmt>250834</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>41859</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16285</ManagementAndGeneralAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
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        <ProgramServicesAmt>38816</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11582</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>618571</ProgramServicesAmt>
        <ManagementAndGeneralAmt>191379</ManagementAndGeneralAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>2511135</ProgramServicesAmt>
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        <ProgramServicesAmt>23188</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>BAD DEBT</Desc>
        <TotalAmt>4039112</TotalAmt>
        <ProgramServicesAmt>4039112</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>3583564</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <TotalAmt>189442</TotalAmt>
        <ProgramServicesAmt>40555</ProgramServicesAmt>
        <ManagementAndGeneralAmt>148887</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
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        <ManagementAndGeneralAmt>82028</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
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        <ManagementAndGeneralAmt>663</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>49281223</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9832588</ManagementAndGeneralAmt>
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        <EOYAmt>591418</EOYAmt>
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        <EOYAmt>8304380</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>53724</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>5394564</EOYAmt>
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      <ReceivablesFromOfficersEtcGrp>
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        <EOYAmt>0</EOYAmt>
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        <EOYAmt>0</EOYAmt>
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      <OthNotesLoansReceivableNetGrp>
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        <EOYAmt>0</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>487069</EOYAmt>
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        <EOYAmt>725172</EOYAmt>
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      <LandBldgEquipAccumDeprecAmt>9590063</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>36266260</EOYAmt>
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        <EOYAmt>6992611</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
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        <EOYAmt>6737915</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
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        <EOYAmt>0</EOYAmt>
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      <IntangibleAssetsGrp>
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        <EOYAmt>1500000</EOYAmt>
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      <OtherAssetsTotalGrp>
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        <EOYAmt>4165718</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>65359724</BOYAmt>
        <EOYAmt>71218831</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>9616059</EOYAmt>
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      <GrantsPayableGrp>
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        <EOYAmt>0</EOYAmt>
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      <DeferredRevenueGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
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      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>1195421</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>12227524</BOYAmt>
        <EOYAmt>17295959</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>48095173</BOYAmt>
        <EOYAmt>52907766</EOYAmt>
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      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
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        <EOYAmt>18273058</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
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        <EOYAmt>38007</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <PermanentlyRstrNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PermanentlyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>17264551</BOYAmt>
        <EOYAmt>18311065</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>65359724</BOYAmt>
        <EOYAmt>71218831</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>3799965</ReconcilationRevenueExpnssAmt>
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      <PriorPeriodAdjustmentsAmt>998</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>-2515699</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
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      <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>
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        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
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      <TotalDirectLobbyingGrp />
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      <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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      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
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        <FormAndLineReferenceDesc>SCHEDULE C, PART II-B, LINE 1I</FormAndLineReferenceDesc>
        <ExplanationTxt>LOBBYING ACTIVITIES: THE ORGANIZATION IS A MEMBER OF THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA, OF WHICH 20% OF ITS $10,000 DUES ARE ATTRIBUTABLE TO LOBBYING, OR $2,000.</ExplanationTxt>
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      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED PENSION LIABILITY</Desc>
        <Amt>16290346</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO THIRD PARTY PAYERS</Desc>
        <Amt>1005613</Amt>
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      <TotalLiabilityAmt>17295959</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>58943758</TotalRevEtcAuditedFinclStmtAmt>
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      <RevenueNotReportedAmt>-4277862</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>63221620</RevenueSubtotalAmt>
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      <RevenueNotReportedFinclStmtAmt>-307844</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>62913776</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>55285372</TotExpnsEtcAuditedFinclStmtAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON LINE 1, BUT NOT FORM 990, PART VIII, LINE 12: $ (4,039,112) BAD DEBT EXPENSE</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT LINE 1: $ ( 210,673) RENTAL EXPENSES ( 97,171) DECREASE IN TRNA ------------ $ ( 307,844)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER EXPENSES INCLUDED ON LINE 1, BUT NOT FORM 990, PART IX, LINE 25: $ 210,673 RENTAL EXPENSES</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 4B</FormAndLineReferenceDesc>
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      <WrittenPolicyInd>true</WrittenPolicyInd>
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      <Percent400Ind>X</Percent400Ind>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>false</FinancialAssistanceBudgetInd>
      <AnnualCommunityBnftReportInd>false</AnnualCommunityBnftReportInd>
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          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
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        <OtherDesc>SKILLED NURSING PHYSICIAN OFFICES</OtherDesc>
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        <HospitalFacilityName>
          <BusinessNameLine1Txt>ELK REGIONAL HEALTH CENTER</BusinessNameLine1Txt>
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        <FacilityNum>1</FacilityNum>
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        <CHNAConductedInd>true</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <CHNAConductedYr>15</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
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        <CHNAConductedWithNonFcltsInd>false</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>true</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>SEE PART V, SECTION C</OwnWebsiteURLTxt>
        <ImplementationStrategyAdoptInd>true</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>15</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>true</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>SEE PART V, SECTION C</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>false</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
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        <ExplainedBasisInd>true</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
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        <FAPAvailableOnWebsiteURLTxt>SEE PART V, SECTION C</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>SEE PART V, SECTION C</FAPAppAvailableOnWebsiteURLTxt>
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        <FAPSummaryOnWebsiteURLTxt>SEE PART V, SECTION C</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
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        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY INPUT: THE CHNA ASSESSMENT CONDUCTED BY TRIPP UMBACH FOR ELK REGIONAL HEALTH CENTER INCLUDED PRIMARY AND SECONDARY DATA COLLECTION, INTERVIEWS WITH COMMUNITY STAKEHOLDERS, FOCUS GROUPS WITH KEY AUDIENCES, AND A COMMUNITY PLANNING RETREAT. THE CHNA REPRESENTED A COMPREHENSIVE COMMUNITY-WIDE PROCESS WHERE ELK REGIONAL HEALTH CENTER CONNECTED WITH A WIDE RANGE OF PUBLIC AND PRIVATE ORGANIZATIONS SUCH AS EDUCATIONAL INSTITUTIONS, HEALTH-RELATED PROFESSIONALS, LOCAL GOVERNMENT OFFICIALS, HUMAN SERVICE ORGANIZATIONS, AND FAITH-BASED ORGANIZATIONS TO EVALUATE THE COMMUNITY'S HEALTH AND SOCIAL NEEDS.</ExplanationTxt>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 6A</FormAndLineReferenceDesc>
        <ExplanationTxt>CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: - PH DUBOIS - PH BROOKVILLE - PH CLEARFIELD</ExplanationTxt>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>WEBSITE WHERE CHNA IS AVAILABLE: HTTPS://WWW.PHHEALTHCARE.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES SMENT/PAGE.ASPX?ID=2021</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 10A</FormAndLineReferenceDesc>
        <ExplanationTxt>WEBSITE WHERE IMPLEMENTATION STRATEGY IS AVAILABLE: HTTPS://WWW.PHHEALTHCARE.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES SMENT/PAGE.ASPX?ID=2021</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>ADDRESSING IDENTIFIED NEEDS: PENN HIGHLANDS ELK LISTENS TO COMMUNITY CONCERNS, ANALYZES HEALTHCARE UTILIZATION AND COSTS, EXPLORES ACCESS ISSUES, AND COLLABORATES WITH AND DEVELOPS EFFECTIVE PROGRAMS TO IMPROVE THE HEALTH OF THOSE IN WEST CENTRAL PENNSYLVANIA. BASED ON THE ABOVE COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS AND THE PRIORITIZED NEEDS, TWO COMMUNITY NEEDS WILL BE IMPLEMENTED AND FURTHER EXPLORED. OF THE IDENTIFIED CHNA AND PRIORITIZED HEALTH NEEDS, PENN HIGHLANDS ELK WILL FOCUS ON TWO OF THE COMMUNITY NEEDS: 1) NAVIGATION AND COORDINATION 2) ACCESS TO CARE THE HEALTH NEEDS NOT BEING ADDRESSED FROM THE CHNA ARE STILL IMPORTANT FOR THE COMMUNITY. HOWEVER, PENN HIGHLANDS ELK REPORTED THAT THESE NEEDS ARE BEING ADDRESSED TO SOME DEGREE BY ORGANIZATIONS, PROGRAMS/INITIATIVES OPERATED BY REGIONAL LOCAL COMMUNITY-BASED ORGANIZATIONS LOCALLY. THROUGH ANALYSIS AND DISCUSSIONS RESULTING FROM A WORK SESSION HELD WITH REPRESENTATIVES FROM PENN HIGHLANDS ELK, THE FOLLOWING NEEDS IDENTIFIED IN THE CHNA THAT WILL NOT BE ADDRESSED ARE: 1) DRUGS AND ALCOHOL SERVICES 2) FREE CLINICS 3) NUTRITION AND WELLNESS ON APRIL 6, 2015, PENN HIGHLANDS ELK COMPLETED A WORK SESSION FACILITATED BY TRIPP UMBACH, WHERE AN IMPLEMENTATION PLAN WAS DISCUSSED AND CONCEPTS WERE DEVELOPED FOR THE NEEDS SELECTED. THE IMPLEMENTATION PLANNING PROCESS INCLUDED THE FOLLOWING STEPS: 1)SELECT KEY COMMUNITY NEEDS WHERE THE HOSPITAL WILL TAKE A LEADERSHIP ROLE 2) IDENTIFY GOALS AND KEY OBJECTIVES THAT WILL BE ACHIEVED THROUGH THE HOSPITAL'S LEADERSHIP IN THE SELECTED NEED AREAS 3) DEVELOP INVENTORIES OF INTERNAL HOSPITAL AS WELL AS EXTERNAL COMMUNITY RESOURCES ALREADY FOCUSED ON THE SELECTED NEED AREAS 4) DEVELOP SPECIFIC STRATEGIES TO BE IMPLEMENTED BY THE HOSPITAL TO ACHIEVE MEASURABLE COMMUNITY HEALTH IMPROVEMENT IN SELECTED NEED AREAS SHORT-TERM GOALS WILL BE MEASURED ANNUALLY IN EACH OF THE PRIORITY AREAS RELATED TO THE PROGRAM. ADJUSTMENTS AND MODIFICATIONS WILL BE MADE TO THE PROGRAM AS ISSUES EMERGE AND DEVELOP. IT IS IMPORTANT TO REPORT THAT PENN HIGHLANDS ELK WILL TAKE THE PRIMARY LEADER ROLE IN ADDRESSING THE LISTED NEEDS. REGIONAL HOSPITALS AND OTHER COMMUNITY ORGANIZATIONS AND HEALTHCARE PROVIDERS WILL ALSO PROVIDE SUPPORTIVE ROLES TO OTHER HEALTH AND COMMUNITY ISSUES AS NEEDED. THE IMPLEMENTATION PLAN INCLUDES RECOMMENDED PROGRAMS AND ACTION STEPS FOR SUCCESSFUL COMMUNITY NEEDS EXECUTION.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, 16C</FormAndLineReferenceDesc>
        <ExplanationTxt>FINANCIAL ASSISTANCE POLICY: HTTPS://WWW.PHHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-POLICY /PAGE.ASPX?ID=3134</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>SCHEDULE H, PART V, SECTION B, LINE 22D</FormAndLineReferenceDesc>
        <ExplanationTxt>MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: AMOUNTS GENERALLY BILLED WILL BE CALCULATED UTILIZING THE LOOK BACK METHOD WHICH REFLECTS THE AVERAGE PAYMENT OVER A RECENT 12 MONTH PERIOD OF PAYMENTS MADE TO PHH/PHPN BY MEDICARE AND ALL PRIVATE INSURERS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>1</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>ERHC RIDGWAY CAMPUS</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>304 METOXET STREET</AddressLine1Txt>
            <CityNm>RIDGWAY</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15853</ZIPCd>
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          <FacilityTxt>MEDICAL EXPRESS PHYSICIAN OFFICES PHYSICAL THERAPY</FacilityTxt>
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      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7, COLUMN F</FormAndLineReferenceDesc>
        <ExplanationTxt>PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $4,039,112.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>COSTING METHODOLOGY: THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1 AND 3. WORKSHEET 6 USED ACTUAL COST DATA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION A, LINES 2, 3 &amp; 4</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE METHODOLOGY: THE MONTHLY BAD DEBT EXPENSE IS COMPRISED OF TWO COMPONENTS. ONE IS THE DIRECT WRITE OFFS FROM ACCOUNTS RECEIVABLE (THE 5500 ACCOUNTS THAT RELATE TO SELF-PAY ADJUSTMENTS) WHICH GO DIRECTLY TO BAD DEBT EXPENSE AND WILL VARY ACCORDING TO THE LEVEL OF ACTIVITY. THE OTHER COMPONENT IS THE ADJUSTMENT TO THE RESERVE ACCOUNT WHICH IS BASED ON THE BALANCES SITTING IN THE VARIOUS SELF-PAY AGE BUCKETS AT THE END OF EACH MONTH. THE ASSIGNMENT OF SELF-PAY BALANCES TO COLLECTION AGENCIES THROUGHOUT THE MONTH AFFECT THIS RESERVE ENTRY. DISCOUNTS ON PATIENT ACCOUNTS ARE PROCESSED BY CREDIT ACCORDING TO THE ESTABLISHED POLICY GUIDELINES. SPECIAL CIRCUMSTANCE DISCOUNTS ARE APPROVED ON A CASE BY-CASE BASIS BY THE PATIENT ACCOUNTS MANAGER. PAYMENTS ON PATIENT ACCOUNTS ARE POSTED BY CREDIT AND ARE BASED ON CASH SUMMARY SHEETS PREPARED BY AN INDIVIDUAL IN THE PAYROLL/FINANCE DEPARTMENT. LINE 2 REPORTS THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS INCLUDES A FOOTNOTE REGARDING BAD DEBT EXPENSE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION B, LINE 8</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, SECTION C, LINE 9B</FormAndLineReferenceDesc>
        <ExplanationTxt>COLLECTION POLICY: COLLECTION PRACTICES FROM DAY 1 SELF-PAY ARE CONSISTENT ACROSS THE ENTIRE SELF-PAY POPULATION. ONCE A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE (IE CHARITY CARE TO SOME DEGREE) THEN THAT PATIENT'S ACCOUNT(S) ARE PROCESSED ACCORDINGLY BALANCE-WISE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>NEEDS ASSESSMENT: THE ORGANIZATION COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015. SEE PART V, SECTION B, FOR ADDITIONAL INFORMATION. THIS IS NOW DONE AT THE PHH LEVEL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>PATIENT EDUCATION ELIGIBILITY FOR ASSISTANCE: THE CHARITY CARE POLICY, IN ITS ENTIRETY, APPEARS ON THE HOSPITAL WEBSITE. THE ASSOCIATED ELIGIBILITY FORM IS OBTAINABLE HERE AS WELL. THE SELF-PAY COLLECTION PROCESS PROVIDES FOR A CHARITY CARE APPLICATION AND EXPLANATION LETTER TO BE SENT ON EVERY OUTSTANDING PATIENT ACCOUNT FOR WHICH THERE IS NOT A PAYMENT MADE SUBSEQUENT TO THE INITIAL STATEMENT BEING RECEIVED. THERE ARE ALSO SIGNS POSTED IN CERTAIN AREAS OF THE HEALTH CENTER WHICH PROMOTE THE EXISTENCE OF THE CHARITY CARE POLICY AND DIRECT INTERESTED INDIVIDUALS ACCORDINGLY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY INFORMATION: THE ORGANIZATION PROVIDES SERVICES TO RESIDENTS OF ALL AGES IN ELK AND CAMERON COUNTIES AND THE SURROUNDING AREAS. ELK AND CAMERON COUNTIES HAVE A POPULATION OF APPROXIMATELY 37,000. ADULTS OVER AGE 65 REPRESENT ABOUT 20% OF THE POPULATION. PERSONS BELOW POVERTY LEVEL ACCOUNT FOR ABOUT 11% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $43,000, AND THE MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS IS APPROXIMATELY $89,000. ELK REGIONAL IS ONE OF TWO MAJOR HEALTH SYSTEMS THAT SERVE THE ELK AND CAMERON COUNTY COMMUNITIES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>PROMOTION OF COMMUNITY HEALTH: ERHC STRIVES TO PROVIDE WELLNESS AND EDUCATIONAL PROGRAMS FOR COMMUNITY MEMBERS TO MAINTAIN A HEALTHY LIFESTYLE. ERHC PROVIDES SMOKE DETECTORS TO PARENTS OF NEWBORNS TO TAKE HOME WITH THEM AND INSTALL IN THEIR HOMES. ERHC WORKS WITH THE LOCAL LIONS CLUB AND ROTARY CLUB TO PROVIDE SERVICES TO THE COMMUNITY. ERHC PARTICIPATES IN ACTIVITIES WITH THE ST. MARYS CHAMBER OF COMMERCE AND BELONGS TO THE BOARDS OF THE FAMILY RESOURCE NETWORK AND THE STATE HEALTH IMPROVEMENT PLAN. ERHC PROVIDES JOB SHADOWING TO THE LOCAL HIGH SCHOOL STUDENTS AND HAS A SCHOOL TO WORK PROGRAM FOR STUDENTS. ERHC ALSO PARTICIPATES IN THE PHEAA PROGRAM TO HIRE STUDENTS AS SUMMER WORKERS TO GIVE THEM WORK EXPERIENCE IN VARIOUS FIELDS. THE ORGANIZATION HAS AN OPEN MEDICAL STAFF AND THE BOARD IS COMPRISED OF PEOPLE WHO ARE LEADERS IN THE COMMUNITY. THE PHYSICIAN OFFICES AND OUTPATIENT THERAPY OFFICES LOCATED THROUGHOUT THE COMMUNITIES GIVE PATIENTS EASIER ACCESS TO VARIOUS SERVICES. ERHC PARTICIPATES IN AND HOLDS HEALTH FAIRS WHERE FREE SCREENINGS AND LOW OR NO COSTS TESTING ARE PROVIDED TO PROMOTE PREVENTATIVE CARE AND HEALTH LIFESTYLES. ERHC HOLDS MANY EDUCATIONAL CLASSES FOR THE PUBLIC SUCH AS DIABETES EDUCATION, WOMEN'S HEALTH ISSUES, SUPPORT GROUPS, ETC. DUBOIS REGIONAL MEDICAL CENTER PROVIDED AN EMPLOYEE TO PROVIDE EDUCATION TO VARIOUS SENIOR CENTERS ON BEHALF OF ERHC. ERHC ALSO OFFERS VARIOUS EXERCISE CLASSES SUCH AS PILATES, BOOT CAMP, YOGA, ETC., ALONG WITH WELLNESS CLASSES. THE ORGANIZATION PERIODICALLY HAS PRESS RELEASES ON DIFFERENCE HEALTH ISSUES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>AFFILIATED HEALTH CARE SYSTEM: ELK REGIONAL HEALTH CENTER IS A FULLY-ACCREDITED, NOT-FOR-PROFIT 80 BED GENERAL ACUTE CARE INSTITUTION BACKED BY THE EXPERTISE OF A DEDICATED, EMPLOYED PHYSICIAN GROUP. WITH CAMPUSES IN ST. MARYS AND RIDGWAY AND PHYSICIAN OFFICES IN A NUMBER OF LOCATIONS THROUGHOUT THE REGION, ELK REGIONAL PROUDLY SERVES THE RESIDENTS OF ELK AND CAMERON COUNTIES. IT IS THE ONGOING MISSION OF THE ELK REGIONAL HEALTH SYSTEM TO PROVIDE PREMIER HEALTHCARE SERVICES TO PATIENTS THROUGH COMMITMENTS TO SERVICE, QUALITY, PEOPLE, FINANCE AND GROWTH - ALL WHILE MAINTAINING ECONOMIC VIABILITY AND KEEPING AN EYE ON THE FUTURE. THE HOSPITAL AND PHYSICIAN OFFICES WORK WITH COMMUNITY NURSES INC., TO PROVIDE FLU SHOT CLINICS TO THE COMMUNITY. THE FOUNDATION AND AUXILIARY, OPERATING UNDER ERHC, PROVIDE EDUCATIONAL CLASSES AND SCHOLARSHIPS. THERE ARE MANY SCREENINGS &amp; HEALTH CLINICS HELD THROUGHOUT THE YEAR TO PROMOTE HEALTHY LIVING &amp; PREVENTATIVE CARE. ERHC ALSO OFFERS EXERCISE, NUTRITION, AND RELAXATION CLASSES. THE HEALTH SYSTEM FOUNDATION PROVIDES FUNDS FOR TWO SCHOLARSHIPS EACH YEAR TO STUDENTS PURSUING HEALTH CARE FIELDS. THESE SCHOLARSHIPS ARE ADMINISTERED BY THE ELK COUNTY COMMUNITY FOUNDATION. COMMUNITY NURSES INC ESTABLISHED A SERENITY GARDEN FOR PINE CREST MANOR (SKILLED NURSING FACILITY) RESIDENTS AND FAMILY AND FOR THE GENERAL PUBLIC TO USE AS A MEDIATION GARDEN. CNI ALSO PROVIDES ADULT DAY CARE SERVICES FOR THE COMMUNITY. THE HOSPITAL AUXILIARY GIVES A SCHOLARSHIP TO A TEEN VOLUNTEER FROM EACH LOCAL SCHOOL WHO ARE GOING TO STUDY A HEALTH CARE RELATED FIELD. THE PHYSICIAN OFFICES AND COMMUNITY NURSES WORK TOGETHER TO PUT ON VARIOUS FLU CLINICS TO PROVIDE ANNUAL FLU SHOTS TO MEMBERS OF THE COMMUNITY. ERHC PROVIDES A SMOKING CESSATION PROGRAM TO THE PUBLIC FOR THOSE WHO ARE TRYING TO QUIT SMOKING. ERHC HAS A CRNP THAT GOES INTO THE LOCAL SCHOOLS EACH YEAR TO EDUCATE STUDENTS ABOUT GOOD HYGIENE AND HEALTH ISSUES ASSOCIATED WITH ADOLESCENCE. THE ORGANIZATION ALSO PROVIDES FREE SPORTS PHYSICALS FOR THE LOCAL YOUTH FOOTBALL TEAM. THE AFFILIATED HEALTH CARE SYSTEM INCLUDES THE COMMUNITY NURSES, INC. AND SUBSIDIARIES, ELK REGIONAL PROFESSIONAL GROUP, INC., AND ELCO HOUSING, INC. IN OCTOBER 2012, THE ELK ENTITIES SIGNED AN AFFILIATION AGREEMENT EFFECTIVE JULY 1, 2013, WITH PENN HIGHLANDS HEALTHCARE, A PENNSYLVANIA NONPROFIT CORPORATION (PENN HIGHLANDS). PENN HIGHLANDS BECAME THE SOLE MEMBER OF ERHC. THIS AFFILIATION EXPANDS TO INCLUDE RELATIONSHIPS WITH ADDITIONAL PENNSYLVANIA NOT-FOR-PROFIT HOSPITALS INCLUDING DUBOIS REGIONAL MEDICAL CENTER LOCATED IN DUBOIS, PA, BROOKVILLE HOSPITAL LOCATED IN BROOKVILLE, PA, AND CLEARFIELD HOSPITAL LOCATED IN CLEARFIELD, PA, AS WELL AS THEIR SUBSIDIARY ORGANIZATIONS.</ExplanationTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARY ELLEN SMITH</PersonNm>
        <TitleTxt>CHIEF NURSING OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>141177</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>19017</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>423</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4274</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>7030</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>171921</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>GREG BAUER</PersonNm>
        <TitleTxt>FORMER CEO/PRESIDENT</TitleTxt>
        <BaseCompensationFilingOrgAmt>316171</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>8408</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>65251</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>1300</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>391130</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>CEO COMPENSATION: PENN HIGHLANDS HEALTHCARE, INC. (PHH), A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO. PHH USES THE FOLLOWING METHODS TO DETERMINE THE COMPENSATION: INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: 457(F) PLAN EMPLOYEE CONTRIBUTIONS GREG BAUER $4,520</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="IRS990ScheduleL">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>ST MARY'S PHARMACYHOME MEDICAL</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>SEE PART V.</RelationshipDescriptionTxt>
        <TransactionAmt>357675</TransactionAmt>
        <TransactionDesc>SEE PART V.</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>KAREN GASPARI</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>SEE PART V.</RelationshipDescriptionTxt>
        <TransactionAmt>33732</TransactionAmt>
        <TransactionDesc>SEE PART V.</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>REBECCA PICCOLO</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>SEE PART V.</RelationshipDescriptionTxt>
        <TransactionAmt>99850</TransactionAmt>
        <TransactionDesc>SEE PART V.</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE L, PART IV</FormAndLineReferenceDesc>
        <ExplanationTxt>BUSINESS TRANSACTIONS: (1) FRANK STRAUB, DIRECTOR, IS THE OWNER OF ST. MARYS PARMACY AND SMP HOME MEDICAL. THE ORGANIZATION PURCHASED PHARMACY DRUGS FOR PINECREST MANOR AND OXYGEN CONCENTRATORS AT A TOTAL COST OF $357,675 FOR FYE 6/30/2016. (2) KAREN GASPARI IS THE SISTER OF LAURIE MACDONALD, ERHC CFO. SHE IS EMPLOYED BY ERHC AND RECEIVED TOTAL COMPENSATION AND BENEFITS $33,732. (3) REBECCA PICCOLO IS THE WIFE OF JOHN PICCOLO, A DIRECTOR OF THE BOARD. SHE IS EMPLOYED AS AN OCCUPATIONAL THERAPIST AND RECEIVED COMPENSATION OF $99,850.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINES 6, 7A, &amp; 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>MEMBERS: PENN HIGHLANDS HEALTHCARE (PHH) HOLDS CERTAIN POWERS, INCLUDING THE APPROVAL OF THE ELECTION AND REMOVAL OF OFFICERS AND DIRECTORS AND APPROVAL OF ANY AND ALL AMENDMENTS TO THE BYLAWS OR OTHER ORGANIZATIONAL/GOVERNANCE DOCUMENTS. PHH SHALL HAVE THE FOLLOWING POWERS WITH RESPECT TO THE ELECTION AND REMOVAL OF DIRECTORS: PRIOR TO THE END OF PHH'S FISCAL YEAR, THE PHH BOARD WILL MEET TO ELECT THE DIRECTORS, WITH THE EXCEPTION OF EX-OFFICIO DIRECTORS. AT LEAST SIXTY (60) DAYS IN ADVANCE OF THIS MEETING, ELK SHALL PROVIDE TO PHH'S GOVERNANCE/NOMINATING COMMITTEE (THE PHH GOVERNANCE/NOMINATING COMMITTEE) A LIST OF ONE OR MORE CANDIDATES (THE NUMBER OF CANDIDATES TO BE DETERMINED IN THE PHH GOVERNANCE/NOMINATING COMMITTEE'S DISCRETION) FOR EACH EXPIRING DIRECTOR POSITION, WITH THE EXCEPTION OF ANY EX-OFFICIO DIRECTORS. THE LIST OF CANDIDATES SHALL HAVE BEEN DEVELOPED BY ELK IN CONSULTATION WITH THIS ORGANIZATION'S BOARD. THE PHH GOVERNANCE/NOMINATING COMMITTEE SHALL REVIEW EACH CANDIDATE IN ACCORDANCE WITH THE CRITERIA SET FORTH IN THE PHH BYLAWS, THE CRITERIA, IF ANY, SET FORTH IN THIS ORGANIZATION'S BYLAWS OR POLICIES FOR WHICH SAID CANDIDATE IS BEING CONSIDERED FOR BOARD SERVICE, AND THE POLICIES AND RULES OF PHH, INCLUDING, WITHOUT LIMITATION, THE CONFLICT OF INTEREST POLICY (ALL OF WHICH SHALL BE REFERRED TO COLLECTIVELY HEREIN AS THE ELIGIBILITY CRITERIA) AND DEVELOP A LIST OF ONE OR MORE CANDIDATES FOR EACH OPEN POSITION (THE NUMBER OF CANDIDATES TO BE DETERMINED IN THE PHH GOVERNANCE/NOMINATING COMMITTEE'S DISCRETION). ONCE THE SLATE OF CANDIDATES IS NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE, THE BOARD OF ELK SHALL SUBMIT TO THE PHH BOARD FOR ELECTION SUCH SLATE OF CANDIDATES FOR THE OPEN BOARD POSITIONS. THE PHH BOARD MAY ELECT BY A VOTE OF THE MAJORITY OR REFUSE TO ELECT EACH CANDIDATE SUBMITTED BY THE BOARD OF ELK AND MAY NOT ELECT ANY CANDIDATE NOT SUBMITTED BY THE BOARD OF ELK AND NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE. THE BOARD OF PHH HAS THE POWER TO REMOVE SUCH DIRECTOR AT ANY TIME WITH OR WITHOUT CAUSE. IN THE EVENT THAT THIS ORGANIZATION DESIRES TO FILL A VACANCY OCCURRING ON ITS BOARD, THE PHH GOVERNANCE/NOMINATING COMMITTEE AND THE BOARD OF PHH, AT THE REQUEST OF ELK, SHALL ACT TO FILL SUCH VACANCY. SUBJECT TO THE APPROVAL OF PHH AS SET FORTH IN THE BYLAWS, THE ARTICLES AND THE BYLAWS MAY BE ALTERED, AMENDED, OR REPEALED AND NEW BYLAWS OR ARTICLES MAY BE ADOPTED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS (2/3) OF THE BOARD. WRITTEN NOTICE OF THE INTENT TO AMEND THE BYLAWS OR THE ARTICLES AND A DRAFT OF THE PROPOSED CHANGE SHALL BE SENT TO ALL DIRECTORS, BY THE SECRETARY, AT LEAST FIVE (5) DAYS PRIOR TO ANY MEETING AT WHICH AMENDMENT OF THE BYLAWS OR THE ARTICLES IS INTENDED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE DRAFT FORM 990 IS REVIEWED BY THE CFO AND THE CONTROLLER. AFTER ALL SUGGESTED CHANGES FROM THE CFO AND CONTROLLER ARE MADE, THE UPDATED DRAFT FORM 990 IS PROVIDED FOR REVIEW TO THE FULL BOARD. ANY QUESTIONS OR COMMENTS FROM THE BOARD ARE ADDRESSED BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY: PENN HIGHLANDS HEALTHCARE, INC. (PHH), MAINTAINS A CONFLICT OF INTEREST POLICY WHICH APPLIES TO ALL SUBSIDIARIES. THE CONFLICT OF INTEREST POLICY APPLIES TO BOARD MEMBERS, OFFICERS, EXECUTIVE EMPLOYEES, AND ANY OTHER MANAGER OR SUPERVISOR EXERCISING SUBSTANTIAL INFLUENCE OVER OPERATIONS. EACH COVERED PERSON WILL PROMPTLY AND FULLY DISCLOSE ALL MATERIAL FACTS OF EVERY ACTUAL OR POTENTIAL DUAL INTEREST EXISTING AT THE TIME WHEN HE/SHE BECOMES A COVERED PERSON, AND ANNUALLY THROUGH EACH PHH SYSTEM ENTITY'S DISCLOSURE STATEMENT, WHICH REQUESTS DISCLOSURE OF RELATIONSHIPS, INVESTMENTS, AND TRANSACTIONS THAT MAY LEAD TO AN ACTUAL CONFLICT OF INTEREST. ALL COMPLETED DISCLOSURE STATEMENTS WILL BE PROVIDED TO THE PHH GOVERNANCE/NOMINATING COMMITTEE. THIS COMMITTEE, IN CONSULTATION WITH THE CHAIRPERSON OR VICE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD, SHALL EVALUATE THE COMPLETED DISCLOSURE STATEMENTS AND DETERMINE IF THERE ARE ANY CONFLICTS THAT ARE SO PERVASIVE AS TO RENDER ANY COVERED PERSON INELIGIBLE FOR SERVICE. THE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD WILL DISCLOSE TO THE FULL BOARD OF SAID PHH SYSTEM ENTITY ALL DUAL INTERESTS REPORTED TO HIM OR HER UNDER THE POLICY AND WILL ALSO MAKE THE DISCLOSURE STATEMENTS OF ALL COVERED PERSONS AVAILABLE TO DIRECTORS AT ANY TIME DURING THE YEAR. IF A POTENTIAL DUAL INTEREST ARISES AS A RESULT OF A CONTEMPLATED PHH SYSTEM ENTITY BOARD (OR COMMITTEE) ACTION, THE CHAIRPERSON OF SAID PHH SYSTEM ENTITY'S BOARD OR THE INTERESTED PERSON SHALL, OR ANY OTHER DIRECTOR MAY, RAISE THE QUESTION OF THE INTERESTED PERSON'S DUAL INTEREST. THE DISINTERESTED MEMBERS OF THE PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) WILL EVALUATE THE DISCLOSURES AND THE MATERIAL FACTS RELATING TO THE TRANSACTION, ARRANGEMENT, OR POLICY GIVING RISE TO THE DUAL INTEREST TO DETERMINE WHETHER THEY INVOLVE ACTUAL CONFLICTS OF INTEREST AND MAY ATTEMPT TO DEVELOP ALTERNATIVES TO REMOVE THE CONFLICT FROM THE TRANSACTION, ARRANGEMENT, OR POLICY. A COVERED PERSON WHO HAS A DUAL INTEREST SHALL NOT BE PRESENT FOR OR SHALL LEAVE ANY PORTION OF A MEETING AT WHICH A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) IS VOTING TO DETERMINE WHETHER A CONFLICT EXISTS, BUT MAY BE PRESENT PRIOR TO THE VOTE TO MAKE A PRESENTATION TO SAID BOARD (OR COMMITTEE), TO DISCLOSE ADDITIONAL FACTS, OR TO RESPOND TO QUESTIONS. IF A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE DETERMINES THAT AN ACTUAL CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON SHALL BE SO ADVISED AND THE CHAIRPERSON OF A PHH SYSTEM ENTITY'S BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE OR DIRECT MANAGEMENT TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, IF THIS HAS NOT ALREADY BEEN DONE. ANY INTERESTED PERSON WHO HAS AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION OR ARRANGEMENT DOES NOT PARTICIPATE IN AND IS NOT PRESENT FOR THE VOTE REGARDING ANY SUCH TRANSACTION OR ARRANGEMENT. IF AN INDIVIDUAL WHOSE COMPANY OR EMPLOYER HAS A BUSINESS RELATIONSHIP WITH A PHH SYSTEM ENTITY, BUT THE INDIVIDUAL DOES NOT HAVE AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THIS BUSINESS RELATIONSHIP, THE INDIVIDUAL MAY NONETHELESS VOLUNTARILY RECUSE HIM/HERSELF FROM VOTING ON ANY MATTERS RELATED TO THE RELATIONSHIP.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINES 15A &amp; 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION DETERMINATION: PENN HIGHLANDS HEALTHCARE, INC. (PHH) PERFORMS THE COMPENSATION REVIEW FOR THE PHH EXECUTIVES, INCLUDING THE CEO OF PH ELK. AN INDEPENDENT COMPENSATION CONSULTANT, YAFFE &amp; COMPANY, IS CONTRACTED TO COMPLETE AN ANNUAL COMPENSATION REVIEW. INCLUDED IN THIS REVIEW IS COMPARATIVE DATA. THE PHH BOARD REVIEWS AND APPROVES THE COMPENSATION. THE CEO ALSO HAS AN ANNUAL EVALUATION COMPLETED BY THE PH ELK BOARD THAT IS SHARED WITH THE PH BOARD DURING AN EXECUTIVE SESSION AT EACH OF THE BOARDS. THESE PROCESSES ARE DOCUMENTED IN THE BOARD MINUTES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENT AVAILABILITY: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST FROM LORI SCUTELLA, ADMINISTRATIVE SECRETARY. DOCUMENTS MAY BE MAILED, E-MAILED, FAXED, OR HELD FOR PICKUP BY REQUESTING PERSONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, SECTION A</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBER COMPENSATION: NO DIRECTORS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. ROSE CAMPBELL IS COMPENSATED FOR HER DUTIES AS CEO OF PH ELK.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER FEES FOR SERVICES: $ 9,928,339 PROFESSIONAL SERVICE FEES 129,922 PHYSICIAN FEES 87,157 BILLING FEES ------------- $ 10,145,418</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER CHANGES IN NET ASSETS: $ (5,608,765) CHANGE IN ACCRUED PENSION LIABILITY 3,093,066 TRANSFERS TO AFFILIATES ------------ $ (2,515,699)</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR">
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ELK VENTURES LLC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>763 JOHNSONBURG ROAD</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>251924733</EIN>
        <PrimaryActivitiesTxt>MEMBER SVCS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <EndOfYearAssetsAmt>42100</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ERHC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ELK REGIONAL SURGERY CENTER REAL ESTATE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1376 BUCKTAIL ROAD</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>272160971</EIN>
        <PrimaryActivitiesTxt>REAL EST MGMT</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <EndOfYearAssetsAmt>0</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ERHC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ELCO HOUSING</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>759 JOHNSONBURG ROAD</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>251639115</EIN>
        <PrimaryActivitiesTxt>HOUSING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ELK REGIONAL PROFESSIONAL GROUP INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>763 JOHNSONBURG ROAD</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>251875183</EIN>
        <PrimaryActivitiesTxt>HEALTH CARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>COMMUNITY NURSES HOME HEALTH &amp; HOSPICE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>757 JOHNSONBURG ROAD STE 200</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>250996070</EIN>
        <PrimaryActivitiesTxt>HEALTH CARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>9</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>CNI</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>COMMUNITY NURSES HOME SUPPORT SERVICES</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>757 JOHNSONBURG ROAD STE 200</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>251623601</EIN>
        <PrimaryActivitiesTxt>HEALTH CARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>9</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>CNI</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>COMMUNITY NURSES INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>757 JOHNSONBURG ROAD STE 200</AddressLine1Txt>
          <CityNm>ST MARYS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15857</ZIPCd>
        </USAddress>
        <EIN>251623598</EIN>
        <PrimaryActivitiesTxt>HEALTH CARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>DUBOIS REGIONAL MEDICAL CENTER</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>100 HOSPITAL AVE</AddressLine1Txt>
          <CityNm>DUBOIS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15801</ZIPCd>
        </USAddress>
        <EIN>251490707</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>BROOKVILLE HOSPITAL</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>100 HOSPITAL RD</AddressLine1Txt>
          <CityNm>BROOKVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15825</ZIPCd>
        </USAddress>
        <EIN>250984595</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>CLEARFIELD HOSPITAL</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>809 TURNPIKE DR</AddressLine1Txt>
          <CityNm>CLEARFIELD</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16830</ZIPCd>
        </USAddress>
        <EIN>250979346</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>NATHANIEL D YINGLING CANCER CENTER</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>815 DOCTORS DR</AddressLine1Txt>
          <CityNm>CLEARFIELD</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16830</ZIPCd>
        </USAddress>
        <EIN>205114093</EIN>
        <PrimaryActivitiesTxt>RADIATION ONC</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>CLEAR-MED PROVIDER CORPORATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO BOX 1260</AddressLine1Txt>
          <CityNm>CLEARFIELD</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16830</ZIPCd>
        </USAddress>
        <EIN>251657668</EIN>
        <PrimaryActivitiesTxt>OUTPAT. PHYS.</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>DRMC EMPLOYEE BENEFITS PLAN TRUST</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>100 HOSPITAL AVE</AddressLine1Txt>
          <CityNm>DUBOIS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15810</ZIPCd>
        </USAddress>
        <EIN>256332829</EIN>
        <PrimaryActivitiesTxt>DRMC EMP BENE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(9)</ExemptCodeSectionTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>PHH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>PENN HIGHLANDS HEALTHCARE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO BOX 447</AddressLine1Txt>
          <CityNm>DUBOIS</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15801</ZIPCd>
        </USAddress>
        <EIN>320345810</EIN>
        <PrimaryActivitiesTxt>MGMT SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>11 C III-FI</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>true</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>true</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>true</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>true</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>