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        <ExplanationTxt>The Internal Revenue Service has ruled that OHA and the Program are tax-exempt organizations as defined under Section 501(c)(6). OHA and the Program are not subject to federal income taxes, except for income from unrelated business activities, if any. Management does not believe there are any significant tax liabilities related to Ohio Healthcare Purchasing, Inc. Accordingly, no provision for federal income taxes has been made in the combined financial statements. Accounting principles generally accepted in the United States of America prescribe recognition thresholds and measurement attributes for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. Tax benefits will be recognized only if the tax position is more likely-than-not sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized will be the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the more-likely-than-not test, no tax benefit will be recorded. Management has concluded that they are unaware of any tax benefits or liabilities to be recognized at December 31, 2022 and 2021.</ExplanationTxt>
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        <CashGrantAmt>30000</CashGrantAmt>
        <PurposeOfGrantTxt>Voter education</PurposeOfGrantTxt>
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          <BusinessNameLine1Txt>Ohioans for a Healthy Economy</BusinessNameLine1Txt>
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          <AddressLine1Txt>34 S Third St</AddressLine1Txt>
          <AddressLine2Txt>Suite 100</AddressLine2Txt>
          <CityNm>Columbus</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>43215</ZIPCd>
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        <IRCSectionDesc>501c4</IRCSectionDesc>
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        <PurposeOfGrantTxt>Voter education</PurposeOfGrantTxt>
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        <ExplanationTxt>THE BOARD OF TRUSTEES AND MANAGEMENT MONITOR THE USE OF GRANTS TO ENSURE THEY ARE USED FOR THEIR INTENDED PURPOSES.</ExplanationTxt>
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          <BusinessNameLine1Txt>Michael Abrams</BusinessNameLine1Txt>
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          <BusinessNameLine1Txt>Mary Gallagher</BusinessNameLine1Txt>
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          <BusinessNameLine1Txt>Ryan Biles</BusinessNameLine1Txt>
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        <TitleTxt>Senior VP, Advocacy</TitleTxt>
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        <BusinessName>
          <BusinessNameLine1Txt>Amy Andres</BusinessNameLine1Txt>
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        <TitleTxt>Senior VP, Health Strategy</TitleTxt>
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          <BusinessNameLine1Txt>Sean McGlone</BusinessNameLine1Txt>
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        <TitleTxt>Senior VP &amp; General Counsel</TitleTxt>
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        <BusinessName>
          <BusinessNameLine1Txt>James Guliano</BusinessNameLine1Txt>
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        <TitleTxt>Senior VP/Chief Clinical Officer</TitleTxt>
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        <BusinessName>
          <BusinessNameLine1Txt>Eric James</BusinessNameLine1Txt>
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        <TitleTxt>Vice President/Chief Information Officer</TitleTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 1a Health or social club dues or initiation fees</FormAndLineReferenceDesc>
        <ExplanationTxt>Executive employees hold club memberships for business use. The employees provide monthly statements to the organization listing out any personal use. The employees then reimburse the organization for any personal use. The club memberships are treated as taxable compensation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>Mike Abrams participates in a SERP 457(f) plan. Amounts includible in income under section 457(f) = $0 Contributions to nonqualified plans (nonvested) = $93,444 Scott Borgemenke participates in a SERP 457(f) plan. Amounts includible in income under section 457(f) = $0 Contributions to nonqualified plans (nonvested) = $138,000</ExplanationTxt>
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            <BusinessNameLine1Txt>Erin Biles</BusinessNameLine1Txt>
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        <RelationshipDescriptionTxt>Family member of Ryan Biles</RelationshipDescriptionTxt>
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        <TransactionDesc>Employment</TransactionDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Line 2a Common Pay Agent</FormAndLineReferenceDesc>
        <ExplanationTxt>OHIO HOSPITAL ASSOCIATION (OHA) EIN 31-4270340 IS THE COMMON PAYING AGENT FOR THE FOLLOWING RELATED ORGANIZATIONS. THEREFORE, ALL APPLICABLE IRS TAX FILINGS ARE REPORTED BY OHA. - OHIO HOSPITALS GROUP RATED WORKERS COMPENSATION PROGRAM, INC. EIN 31-1314404 - THE RESEARCH &amp; EDUCATIONAL FOUNDATION OF THE OHIO HOSPITAL ASSOCIATION EIN 31-6060347 - OHIO HEALTHCARE PURCHASING EIN 20-0414070 THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, OHA, FOR THE YEAR ENDED DECEMBER 31, 2022 WAS 56. FOR PURPOSES OF REPORTING THE NUMBER OF EMPLOYEES ON THE FORM 990, PART V, LINE 2A, THERE WERE THE FOLLOWING FOR EACH RESPECTIVE ORGANIZATION: - OHIO HOSPITAL ASSOCIATION - 53 EMPLOYEES - OHIO HOSPITALS GROUP RATED WORKERS COMPENSATION PROGRAM, INC. - 0 EMPLOYEES - THE RESEARCH &amp; EDUCATIONAL FOUNDATION OF THE OHIO HOSPITAL ASSOCIATION - 3 EMPLOYEES - OHIO HEALTHCARE PURCHASING - 0 EMPLOYEES</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b PROCESS USED TO DETERMINE COMPENSATION OF OTHER OFFICERS</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION CURRENTLY USES AN OUTSIDE CONSULTANT TO PERIODICALLY PROVIDE A BENCHMARK OF COMPARABLE SALARY RANGES FOR ALL OFFICERS AND KEY EMPLOYEES. OHIO HOSPITAL ASSOCIATION'S COMPENSATION IS BASED ON THE USE OF THIS DATA FOR SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILAR SIZED ASSOCIATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 1a Executive Committee</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR, CHAIR-ELECT, IMMEDIATE PAST CHAIR, SECRETARY/TREASURER, AND PRESIDENT. THE EXECUTIVE COMMITTEE SHALL BE AUTHORIZED TO ACT ON BEHALF OF THE BOARD OF TRUSTEES BETWEEN MEETINGS OF THE BOARD AND SHALL SUBMIT SUCH ACTIONS TO THE BOARD FOR RATIFICATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization is organized as an Association with organizational members and personal members. Organizational memberships consist of the following: Type I: Hospitals that are general or special that provide inpatient care for those requiring a short term stay; Type II: All other hospitals that provide inpatient care; Type III: Health Care Systems; Type IV: Other healthcare organizations that are owned or controlled by a hospital (i.e. home care, hospices); Type V: Same as IV, except they are not controlled by hospital; and Type VI: Hospital auxiliaries and other service groups. All of the above have voting privileges. Personal memberships: persons associated with organizational members. Personal members do not have voting privileges.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS ORGANIZED AS AN ASSOCIATION WITH ORGANIZATIONAL MEMBERS AND PERSONAL MEMBERS. Members have the following rights with respect to electing members of the governing body: 1.16. Nominations: In accordance with Article VII (Board of Trustees) of the Constitution, nominations for election to the Board of Trustees shall be presented by the Nominating Committee after completion of the process described in this section as follows: 1.16.1. Notification to Membership: The Nominating Committee Chair shall be responsible for notifying the President and the Association office of the names of the persons to be recommended by the Nominating Committee for election to the positions of Chair-Elect, Secretary/Treasurer and Trustees-at-Large thirty (30) days before election. Upon receipt of the slate of nominees recommended by the Nominating Committee for election the Association office shall forward such names to the chief executive officers of those Organizational members entitled to the right to vote. 1.16.2. Additional Nominations: Additional nominations for the offices of Chair-Elect, Secretary/Treasurer and Trustees-at-Large may be brought before the membership in the following manner: 1.16.2.1. Any eligible member may be nominated by written petition of no fewer than thirty (30) chief executive officers of Type I, II or III Organizational members. 1.16.2.2. Nominations by petition must be received in the office of the Association at least fifteen (15) days prior to election. 1.16.2.3. All voting members of the Association shall receive written notification from the Association office of all valid nominations, including those nominations by petition.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 and supplemental schedules were reviewed by management and the Audit/Finance Committee Chair with the paid tax preparer. A copy of the organization's final form 990 (including required schedules), as ultimately filed with the IRS, was provided to each voting member of the organization's governing body, officers, and management prior to its filing with the IRS.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>EACH TRUSTEE, DIRECTOR, PRINCIPAL OFFICER, other officer, key employee, AND MEMBER OF A COMMITTEE WITH BOARD DESIGNATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS TAX-EXEMPT AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. After a disclosure, and after any discussions with the interested person, the interested person may be asked by the chairperson to leave the board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. If a conflict of interest exists, the interested person may make a presentation to the board or committee and may be asked to leave the meeting during the discussion of, and the vote on, the arrangement that results in the conflict. After exercising due diligence, the board or committee shall determine whether the company can obtain a more advantageous arrangement with reasonable efforts from a person that would not give rise to a conflict of interest. If that is not reasonably attainable, the board or committee shall determine by a majority vote of the disinterested directors whether the arrangement is in the company's best interest.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>An independent compensation committee delegated by the Board of Trustees is responsible for the yearly compensation review of the Chief Executive Officer (CEO). Outside consultants, salary surveys, and data from comparable organizations are used in the process of determining the CEO's compensation. This process was performed in 2022 and is documented within the compensation committee minutes.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy and financial statements are available upon request from the organization.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VIII, Line 2f Other Program Service Revenue</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Income - Total Revenue: 394561, Related or Exempt Function Revenue: 394561, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Loss on equity investment in joint venture - Total Revenue: -1456, Related or Exempt Function Revenue: -1456, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;</ExplanationTxt>
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        <PrimaryActivitiesTxt>SEE PART VII</PrimaryActivitiesTxt>
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          <AddressLine1Txt>155 E BROAD ST SUITE 301</AddressLine1Txt>
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        <EIN>316060347</EIN>
        <PrimaryActivitiesTxt>SEE PART VII</PrimaryActivitiesTxt>
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        <PublicCharityStatusTxt>Type I</PublicCharityStatusTxt>
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          <BusinessNameLine1Txt>FRIENDS OF OHIO HOSPITALS</BusinessNameLine1Txt>
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          <AddressLine1Txt>155 E BROAD ST</AddressLine1Txt>
          <AddressLine2Txt>Suite 301</AddressLine2Txt>
          <CityNm>COLUMBUS</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>43215</ZIPCd>
        </USAddress>
        <EIN>311237308</EIN>
        <PrimaryActivitiesTxt>SEE PART VII</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>OH</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>527</ExemptCodeSectionTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>OHA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Q3 Health Innovation Partners LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>30 North Third St Suite 600</AddressLine1Txt>
          <CityNm>Harrisburg</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>17101</ZIPCd>
        </USAddress>
        <EIN>830909844</EIN>
        <PrimaryActivitiesTxt>Quality Improvement</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>OHA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>Related</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>-1673</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>32006</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>false</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>true</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.3333</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>OHIO HEALTHCARE PURCHASING INC DBA OHA SOLUTIONS</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>155 E BROAD ST SUITE 301</AddressLine1Txt>
          <CityNm>COLUMBUS</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>43215</ZIPCd>
        </USAddress>
        <EIN>200414070</EIN>
        <PrimaryActivitiesTxt>PURCHASING CO</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>OH</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>OHA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C Corporation</EntityTypeTxt>
        <ShareOfTotalIncomeAmt>-15116</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>2049204</ShareOfEOYAssetsAmt>
        <OwnershipPct>1</OwnershipPct>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>true</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Research and Educational Foundation of OHA</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>Q</TransactionTypeTxt>
        <InvolvedAmt>173798</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Primary Activity</FormAndLineReferenceDesc>
        <ExplanationTxt>1. Ohio Hospitals Group Rated Workers Comp Primary Activity: The primary purpose of The Ohio Hospitals Group Rated Workers Compensation Program, Inc. is to develop and implement programs that will promote a safe working environment and reduce health care costs. 2. The Research and Educational Foundation Primary Activity: TO EVALUATE, FOCUS AND ENGAGE IN CHANGE ACTIVITIES THAT LEAD AND ENABLE THE PURSUIT OF EXCELLENCE IN SAFETY AND QUALITY AND IN IMPROVING THE HEALTH OF OUR COMMUNITIES. 3. Friends of Ohio Hospitals Primary Activity: THE ORGANIZATION MAKES CONTRIBUTIONS IN SUPPORT OF POLITICAL CANDIDATES AND PARTIES IN THE INTEREST OF OHIO HOSPITALS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
