﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2023v5.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-11-07T13:41:37+00:00</ReturnTs>
    <TaxPeriodEndDt>2023-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>346565596</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>ERNST &amp; YOUNG US LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>ONE MANHATTAN WEST</AddressLine1Txt>
        <CityNm>NEW YORK</CityNm>
        <StateAbbreviationCd>NY</StateAbbreviationCd>
        <ZIPCd>100018604</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990EZ</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>141684387</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>Kingston Regional Health Care System Inc</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>KING</BusinessNameControlTxt>
      <PhoneNum>8459436084</PhoneNum>
      <USAddress>
        <AddressLine1Txt>105 MARYS AVENUE</AddressLine1Txt>
        <CityNm>KINGSTON</CityNm>
        <StateAbbreviationCd>NY</StateAbbreviationCd>
        <ZIPCd>12401</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>Joshua Ratner</PersonNm>
      <PersonTitleTxt>Chief Executive Officer</PersonTitleTxt>
      <PhoneNum>8459436943</PhoneNum>
      <SignatureDt>2024-11-07</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>Yucen Zhong</PreparerPersonNm>
      <PTIN>P01593150</PTIN>
      <PhoneNum>2127733000</PhoneNum>
      <PreparationDt>2024-11-06</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2024-10-15 13:58:12Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="3">
    <IRS990EZ documentId="IRS990EZ" softwareId="23017437" softwareVersionNum="2023v5.1">
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <ScheduleBNotRequiredInd>X</ScheduleBNotRequiredInd>
      <WebsiteAddressTxt>N/A</WebsiteAddressTxt>
      <Organization501c3Ind referenceDocumentId="IRS990ScheduleA">X</Organization501c3Ind>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <GrossReceiptsAmt>0</GrossReceiptsAmt>
      <ContributionsGiftsGrantsEtcAmt>0</ContributionsGiftsGrantsEtcAmt>
      <ProgramServiceRevenueAmt>0</ProgramServiceRevenueAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <InvestmentIncomeAmt>0</InvestmentIncomeAmt>
      <GainOrLossFromSaleOfAssetsAmt>0</GainOrLossFromSaleOfAssetsAmt>
      <SpecialEventsNetIncomeLossAmt>0</SpecialEventsNetIncomeLossAmt>
      <GrossProfitLossSlsOfInvntryAmt>0</GrossProfitLossSlsOfInvntryAmt>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueAmt>0</TotalRevenueAmt>
      <GrantsAndSimilarAmountsPaidAmt>0</GrantsAndSimilarAmountsPaidAmt>
      <OtherExpensesTotalAmt>0</OtherExpensesTotalAmt>
      <TotalExpensesAmt>0</TotalExpensesAmt>
      <ExcessOrDeficitForYearAmt>0</ExcessOrDeficitForYearAmt>
      <NetAssetsOrFundBalancesBOYAmt>-34124</NetAssetsOrFundBalancesBOYAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <NetAssetsOrFundBalancesEOYAmt>-34124</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIInd>X</InfoInScheduleOPartIIInd>
      <OtherAssetsTotalDetail>
        <BOYAmt>80528</BOYAmt>
        <EOYAmt>80528</EOYAmt>
      </OtherAssetsTotalDetail>
      <Form990TotalAssetsGrp>
        <BOYAmt>80528</BOYAmt>
        <EOYAmt>80528</EOYAmt>
      </Form990TotalAssetsGrp>
      <SumOfTotalLiabilitiesGrp>
        <BOYAmt>114652</BOYAmt>
        <EOYAmt>114652</EOYAmt>
      </SumOfTotalLiabilitiesGrp>
      <NetAssetsOrFundBalancesGrp>
        <BOYAmt>-34124</BOYAmt>
        <EOYAmt>-34124</EOYAmt>
      </NetAssetsOrFundBalancesGrp>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <PrimaryExemptPurposeTxt>THE ORGANIZATION OWNS 33.33% OF AN AMBULATORY SURGERY CENTER.</PrimaryExemptPurposeTxt>
      <ProgramSrvcAccomplishmentGrp>
        <DescriptionProgramSrvcAccomTxt>THE ORGANIZATION OWNS 33.33% OF AN AMBULATORY SURGERY CENTER THAT SPECIALIZES IN ANESTHESIOLOGY.</DescriptionProgramSrvcAccomTxt>
        <GrantsAndAllocationsAmt>0</GrantsAndAllocationsAmt>
        <ProgramServiceExpensesAmt>0</ProgramServiceExpensesAmt>
      </ProgramSrvcAccomplishmentGrp>
      <TotalProgramServiceExpensesAmt>0</TotalProgramServiceExpensesAmt>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>PAMELA CARROAD</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>MARTIN CASCIO MD</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>EUGENE P HESLIN MD</PersonNm>
        <TitleTxt>CHAIRPERSON</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>THOMAS JACOBI</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>MARK JOSEFSKI MD</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>CRAIG SICKLER</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHrsPerWkDevotedToPosRt>0.100</AverageHrsPerWkDevotedToPosRt>
        <CompensationAmt>0</CompensationAmt>
        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
        <ExpenseAccountOtherAllwncAmt>0</ExpenseAccountOtherAllwncAmt>
      </OfficerDirectorTrusteeEmplGrp>
      <ActivitiesNotPreviouslyRptInd>false</ActivitiesNotPreviouslyRptInd>
      <ChgMadeToOrgnzngDocNotRptInd>false</ChgMadeToOrgnzngDocNotRptInd>
      <OrganizationHadUBIInd>false</OrganizationHadUBIInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <OrganizationDissolvedEtcInd>false</OrganizationDissolvedEtcInd>
      <Form1120PolFiledInd>false</Form1120PolFiledInd>
      <MadeLoansToFromOfficersInd>false</MadeLoansToFromOfficersInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <StatesWhereCopyOfReturnIsFldCd>NY</StatesWhereCopyOfReturnIsFldCd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>ERIN NAGY</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>105 MARYS AVENUE</AddressLine1Txt>
          <CityNm>KINGSTON</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>12401</ZIPCd>
        </USAddress>
        <PhoneNum>8459436084</PhoneNum>
      </BooksInCareOfDetail>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <DonorAdvisedFndsInd>false</DonorAdvisedFndsInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <TanningServicesProvidedInd>false</TanningServicesProvidedInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd>false</TransactionWithControlEntInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <OtherEmployeePaidOver100kCnt>0</OtherEmployeePaidOver100kCnt>
      <FiledScheduleAInd>true</FiledScheduleAInd>
    </IRS990EZ>
    <IRS990ScheduleA documentId="IRS990ScheduleA" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SupportingOrganization509a3Ind>X</SupportingOrganization509a3Ind>
      <SupportingOrgType1Ind>X</SupportingOrgType1Ind>
      <SupportedOrganizationsCnt>1</SupportedOrganizationsCnt>
      <SupportedOrgInformationGrp>
        <SupportedOrganizationName>
          <BusinessNameLine1Txt>HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS</BusinessNameLine1Txt>
        </SupportedOrganizationName>
        <EIN>141349558</EIN>
        <OrganizationTypeCd>3</OrganizationTypeCd>
        <GoverningDocumentListedInd>true</GoverningDocumentListedInd>
        <SupportAmt>0</SupportAmt>
        <OtherSupportAmt>0</OtherSupportAmt>
      </SupportedOrgInformationGrp>
      <SupportedOrganizationsTotalCnt>1</SupportedOrganizationsTotalCnt>
      <SupportSumAmt>0</SupportSumAmt>
      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <Form990SchASupportingOrgGrp>
        <ListedByNameGoverningDocInd>true</ListedByNameGoverningDocInd>
        <SuprtOrgNoIRSDeterminationInd>false</SuprtOrgNoIRSDeterminationInd>
        <SupportedOrgSectionC456Ind>false</SupportedOrgSectionC456Ind>
        <SupportedOrgNotOrganizedUSInd>false</SupportedOrgNotOrganizedUSInd>
        <OrganizationChangeSuprtOrgInd>false</OrganizationChangeSuprtOrgInd>
        <SupportNonSupportedOrgInd>false</SupportNonSupportedOrgInd>
        <PaymentSubstantialContribtrInd>false</PaymentSubstantialContribtrInd>
        <LoanDisqualifiedPersonInd>false</LoanDisqualifiedPersonInd>
        <ControlledDisqualifiedPrsnInd>false</ControlledDisqualifiedPrsnInd>
        <DisqualifiedPrsnControllIntInd>false</DisqualifiedPrsnControllIntInd>
        <DisqualifiedPrsnOwnrIntInd>false</DisqualifiedPrsnOwnrIntInd>
        <ExcessBusinessHoldingsRulesInd>false</ExcessBusinessHoldingsRulesInd>
        <ContributionControllerInd>false</ContributionControllerInd>
        <ContributionFamilyInd>false</ContributionFamilyInd>
        <Contribution35ControlledInd>false</Contribution35ControlledInd>
      </Form990SchASupportingOrgGrp>
      <Form990SchAType1SuprtOrgGrp>
        <PowerAppointMajorityDirTrstInd>true</PowerAppointMajorityDirTrstInd>
        <OperateBenefitNonSuprtOrgInd>false</OperateBenefitNonSuprtOrgInd>
      </Form990SchAType1SuprtOrgGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990-EZ, Part II, Line 24b Other Assets</FormAndLineReferenceDesc>
        <ExplanationTxt>INVEST.- KINGSTON AMBULATORY SURGERY CENTER - BOY:64528,EOY:64528; SECURITY DEPOSITS - BOY:16000,EOY:16000;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990-EZ, Part II, Line 26b Total Liabilities</FormAndLineReferenceDesc>
        <ExplanationTxt>DUE TO HEALTHALLIANCE HOSPITAL BROADWAY - BOY:114652,EOY:114652;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990-EZ, Part III, Exempt Purpose PRIMARY EXEMPT PURPOSE</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION OWNS 33.33% OF AN AMBULATORY SURGERY CENTER.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>